Comparison of Transverse Preputial Island Flap, Onlay Island Flap and Tubularized Incised Plate Urethroplasty for Proximal Hypospadias

Kim, Kun Suk; Lee, Tae Kyung; Kim, Hongsik; Park, Hyungkeun; Park, Jong Yeon; Oh, Seung June

Abstract

PURPOSE: Numerous operative techniques have been developed to correct proximal hypospadias. Transverse preputial island flap urethroplasty have provided reliable results for the repair of proximal hypospadias, and the versatility of the preputial flap led to its adaptation as an onlay flap that could be sewn onto an intact or preserved urethral plate. Recently, tubularized incised plate urethroplasty(Snodgrass procedure) have been reported with good results. We retrospectively analyzed our experiences with these three techniques to know which procedure is recommendable for repair of proximal hypospadias.
MATERIALS AND METHODS
Between January, 1994 and June, 1998, 44 patients underwent repair for the proximal hypospadias by a single surgeon using an transverse preputial island flap(21), onlay flap(16) and tubularized incised plate(7) procedure. We analysed the surgical outcome such as surgical complications according to each procedures.
RESULTS
Postoperative complication rate was 57% for transverse preputial island flap, 13% for onlay flap and 14% for tubularized incised plate procedure. The rate of fistula formation were 42%, 13% and 14%, respectively. One diverticulum and two strictures were developed in three patients who underwent transverse preputial island flap procedure, whereas no diverticulum or stricture was developed after onlay or tubularized incised plate procedure. Cosmetic results were excellent in tubularized incised plate urethroplasty.
CONCLUSIONS
Onlay or tubularized incised plate urethroplasty using an preserved urethral plate had better outcomes compared to the transverse preputial island flap procedure. The technique using urethral plate could be recommendable as first choice for proximal hypospadias although transverse preputial island flap procedure is worthy to be considered for more complicated cases.