International Urology and Nephrology

, Volume 44, Issue 5, pp 1311–1318

Kutlay technique for hypospadias repair

  • Ilhan Gecit
  • Daghan Isik
  • Necip Pirincci
  • Salim Bilici
  • Mustafa Gunes
  • Yasin Canbaz
  • O. Faruk Kocak
Urology – Original Paper

Abstract

Objective

Although many techniques have been described, new techniques with a wide range of therapeutic options are needed. The Kutlay technique is a novel technique that is based on the reconstruction of the neourethra with two horizontal meatal-based skin flaps. In the present study, the data of 31 patients who underwent surgery with the Kutlay technique are presented.

Patients and methods

Thirty-one patients with hypospadias with an average age of 5.6 years who did not have previous hypospadias repair were operated on with the Kutlay technique. Ten patients had chordee. Among those patients, three patients were circumcised.

Results

The patients were followed up for 4–13 months (average, 9.3 months). During the follow-up period, a fistula was observed in only one patient. None of the patients developed neourethral dehiscence, meatal stenosis, urethral stricture, wound infection, penile torsion, hematoma, or persistent or recurrent chordee. On uroflowmetry studies, the maximum flow rate of the patients was approximately 10.5 ml/s (range, 6–17 ml/s). The patients were observed to void with a single straight urinary stream in a forward direction.

Conclusion

The Kutlay technique is a technique that is easily applied in patients with chordee and that provides a low risk of fistulas and acceptable functional and esthetic results. The factors that reduce the risk of fistula are the lack of the superposition of the suture lines of the skin and the urethra, the reconstruction of the urethra with well-vascularized flaps, and the replacement of the neourethra in its appropriate location through the tunnel created in the glans.

Keywords

Hypospadias Kutlay technique Meatal-based flap Chordee 

References

  1. 1.
    Borer JG, Retik AB (2007) Pediatric urology. In: Wein AJ (ed) Campbell-Walsh urology, 9th edn. WB Saunders, Philadelphia, pp 3740–3743Google Scholar
  2. 2.
    Kutlay R, Isik D, Ercel C et al (2010) A new technique for correction of distal penile hypospadias. Ann Plast Surg 65:66–69PubMedCrossRefGoogle Scholar
  3. 3.
    Belman AB (1997) Hypospadias update. Urology 49:166–172PubMedCrossRefGoogle Scholar
  4. 4.
    Baskin LS, Ebbers MB (2006) Hypospadias: anatomy, etiology, and technique. J Pediatr Surg 41:463–472PubMedCrossRefGoogle Scholar
  5. 5.
    Malone PR (2009) Urethrocutaneous fistula: preserve the tract and turn it inside out: the patio repair. BJU Int 104:550–554PubMedCrossRefGoogle Scholar
  6. 6.
    Rushton HG, Belman AB (1998) The split prepuce in situ onlay hypospadias repair. J Urol 160:1334–1336CrossRefGoogle Scholar
  7. 7.
    Asopa HS (1998) Newer concepts in the management of hypospadias and its complications. Ann R Coll Surg Engl 80:161–168PubMedGoogle Scholar
  8. 8.
    Akbiyik F, Tiryaki T, Senel E et al (2009) Clinical experience in hypospadias: results of tubularized incised plate in 496 patients. Urology 73:1255–1257PubMedCrossRefGoogle Scholar
  9. 9.
    Uygur MC, Unal D, Tan MO et al (2002) Factors affecting outcome of one-stage anterior hypospadias repair: analysis of 422 cases. Pediatr Surg Int 18:142–146PubMedCrossRefGoogle Scholar
  10. 10.
    Sunay M, Dadali M, Karabulut A et al (2007) Our 23-year experience in urethrocutaneous fistulas developing after hypospadias surgery. Urology 69:366–368PubMedCrossRefGoogle Scholar
  11. 11.
    Smith D (1973) A de-epithelialised overlap flap technique in the repair of hypospadias. Br J Plast Surg 26:106–114PubMedCrossRefGoogle Scholar
  12. 12.
    Atik B, Tan O, Mutaf M et al (2008) Skin perforators of back region: anatomical study and clinical applications. Ann Plast Surg 60:70–75PubMedCrossRefGoogle Scholar
  13. 13.
    Atik B, Tan O, Kıymaz N et al (2006) Bilobed fasciocutaneous flap closure of large meningomyeloceles. Ann Plast Surg 56:562–564PubMedCrossRefGoogle Scholar
  14. 14.
    Hadidi AT (2004) Protective intermediate layer. In: Hadidi AT, Azmy AF (eds) Hypospadias surgery, 1st edn. Springer, Berlin, pp 237–241Google Scholar
  15. 15.
    Retik AB, Keating M, Mandell J (1988) Complications of hypospadias repair. Urol Clin North Am 15:223–236PubMedGoogle Scholar
  16. 16.
    Djakovic N, Nyarangi-Dix J, Ozturk A et al (2008) Hypospadias. Adv Urol 650135:1–7CrossRefGoogle Scholar
  17. 17.
    Yerkes EB, Adams MC, Miller DA et al (2000) Y-to-I wrap: use of the distal spongiosum for hypospadias repair. J Urol 163:1536–1538PubMedCrossRefGoogle Scholar
  18. 18.
    Bilici S, Sekmenli T, Gunes M et al (2011) Comparison of dartos flap and dartos flap plus spongioplasty to prevent the formation of fistulae in the snodgrass technique. Int Urol Nephrol 43:943–948PubMedCrossRefGoogle Scholar
  19. 19.
    Samuel M, Capps S, Worthy A (2002) Distal hypospadias: which repair? BJU Int 90:88–91PubMedCrossRefGoogle Scholar
  20. 20.
    Devine CJ Jr, Horton CE (1977) Hypospadias repair. J Urol 118:188–193PubMedGoogle Scholar
  21. 21.
    Horton CE, Sadove RC, Devine CJ Jr (1990) Reconstruction of male genital defects: congenital. In: McCarthy JG (ed) Plastic surgery, 1st edn. W.B. Saunders Company, Philadelphia, pp 4153–4179Google Scholar
  22. 22.
    Snodgrass W (1994) Tubularized, incised plate urethroplasty for distal hypospadias. J Urol 151:464–465PubMedGoogle Scholar
  23. 23.
    Snodgrass W, Bush N (2011) Tubularized incised plate proximal hypospadias repair: continued evolution and extended applications. J Pediatr Urol 7:2–9PubMedCrossRefGoogle Scholar
  24. 24.
    Imamoglu MA, Bakirtas H (2003) Comparison of two methods–Mathieu and Snodgrass–in hypospadias repair. Urol Int 71:251–254PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2012

Authors and Affiliations

  • Ilhan Gecit
    • 1
  • Daghan Isik
    • 2
  • Necip Pirincci
    • 1
  • Salim Bilici
    • 3
  • Mustafa Gunes
    • 1
  • Yasin Canbaz
    • 2
  • O. Faruk Kocak
    • 2
  1. 1.Department of Urology, School of MedicineYuzuncu Yil UniversityVanTurkey
  2. 2.Department of Plastic and Reconstructive Surgery, School of MedicineYuzuncu Yil UniversityVanTurkey
  3. 3.Department of Pediatric Surgery, School of MedicineYuzuncu Yil UniversityVanTurkey

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