Summary
Background
Choosing between flaps or grafts to substitute the urethral plate in 2-stage hypospadias
repair has been a matter of debate with no consensus in the literature. Flaps have
reliable blood supply that maybe theoretically less liable for strictures or contractures.
Grafts are more versatile, which can be used in primary and recurrent cases when healthy
local skin is deficient.In this report, our aim was to compare outcomes of grafts
and flaps when used to substitute the urethral plate in two-stage repair of primary
proximal hypospadias with ventral curvature.
Methods
This retrospective study included primary cases of hypospadias with significant curvature
who underwent two-stage repair using either grafts or flaps to substitute the urethral
plate in the first stage. Cases included in the study were divided into two groups
according to the technique of substituting the urethral plate at the first stage of
repair. During first part of the study period (2015 through 2018), we mostly used
grafts to substitute the urethral plate (group A); later, we shifted to skin flaps
(Group B) during the period 2019 through 2021.
Results
The study included 37 boys with primary proximal hypospadias who underwent two-stage
hypospadias repair. The meatus position was penoscrotal in 18, scrotal in 16, and
perineal in three. Inner preputial graft was used to substitute the urethral plate
in 18 cases (group A), while dorsal skin flaps were used in 19 (group B). Out of the
37 cases, 27 were available at follow-up after second stage (group A=14; group B=13).
Follow up period ranged between 6 and 42 months (mean 19.7; median 18.5). Overall,
14 cases required reoperations for different indications: partial disruptions of distal
part of the repair in six, closure of urethro-cutaneous fistula in six, and urethral
strictures in two. The rate of complications was higher in group A (10 cases: 71%)
compared to group B (4 cases: 31%) (Fisher exact test, p-value= 0.057).
Conclusion
Grafts were associated with higher complication rate than flaps when used to substitute
the urethral plate in two-stage repair of proximal hypospadias with chordee.
Type of study and Level of Evidence
This is non-randomized comparative study (level III evidence).
Keywords
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Article info
Publication history
Accepted:
March 13,
2023
Received in revised form:
March 9,
2023
Received:
December 16,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Published by Elsevier Inc.
