Pedicled preputial island flap for double functions in hypospadias surgery

To use the prepuce for double functions one as a second layer for the neourethra to decrease the incidence of urethrocutaneous fistula and the second as a skin covering for the ventral aspect of the penis.

From January 2013 to December 2016, 37 cases of hypospadias with mild to moderate chordee were included in this study. The cases with ventral penile skin defect were managed by tubularized incised plate urethroplasty (TIPU) using pedicled preputial flap. Recurrent cases, cases with severe chordee which necessitated division of the urethral plate, and cases with penoscrotal hypospadias were excluded from this study.

Thirty-seven cases of hypospadias aged 9-60 months with a mean age of 24.8 months were included in this study. Coronal (n= 9 cases; 24.3%), distal penile (n=11; 29.9%), and midpenile hypospadias (n= 17; 45.9%) were detected in respective number of patients. Postoperative complications consisted of external meatal stenosis (n=2; 8.1%), and one case with urethrocutaneous fistula. Skin necrosis was not reported in this study. Follow-up visits were performed at 1, 3 and 6 months which showed good cosmetic appearance that was accepted by their parents.

This technique was beneficial in decreasing the rate of skin necrosis, as it keeps the blood supply to the preputial skin intact, and decreases the incidence of urethrocutaneous fistula.