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Published on: January 7, 2019
Hypospadias Penile Skin Landmarks Technique for Preputial Reconstruction in Distal and Mid-penile Hypospadias
Harparkash Singh Miglani1, Vikesh Agrawal2, Debjani Das3
1Child Surgery Centre, Miglani Hospital, Amritsar, Punjab, India.
Background:
Hypospadias repair has traditionally involved tubularized incised plate urethroplasty, often necessitating circumcision or preputial sacrifice due to dartos flap usage for waterproofing. However, many parents prefer preputial preservation for cultural and aesthetic reasons. No standardized technique currently exists for preputial reconstruction in distal and mid-penile hypospadias. We describe the hypospadias penile skin landmarks (HPS landmarks) technique based on ventral raphe classification and dorsal skin landmarks, a refined surgical approach leveraging natural penile skin creases to facilitate effective preputial reconstruction while maintaining functional and cosmetic outcomes.
Methods:
This prospective study, conducted at two centers in India (January 2021-June 2024), included 67 patients (6 months-18 years) with distal and mid-penile hypospadias. A new classification system for ventral raphe and dorsal skin landmarks was proposed to guide preputial reconstruction. Surgical principles involved three key steps: (1) identifying and marking anatomical skin landmarks, (2) selective tissue dissection and preservation, and (3) midline approximation for symmetrical preputial restoration. Functional and cosmetic outcomes, including urethral patency, urinary stream, preputial symmetry, and complications, were assessed postoperatively.
Results:
Among 67 cases (52 distal, 15 mid-penile hypospadias), the median age was 14 months, and the mean operative time was 110 ± 18 min. Urethrocutaneous fistula occurred in two patients (2.98%), preputial dehiscence in two (2.98%), and three (4.48%) exhibited persistent dorsal hooding. No cases of glans dehiscence, metal stenosis, or residual chordee were noted. Parental satisfaction was high, with favorable functional and aesthetic outcomes.
Conclusion:
The HPS landmarks technique provides a refined surgical approach to preputial reconstruction in distal and mid-penile hypospadias, preserving prepuce integrity while ensuring functional and cosmetic success. By leveraging anatomical skin creases using the described classification, this technique minimizes preputial complications and offers a culturally acceptable alternative for patients desiring preputial preservation. Further long-term studies are warranted to validate its widespread applicability.
