Evaluation of Onlay Island Flap Technique in Shallow Urethral Plate Hypospadiasis
Leily Mohajerzadeh1, Alireza Mirshemirani1, Mohsen Rouzrokh1
1Pediatric Sugery Department, Mofid Children's Hospital, Iran University of Medical Sciences, Tehran, IR Iran.
Insights
The onlay island flap technique provides good results for hypospadias repair in children with shallow urethral plates. This surgical method effectively addresses chordee and achieves satisfactory cosmetic outcomes with low complication rates.
Area of Science:
- Pediatric Urology
- Congenital Anomalies
- Surgical Reconstruction
Background:
- Hypospadias is a common male congenital genital anomaly requiring early surgical intervention.
- Effective hypospadias repair aims for urethral continuity, curvature correction, and aesthetic results with minimal complications.
- The onlay island flap technique is one of several challenging reconstructive options.
Purpose of the Study:
- To evaluate the outcomes of the onlay island flap technique for hypospadias repair.
- Specifically assess its efficacy in cases with a shallow urethral plate.
Main Methods:
- A prospective study involving 23 male patients (mean age 30 months) undergoing onlay island flap repair.
- The technique was applied to hypospadias types except subcoronal, with Nesbit's dorsal plication for chordee.
- Urethroplasty was performed without glansplasty in cases with very small glans.
Main Results:
- All 23 patients had a shallow urethral plate (< 6 mm); 18 had chordee, corrected in 16 cases.
- Complications included meatal stenosis (2 cases) and urethrocutaneous fistula (2 cases), both surgically repaired.
- Mean follow-up was 13 months, with excellent esthetic outcomes reported for cases with glansplasty.
Conclusions:
- The onlay island flap technique demonstrates acceptable results for hypospadias repair.
- It effectively manages meatal stenosis, urethrocutaneous fistula, and achieves favorable esthetic outcomes.
Background:
Hypospadias is one of the most common congenital genital anomalies in males that necessitates to be operated early in infancy (when 6 to 9 months old). On the other hand, hypospadias is a challenging field of pediatric urology with multiple reconstruction techniques. A perfect hypospadias repair is supposed to return urethral continuity with sufficient caliber, eradicate phallus curvature, and supply an acceptable appearance with low complications.
Objectives:
This study aimed to evaluate the outcomes of using onlay island flap technique in the repair of hypospadias with shallow urethral plate.
Patients And Methods:
In this prospective study within June 2012 to December 2013, we performed onlay island flap procedure to repair hypospadias with shallow urethral plate measuring less than 6 millimeter. This technique was selected for all types of hypospadiasis except subcoronal type. Nesbit's dorsal plication procedure was established for chordee. In cases with very small glans, urethroplasty was performed without glansplasty.
Results:
Twenty three patients with mean age of 30 (range 10 - 60) months underwent onlay island flap repair; all had a shallow urethral plate < 6 mm, 3 had a very small glans, and 18 had chordee. Meatus was located in distal shaft in 5 cases, mid shaft in 8, proximal in 6 and penoscrotal type in 4 patients. Chordee was corrected with Nesbit's dorsal plication in 16 cases. Complications were: meatal stenosis in 2 cases and urethrocutaneous fistula in 2 patients, all of which were repaired surgically. Mean follow up time was 13 (3 - 20) months. All cases that had glansplasty have excellent esthetic appearance.
Conclusions:
This technique offers acceptable results regarding meatal stenosis, urethrocutaneous fistula and esthetic outcome.
