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Double-face preputial island flap revisited: is it a reliable one-stage repair for severe hypospadias?

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World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

We have studied outcome of double-face preputial island flap (DFPIF) technique in severe types of hypospadias: penoscrotal, scrotal and perineal.

Methods

We have used DFPIF in 75 boys at a median age of 1.1 years (1.0–1.5). The meatus was penoscrotal, scrotal or perineal after de-gloving the penis. The inner face of the foreskin was used for urethroplasty and the outer face for ventral skin covering. Modifications were added: proximal anastomosis was protected by a spongioplasty; in case of urethral plate transection, we anastomosed on onlay proximal and distal segments of the flap (onlay-tube-onlay) and the tubularized part was sutured to corpus cavernosa. FU was scheduled at one month then every 3 months for a year then annually. At each consultation, the surgeon filled out a detailed cosmetic and functional sheet including flowmeter.

Results

Thirty-four patients had onlay preputial flap repair with urethral plate preservation. Forty-one had the onlay-tube-onlay technique. All children had a curvature, 19 had a significant residual curvature after dissection, corrected by dorsal plication (n = 9) and ventral lengthening (n = 10). Median FU was 4.2 years (2.7–6.5). 36 children (48%) had complications and needed redo surgery: 12 fistulas, 11 diverticula, 7 meatal stenosis, 3 strictures and 2 residual curvatures. All children but three voided within the normal limits for their age.

Conclusion

DFPIF remains a good option for a one-stage repair of severe hypospadias. After a median of 1.8 procedures, the final success rate was 96%. The healthy well-vascularized ventral skin allows safe redo surgery when needed.

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Authors and Affiliations

  1. Department of Pediatric Surgery and Urology, Hôpital Robert Debré, Centre de Référence Maladies Endocriniennes de la Croissance et du Développement (CRMERC), APHP, University of Paris, Paris, France

    Thomas Blanc, Matthieu Peycelon, Mohammed Siddiqui, Cecile Muller, Annabel Paye-Jaouen & Alaa El-Ghoneimi

Authors
  1. Thomas Blanc
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  2. Matthieu Peycelon
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  3. Mohammed Siddiqui
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  4. Cecile Muller
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  5. Annabel Paye-Jaouen
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  6. Alaa El-Ghoneimi
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Contributions

TB: project development, Data collection, Data analysis, Manuscript writing/editing, MP: Statistical analysis, Manuscript writing/editing, MS: Data collection, CM: Data collection, APJ: Data collection, Data analysis, AEG: project development, Data analysis, Manuscript writing/editing.

Corresponding author

Correspondence to Alaa El-Ghoneimi.

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The authors declare that they have no conflict of interest.

Ethics approval

Ethical approval was waived by the local Ethics Committee of the university hospital Robert Debré, in view of the retrospective nature of the study and all the procedures being performed were part of the routine care. Meanwhile, a written consent for photography use for research was obtained for each photography shown in the manuscript and signed by the parents.

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Blanc, T., Peycelon, M., Siddiqui, M. et al. Double-face preputial island flap revisited: is it a reliable one-stage repair for severe hypospadias?. World J Urol 39, 1613–1624 (2021). https://doi.org/10.1007/s00345-020-03324-7

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  • DOI: https://doi.org/10.1007/s00345-020-03324-7

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