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The split prepuce in situ onlay hypospadias repair
1Department of Pediatric Urology, Children's National Medical Center, Washington, DC 20010, USA.
Insights
A modified hypospadias repair, the split prepuce in situ onlay repair, shows promising results for children with coronal to mid-shaft hypospadias. This technique reduces complications and offers good cosmetic outcomes.
Area of Science:
- Pediatric Urology
- Surgical Innovation
Background:
- Hypospadias repair is a common pediatric urological procedure.
- Onlay hypospadias repair techniques aim to reconstruct the urethra and glans.
- Optimizing flap vascularity and coverage is crucial for successful outcomes.
Purpose of the Study:
- To describe a modified onlay hypospadias repair technique: split prepuce in situ onlay repair.
- To report the surgical outcomes of the first 100 patients undergoing this modified procedure.
Main Methods:
- The study included 100 boys with coronal to mid-shaft hypospadias, mean age 11 months.
- The split prepuce in situ onlay repair preserves the blood supply of the preputial flap.
- Abundant subcutaneous tissue from the flap covers neourethral suture lines.
Main Results:
- A low complication rate was observed, with only 5 reoperations needed (1 hematoma, 4 fistulas).
- No cases of meatal stenosis, urethral stricture, meatal retraction, or acquired urethral diverticulum required reoperation.
- Excellent cosmetic results were achieved in all patients.
Conclusions:
- The split prepuce in situ onlay hypospadias repair is a versatile technique for hypospadias.
- It enhances flap vascularity and provides robust coverage for the neourethra.
- This method leads to a reduced complication rate and satisfactory cosmetic results.
Purpose:
We describe the surgical technique and report the results of the first 100 patients who underwent a modification of the onlay hypospadias repair, which we refer to as split prepuce in situ onlay repair.
Materials And Methods:
We treated 100 boys with a mean age of 11 months at surgery who had coronal to mid shaft hypospadias with split prepuce in situ onlay hypospadias repair. The operative technique varies from that of the standard onlay procedure by preserving the whole blood supply of the half of the prepuce used for the island onlay flap, and using its abundant subcutaneous tissue to cover completely the suture lines used to create the neourethra.
Results:
Only 5 complications required reoperation, including 1 hematoma evacuation and 4 urethrocutaneous fistulas. No patient had meatal stenosis, urethral stricture, meatal retraction or acquired urethral diverticulum necessitating reoperation. A good cosmetic result was obtained in all cases.
Conclusions:
Split prepuce in situ onlay hypospadias repair is applicable in virtually all cases of coronal to mid shaft hypospadias. It optimizes the blood supply to the island flap and provides well vascularized coverage of the neourethra, resulting in a decreased complication rate.