Skip to main content
SpringerLink
Log in

Staged transverse preputial island flap urethroplasty for proximal hypospadias: a single-center experience

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the intermediate outcomes of our institution’s experience with staged TPIF urethroplasty for proximal hypospadias repair.

Methods

We retrospectively evaluated the medical records of patients who underwent repair of proximal hypospadias using staged TPIF urethroplasty at our hospital from 2011 to 2017.

Results

One hundred and two patients were included in the present study. The mean follow-up was 52.4 months (range 13–74 months). The mean age at the time of the first surgery was 13.5 months (range 11–65 months). There were two main types of initial complications including meatal stenosis in four (3.9%) and urethrocutaneous fistula in three (2.9%) patients after the first stage. Surgical complications were seen in 15 patients after second stage, including urethrocutaneous fistulas in 8 (7.8%), urethral strictures in 5 (4.9%), urethral diverticula in 2 (1.9%). Overall complication rates after second stage were 14.7%. The incidence of fistulas was lower in patients who underwent repair with a tunica vaginalis flap (1/29, 3.4%) than with the dartos fascia (7/73, 9.6%; p = 0.435).

Conclusions

Our results show that staged TPIF urethroplasty is a viable and durable technique for primary severe proximal hypospadias. This procedure was associated with a 14.7% complication rate in the present study. Staged TPIF urethroplasty can reduce the incidence of urethral strictures and diverticula associated with the second stage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Stanasel I, Le HK, Bilgutay A, Roth DR, Gonzales ET Jr, Janzen N et al (2015) Complications following staged hypospadias repair using transposed preputial skin flaps. J Urol 194:512–516. https://doi.org/10.1016/j.juro.2015.02.044

    Article  PubMed  PubMed Central  Google Scholar 

  2. McNamara ER, Schaeffer AJ, Logvinenko T, Seager C, Rosoklija I, Nelson CP et al (2015) Management of proximal hypospadias with 2-stage repair: 20-year experience. J Urol 194:1080–1085. https://doi.org/10.1016/j.juro.2015.04.105

    Article  PubMed  PubMed Central  Google Scholar 

  3. Pippi SJ, Sayed S, Salle A, Bagli D, Farhat W, Koyle M et al (2016) Proximal hypospadias: a persistent challenge. Single institution outcome analysis of three surgical techniques over a 10-year period. J Pediatr Urol 12:21–28. https://doi.org/10.1016/j.jpurol.2015.06.011

    Article  Google Scholar 

  4. Long CJ, Chu DI, Tenney RW, Morris AR, Weiss DA, Shukla AR et al (2017) Intermediate-term followup of proximal hypospadias repair reveals high complication rate. J Urol 197:852–858. https://doi.org/10.1016/j.juro.2016.11.054

    Article  PubMed  Google Scholar 

  5. Chen C, Yang TQ, Chen JB, Sun N, Zhang WP (2016) the effect of staged transverse preputial island flap urethroplasty for proximal hypospadias with severe chordee. J Urol 196:1536–1540. https://doi.org/10.1016/j.juro.2016.05.098

    Article  PubMed  Google Scholar 

  6. Grosos C, Bensaid R, Gorduza DB, Mouriquand P et al (2014) Is it safe to solely use ventral penile tissues in hypospadias repair? Long-term outcomes of 578 Duplay urethroplasties performed in a single institution over a period of 14 years. J Pediatr Urol 10:1232–1237. https://doi.org/10.1016/j.jpurol.2014.07.003

    Article  CAS  PubMed  Google Scholar 

  7. Cambareri GM, Yap M, Kaplan GW (2017) Hypospadias repair with onlay preputial graft:a 25-year experience with long-term follow-up. BJU Int 118:451–457. https://doi.org/10.1111/bju.13419

    Article  Google Scholar 

  8. Faasse MA, Liu DB (2017) Early vs. late-presenting urethroplasty complications after hypospadias repair: A retrospective analysis of patient follow-up. J Pediatr Urol 13:351–354. https://doi.org/10.1016/j.jpurol.2017.05.017

