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Published on: November 30, 2010
[Surgical correction of hypospadias using a vascularized onlay flap]
1Urologická klinika Vseobecné fakultní nemocnice, Praha.
Insights
The onlay technique effectively treats hypospadias using a urethral plate and preputial flap. This method offers a one-stage solution with fewer complications than other surgical options.
Area of Science:
- Urology
- Pediatric Surgery
Context:
- Hypospadias, a congenital condition, requires surgical correction.
- The onlay technique utilizes the urethral plate and vascularized preputial flap to construct a neourethra.
Purpose:
- To evaluate the efficacy and complication rates of the onlay technique for hypospadias repair.
- To assess its applicability in various hypospadias classifications and secondary urethral issues.
Summary:
- The onlay technique was performed on 51 patients (10 months to 27 years old) for hypospadias, including severe proximal forms.
- Additional procedures like chordectomy and plication were performed in some cases. The technique was also used for secondary strictures and fistulas.
- Complications included neourethral issues (7.8%) and partial skin necrosis in a small percentage of patients.
Impact:
- The onlay method is a universal and effective solution for proximal hypospadias.
- It demonstrates a significantly lower complication rate compared to tubulized plastic operations.
- Enables a definitive one-stage repair, even in early childhood.
Abstract:
The principle of the onlay technique is to create a neourethra from the preserved urethral plate to which the vascularized flap of the prepuce is applied. Thus 51 patients were operated 10 months to 27 years old, half of them were under 5 years. By this method hypospadias was treated from coronary to perineal ones. In 16 patients chordectomy was performed, in 6 plications of the cavernous bodies because of their disproportion of the ventral and dorsal side. In three instances it was necessary to transsection the urethral plate and supplement the onlay flap by tubulization of the neourethra. The method was also used in secondary strictures of the urethra after urethroplasty and in occlusions of a fistula. Complications of the neourethra were recorded in 4 (7.8%) patients. Another four patients had a partial necrosis of the skin cover. The onlay method is becoming universal for resolving the proximal variant of hypospadias, it is associated with a considerably smaller number of complications than tubulized plastic operations and makes possible a definite one-stage solution already at an early age.
