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Transverse preputial onlay island flap urethroplasty for single-stage correction of proximal hypospadias

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Abstract

Aims and objectives

Transverse preputial onlay island flap urethroplasty (TPOIF) was described initially for distal hypospadias, but has seen extended application for proximal hypospadias. We describe a set of modifications in the technique and results in a large series of proximal hypospadias.

Materials and methods

All children who underwent TPOIF repair for proximal hypospadias (proximal penile, penoscrotal and scrotal) from June 2006 to June 2013 by a single surgeon were prospectively followed till June, 2014. A standard technique and postoperative protocol were followed. Salient points to be emphasized in the technique: (1) dissection of the dartos pedicle till penopubic junction to prevent penile torsion, (2) incorporation of the spongiosum in the urethroplasty, (3) midline urethral plate incision in glans (hinging the plate), (4) Dartos blanket cover on whole urethroplasty.

Results

Out of 136 children with proximal hypospadias, 92 children who underwent TPOIF formed the study group. Out of 92 children, 48 (52 %) children required a tunica albuginea plication for chordee correction. In total, 16 (17 %) patients developed 24 complications and 11 children (12 %) required second surgeries: fistula closure in 7 (with meatoplasty in 5), glansplasty for glans dehiscence in 2 and excision of diverticulum in 2. Two children required a third surgery. Only 5 children had a noticeable penile torsion (less than 30 degree), and 7 had a patulous meatus.

Conclusions

Transverse preputial onlay island flap urethroplasty can deliver reliable cosmetic and functional outcomes in proximal hypospadias.

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Authors contributions

A.K.S. wrote the first draft and was responsible for study design, data collection, interpretation and analysis. M.D. was responsible for data collection and interpretation and manuscript writing. V.J. was responsible for data collection, data analysis and literature review. All the authors have reviewed and contributed toward the final draft.

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Authors and Affiliations

  1. MITR Hospital, Kharghar, Navi Mumbai, India

    Arbinder Kumar Singal & Manish Dubey

  2. Hypospadias Foundation, Kharghar, Navi Mumbai, India

    Arbinder Kumar Singal, Manish Dubey & Viral Jain

  3. Division of Pediatric Urology, MGM Institute of Health Sciences, Kamothe, Maharashtra, India

    Arbinder Kumar Singal

  4. One Vision Health and Research Foundation, Navi Mumbai, India

    Arbinder Kumar Singal & Viral Jain

  5. Case Western Reserve (MetroHealth) Program, Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA

    Viral Jain

Authors
  1. Arbinder Kumar Singal
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  2. Manish Dubey
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  3. Viral Jain
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Corresponding author

Correspondence to Arbinder Kumar Singal.

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Conflict of interest

All the authors declare no conflict of interest.

Ethical standards

Informed consent was obtained from parent/guardian of all the patients. The study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

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Singal, A.K., Dubey, M. & Jain, V. Transverse preputial onlay island flap urethroplasty for single-stage correction of proximal hypospadias. World J Urol 34, 1019–1024 (2016). https://doi.org/10.1007/s00345-015-1686-1

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  • DOI: https://doi.org/10.1007/s00345-015-1686-1

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