Onlay Island Flap Hypospadias Repair ; Experience of 45 Cases

Ha, Hyug Soo; Kim, Kwang Sae

Abstract

PURPOSE: The onlay island flap urethroplasty, a variation of the transverse preputial island flap, was originally introduced as an alternative to the meatal-based flap urethroplasty for anterior hypospadias. Recently, the indications for use of the onlay island flap urethroplasty have been extended to include repair of more proximal hypospadias with/without moderate degrees of chordee. We evaluated application and outcome of onlay island flap hypospadias repair.
MATERIALS AND METHODS
We analyzed medical records of 126 patients who underwent primary hapospadias repair at our hospital during recent 10 years with respect to age at surgery, type of hypospadias, surgical technique and outcome. A minimum follow-up of 6 months was necessary for inclusion of the study.
RESULTS
Age ranged from 7 months to 32 years(mean 6.7 years). For 59 patients with anterior hypospadias, 14 onlay island flap, 21 MAGPI, 14 pyramid, 8 Mathieu and 2 tubularized incised plate urethroplasties were performed. For 67 patients with mid to posterior hypospadias, 31 onlay island flap, 29 transverse island flap, 3 King, 3 augmented Duckett (Transverse island flap+hiersch-Duplay) and 1 tubularized incised plate urethroplasty were performed. Out of total 129 patients, 45 patients underwent onlay island flap repairs including combined with 7 dorsal penile plications. Out of 31 patients who underwent onlay island flap repairs, 3 patients developed complications. Out of 29 patients who underwent transverse preputial island flap repair, 13 patients developed complications. During the period of first 5 years, we performed 10 onlay island flap and 21 transverse island flap repairs for 37 mid to posterior hypospadias, whereas during the second 5 years, we did 21 onlay island and 8 transverse island flap repairs for 30 mid to posterior hypospadias.
CONCLUSIONS
The onlay island flap hypospadias repair with/without dorsal penile plication was even applied to mid and posterior hypospadias as well as anterior hypospadias. The onlay island flap hypospadias repair maintained its technical advantages and lower complication rate compared to transverse island flap. More favorable results were obtained through as possible as preservation of urethral plate in hypospadias repair.