The one-step strategy is associated with 68.5% success in a single operation, whereas 31.5% will need a second repair. We recognize that meatal problems are mostly associated with fistulae and diverticula; therefore, we recommend a final acceptable proximal glandar opening that will not compromise the neourethra.

Purpose:To develop a rabbit experimental study to test the hypothesis that surgical repair of hypospadias with severe ventral curvatures might be completed in one stage, if a graft, such as buccal mucosa, could be placed over the tunica vaginalis flap used in corporoplasty for ventral lengthening, with the addition of an onlay preputial island flap to complete the urethroplasty.Materials and methods:The experimental procedure with rabbits included a tunica vaginalis flap for reconstruction of the corpora after corporotomy, simulating a ventral lengthening operation. A buccal mucosa graft was placed directly on top of the flap, and the urethroplasty was completed with an onlay preputial island flap. Eight rabbits were divided into 4 groups, sacrificed at 2, 4, 8 and 12 weeks postoperatively, and submitted to histological evaluation.Results:We observed a large number of complications, such as fistula (75%), urinary retention (50%) and stenosis (50%). There were two deaths related to the procedure. Histological evaluation demonstrated a severe and persistent inflammatory reaction. No viable tunica vaginalis or buccal mucosa was identified.Conclusions:In this animal model, the association of a buccal mucosa graft over the tunica vaginalis flap was not successful, and resulted in complete loss of both tissues.

PURPOSEComplex primary Hypospadias repair that deserve urethral plate division is treated mostly in two steps, but not necessarily in two surgeries. Our aim in this review was to recheck our long-term results with a onestage strategy we published in the past based on simultaneous reconstruction of the urethral plate with dorsal buccal mucosa graft and onlay transverse preputial flap anastomosis protected in the end by a tunica vaginalis flap (the three-in-one concept). MATERIAL AND METHODSWe found 35 patients operated with primary scrotal, penoscrotal and perineal Hypospadias between March 2002 and June 2008. We reviewed all charts active in follow-up and made phone interviews for those not seen for the last 24 months. We investigated parameters such as UTI occurrence, fistula, residual curvature, meatal stenosis, urethral diverticula, urethral dehiscence, orchitis and parental perception. RESULTSSurgical complications occurred in 11 patients (31%) and are listed: 4 meatal stenosis, 4 diverticula, 5 fistulas and 2 residual penile curvatures (total 42%). Meatal dilatation was successful in 2 cases that reflected in 2 fistula resolution. The reoperation rate was 25.7% and consisted mostly of simple procedures like fistula closure, meatotomy and complex diverticula repair in 3 cases. Two patients presented recurrent orchitis and UTI but were associated with infrequent voiding characteristics. End parental perception after treatment was excellent for 57% (20 patients) and good or acceptable for the rest. CONCLUSIONSWe concluded that one-step strategy as here described is associated with 69% chance of one single operation without any complication to treat complex Hypospadias forms, whereas 25.7% will need a second repair. We recognize that meatal problems are mostly associated with fistula and diverticula and therefore we recommend a final acceptable proximal glandar opening that may not compromise the neourethra.

_______________________________________________________________________________________ Introduction: Vesicostomy should be considered in children with neuropathic bladder in case first-line therapies fail. This simple and reversible procedure can reduce febrile urinary tract infections and protect the upper urinary tract (1) until more definitive alternatives can be proposed.

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