International Urology and Nephrology

, Volume 51, Issue 2, pp 187–191 | Cite as

Foreskin reconstruction at the time of single-stage hypospadias repair: is it a safe procedure?

  • Riccardo ManueleEmail author
  • Carlotta Senni
  • Kalpana Patil
  • Arash Taghizadeh
  • Massimo Garriboli
Urology - Original Paper



Foreskin reconstruction (FR) is a recognised, yet debated, option for patients undergoing single-stage hypospadias repair (HR).


We evaluated the incidence of complications after single-stage HR in our institution. This is a retrospective review of all single-stage HR. Patients were classified into group 1 (circumcision) and group 2 foreskin reconstruction (FR). Urethroplasty and foreskin complications were recorded. Statistics used are as follows: Mann–Whitney test to compare age at operation and length of follow-up (FU); Chi-Square test to analyse the incidence of urethral complications and need for reoperation; Log rank test to compare the survival curves; p statistically significant < 0.05. Data are presented as median (range).


304 patients were identified, operated between January 2010 and December 2016, and 20 were excluded: 6 already circumcised at the time of the surgery, 3 with megameatus intact prepuce, 11 lost at FU. 284 patients were included: 161 circumcised and 123 FR. Median age at the operation was 17 months (8–179) (group 1) and 17 months (8–148) (group 2) (p = 0.71). Length of FU was 19 months (8–91) (group 1) and 17 months (4–87) (group 2) (p = 0.45). The survival curve was homogeneous (p = 0.28). Urethroplasty complications occurred in 32/161 (20%) (group 1) and in 21/123 (17%) (group 2) (p = 0.55). Foreskin complications occurred in 18/123 (15%). A second operation was required in 33 boys in each group, (20% group 1 and 27% group 2) (p = 0.21).


FR does not increase the complication rate or the need for a reoperation after single-stage HR. Parents should be offered the option between the two procedures according to their personal preference.


Foreskin reconstruction Hypospadias repair Urethroplasty Complications 


Author contributions

Mr. RM: data collection/data management, data analysis, manuscript writing/editing. Ms. CS: data collection. Mrs. KP: manuscript editing, surgeon of operations. Mr. AT: manuscript editing, surgeon of operations. Mr. MG: project development, manuscript editing, data analysis, surgeon of operations.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Heloury Y, Cheng EY (2014) Distal hypospadias: circumcision vs preputial reconstruction. J Urol 191:17–19CrossRefGoogle Scholar
  2. 2.
    Sndograss W, Dajusta D, Villanueva C, Bush N (2013) Foreskin reconstruction does not increase urethroplasty or skin complication after distal TIP hypospadias repair. J Pediatr Urol 9:401–408CrossRefGoogle Scholar
  3. 3.
    Suoub M, Dave S, El-Hout Y, Braga LH, Farhat WA (2008) Distal hypospadias repair with or without foreskin reconstruction: a single-surgeon experience. J Pediatr Urol 4:377–380CrossRefGoogle Scholar
  4. 4.
    Klijn AJ, Dik P, de Jong TP (2001) Results of preputial reconstruction in 77 boys with distal hypospadias. J Urol 165:1255CrossRefGoogle Scholar
  5. 5.
    Antao B, Lansdale N, Roberts J, Mackinon E (2007) Factors affecting the outcome of foreskin reconstruction in hypospadias surgery. J Pediatr Urol 3:127–131CrossRefGoogle Scholar
  6. 6.
    Esposito C, Savanelli A, Escolino M et at (2014) Preputioplasty associated to urethroplasty for correction of distal hypospadias: a prospective study and poposition of a new objective scoring system for evaluation of esthetic and functional outcome. J Pediatr Urol 10:294–299CrossRefGoogle Scholar
  7. 7.
    Rampersad R et al (2017) Foreskin reconstruction vs circumcision in distal hypospadias. Pediatr Surg Int 33:1131–1137CrossRefGoogle Scholar
  8. 8.
    Snodgrass W (2012) Foreskin reconstruction. Bolnick et al Surgical guide to circumcision. Springer, London, pp 177–181CrossRefGoogle Scholar
  9. 9.
    Snodgrass W, Koyle M, Baskin L, Caldamone A (2006) Foreskin preservation in penile surgery. J Urol 176:711–714CrossRefGoogle Scholar
  10. 10.
    Kallampallil J, Hennayake S (2013) Foreskin retractility following hypospadias repair with preputioplasty—medium term outcomes. J Pediatr Urol 9:1204–1209CrossRefGoogle Scholar
  11. 11.
    Castagnetti M, Bagnara V, Rigamonti W, CImador M, Esposito C (2017) Preputial reconstruction in hypospadias repair. J Pediatr Urol 13:102–109CrossRefGoogle Scholar
  12. 12.
    Zimmermann E, Woodward M (2014) O Isolated preputial reconstruction in distal hypospadias. J Pediatr Urol 10:399.e1-399.e2CrossRefGoogle Scholar
  13. 13.
    Schneuer FJ, Holland AJA, Pereira G, Bower C, Nassar N (2015) Prevalence, repairs and complications of hypospadias: an Australian population-based study. Arch Dis Child 100:1038–1043CrossRefGoogle Scholar
  14. 14.
    Rynja SP, de Jong TP, Bosch JL, de Kort LM (2011) Functional, cosmetic and psychosexual results in adult men who underwent hypospadias correction in childhood. J Pediatr Urol 7:504–515CrossRefGoogle Scholar
  15. 15.
    Singh-Grewal D, Macdessi J, Craig J (2005) Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies. Arch Dis Child 90:853–858CrossRefGoogle Scholar
  16. 16.
    Hayashi Y, Kojima Y, Mizuno K et al (2008) Modified foreskin reconstruction for distal hypospadias and chordee without hypospadias. Int J Urol 15:646–648CrossRefGoogle Scholar
  17. 17.
    Laumann EO, Masi CM, Zuckerman EW (1997) Circumcision in the United States. Prevalence, prophylactic effects, and sexual practice. J Am Med Ass 277:1052–1057CrossRefGoogle Scholar
  18. 18.
    Shimada K, Matsumoto F, Matsui F, Takano S (2008) Prepuce sparing hypospadias repair with tubularized incised plate urethroplasty. Int J Urol 15:720–723CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Paediatric UrologyEvelina London Children’s HospitalLondonUK

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