    Article  Google Scholar 

  9. Duckett JJ (1980) Transverse preputial island flap technique for repair of severe hypospadias. Urol Clin N Am 7:423–430

    Google Scholar 

  10. Castagnetti M, El-Ghoneimi A (2010) Surgical management of primary severe hypospadias in children: systematic 20-year review. J Urol 184:1469–1474. https://doi.org/10.1016/j.juro.2010.06.044

    Article  PubMed  Google Scholar 

  11. Springer A, Krois W, Horcher E (2011) Trends in hypospadias surgery: results of a worldwide survey. Eur Urol 60:1184–1189. https://doi.org/10.1016/j.eururo.2011.08.031

    Article  PubMed  Google Scholar 

  12. Snodgrass W, Bush N (2011) Tubularized incised plate proximal hypospadias repair: continued evolution and extended applications. J Pediatr Urol 7:2–9. https://doi.org/10.1016/j.jpurol.2010.05.011

    Article  PubMed  Google Scholar 

  13. Pescheloche P, Parmentier B, Hor T et al (2018) Tunica vaginalis flap for urethrocutaneous fistula repair after proximal and mid-shaft hypospadias surgery: a 12-year experience. J Pediatr Urol 14:421. https://doi.org/10.1016/j.jpurol.2018.03.026

    Article  PubMed  Google Scholar 

  14. Fahmy O, Khairul-Asri MG, Schwentner C, Schubert T, Stenzl A, Zahran MH et al (2016) Algorithm for optimal urethral coverage in hypospadias and fistula repair: a systematic review. Eur Urol 70:293–298. https://doi.org/10.1016/j.eururo.2015.12.047

    Article  PubMed  Google Scholar 

  15. Huang Y, Xie H, Lv Y, Yu L, Sun L, Li X et al (2017) One-stage repair of proximal hypospadias with severe chordee by in situ tubularization of the transverse preputial island flap. J Pediatr Urol 13:296–299. https://doi.org/10.1016/j.jpurol.2017.02.015

    Article  PubMed  Google Scholar 

  16. Aigen AB, Khawand N, Skoog SJ, Belman AB (1987) Acquired megalourethra: an uncommon complication of the transverse preputial island flap urethroplasty. J Urol 137:712–713

    Article  CAS  PubMed  Google Scholar 

  17. Cheng EY, Kropp BP, Pope JT, Brock JW et al (2003) Proximal division of the urethral plate in staged hypospadias repair. J Urol 170:1580–1584. https://doi.org/10.1097/01.ju.0000084258.93064.f4

    Article  PubMed  Google Scholar 

  18. Vallasciani S, Berrettini A, Nanni L, Manzoni G, Marrocco G (2013) Observational retrospective study on acquired megalourethra after primary proximal hypospad ias repair and its recurrence after tapering. J Pediatr Urol 9:364–367. https://doi.org/10.1016/j.jpurol.2012.05.005

    Article  CAS  PubMed  Google Scholar 

  19. Badawy H, Orabi S, Hanno A, Abdelhamid H (2018) Posterior hypospadias: evaluation of a paradigm shift from single to staged repair. J Pediatr Urol 14:21–28. https://doi.org/10.1016/j.jpurol.2017.07.007

    Article  Google Scholar 

Download references

Funding

This study was funded by the Beijing Municipal Administration of Hospitals “Dengfeng” Talent Trainning Plan (DFL20151102) and Beijing Municipal Administration of Hospitals “Yangfan Plan”: Pediatric Urology (ZYLX201709).

Author information

Authors and Affiliations

  1. Department of Urology, Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing, 100045, China

    Chaoxu Wang, Hongcheng Song & Weiping Zhang

Authors
  1. Chaoxu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hongcheng Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Weiping Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hongcheng Song.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interests regarding the publication of this paper. All authors have received grants from Beijing Children’s Hospital.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

No informed consent has been collected since it is a retrospective study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, C., Song, H. & Zhang, W. Staged transverse preputial island flap urethroplasty for proximal hypospadias: a single-center experience. Pediatr Surg Int 35, 823–827 (2019). https://doi.org/10.1007/s00383-019-04480-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-019-04480-7

Keywords

Search

Navigation