Korean J Urol.  2006 Nov;47(11):1225-1229. 10.4111/kju.2006.47.11.1225.

Surgical Correction of Post-hypospadias Repair Urethral Diverticulum and Stricture using Rotational Flap

• Lee HY
• Han SW

• KMID: 2294283
• DOI: http://doi.org/10.4111/kju.2006.47.11.1225

Abstract

Purpose
We report 10 cases of successfully corrected post-hypospadias repair urethral stricture with diverticulum, which were refractory to repeated dilation and visual urethrotomy using rotational flap of the diverticular tissue.
Materials and Methods
Among those who visited our clinic for voiding difficulty and post-void dribbling following hypospadias repair from February 2003 to February 2006, 10 children who were refractory to repeated urethral dilation and visual internal urethrotomy, and in whom urethral diverticulum was identified via retrograde urethrogram (RGU) and physical examination were operated using this technique.
Results
The previous urethroplasties included 1 combined meatal island onlay proximal transverse island flap (MIOPTI), 2 MIOPTIs, 1 Hodgsons operation, 5 tubularized incised plate urethroplasties and 1 Thiersch- Duplay procedure; they all underwent at least 2 visual internal urethrotomies under general anesthesia and numerous urethral dilations on an outpatient basis. The location of the diverticulum were mid-penile in 6 patients, proximal penile in 2 and bulbous in 2; urethral strictures distal to the diverticulum were found in 7 and some degree of narrowing was noted in 3. A flap about twice the length of the stricture was designed in the diverticulum and by rotating the flap, the lumen of the strictured portion was expanded and the size of the diverticulum naturally reduced. No voiding difficulty was noted with only a minimal amount of post-void residual urine on follow-up.
Conclusions
Rotation flap is a technique that can simultaneously solve the problems of a stricture and diverticulum by using relatively well vascularized tissue of the diverticulum. This technique is especially recommended for those children who lack healthy urethral tissue or its substitute due to repeated dilation and internal urethrotomies.

Keyword

Hypospadias; Diverticulum; Urethral stricture

MeSH Terms

Anesthesia, General
Child
Constriction, Pathologic*
Diverticulum*
Female
Follow-Up Studies
Humans
Hypospadias
Inlays
Male
Outpatients
Physical Examination
Urethral Stricture

Figure

• 

  Fig. 1 Retrograde urethrogram showing the diverticulum. (A) Urethral stricture (white arrow) with a proximal diverticulum and distal aneurysmal dilatation. (B) Diverticulum with proximal & distal stricture (black arrows).

• 

  Fig. 2 (A) Design of a flap on the diverticulum approximately twice the length of stricture portion. (B) Rotation of the flap towards the stricture portion. (C) Suture of the flap to the stricture portion.

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