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Published on: January 7, 2019
Scrotal flaps for skin deficit correction after failed hypospadias repair
Dina Manasherova1, German Kozyrev2
1Department of Pediatric Urology-Andrology, Institute of Medicine, Peoples' Friendship University of Russia, Mikluho-Maklaya St., 6, Moscow, 117198, Russia; Faculty of Medicine, Moscow State University, Lomonosovsky pr., 27k1, Moscow, 119292, Russia.
Insights
Scrotal flaps effectively correct skin deficits in re-operative hypospadias surgery for children. This approach yields good cosmetic and functional outcomes, improving treatment results for complex cases.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
Background:
- Hypospadias repair in children often requires multiple attempts.
- Significant skin deficits present challenges in re-operative cases.
- Previous repairs can lead to ventral or circumferential skin loss.
Purpose of the Study:
- To evaluate scrotal flap efficacy for skin deficit correction in re-operative hypospadias surgery.
- To improve treatment outcomes for pediatric hypospadias patients with prior failed repairs.
Main Methods:
- A study of 46 pediatric patients with hypospadias and 3-7 prior failed repairs.
- Patients were divided into two groups based on skin deficit type (ventral/proximal vs. circumferential/mid-shaft).
- Scrotal flaps were utilized for skin defect coverage, with 2-8 year follow-up assessing cosmetic and functional results.
Main Results:
- No statistically significant difference in fistula or glans dehiscence between groups.
- Overall complication rates were similar: 25% in Group I and 27.3% in Group II.
- Good cosmetic results were achieved in the majority of patients, with satisfactory outcomes in a small percentage.
Conclusions:
- Scrotal flaps are effective for correcting skin deficits in re-operative hypospadias surgery.
- This technique provides good cosmetic and functional results for midshaft and proximal hypospadias.
- Scrotal flaps offer a viable solution for complex pediatric hypospadias cases with significant skin loss.
Purpose:
To analyze the effectiveness of scrotal flaps' use for skin deficit correction in re-operative cases to improve hypospadias' treatment results in children.
Methods:
In the Urology Department of the Russian Children's Clinical Hospital (from 2013 to 2019) 46 patients were treated with hypospadias who underwent 3 to 7 failed repairs before being admitted to the clinic. Patients were divided into two groups: Group I - 24 patients with ventral skin deficit and proximal hypospadias; Group II - 22 patients with circumferential skin deficit and mid-shaft hypospadias. Scrotal flaps were used in both groups to cover the skin defect. The results were analyzed in short- and long-term follow-up of 2-8 years. Cosmetic results according to Hypospadias Objective Penile Evaluation scale, as well as functional results (recovery of independent free urination, lack of complications) were assessed.
Results:
In long term follow-up, there is no statistically significant difference between Group I and Group II in number of fistulas and cases of glans dehiscence. Total number of complications in Group I - 6 (25%) vs 6 (27.3%) in Group II. Good cosmetic results were obtained in most patients of both groups, and satisfactory cosmetic results in 1 patient (4.1%) from Group I, and 2 patients (9.1%) from Group II (Table).
Conclusion:
In re-operative cases of midshaft and proximal hypospadias repairs, scrotal flaps allow to obtain good cosmetic and functional results, correcting ventral and circumferential skin deficit.
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