Comparative study of one-stage and the novel two-stage urethroplasty using the transected urethral plate and transverse preputial island flap (TPIF) for severe hypospadias: a single-center experience

Abstract

Background: To evaluate a novel two-stage method of urethroplasty using a transected urethral plate and transverse preputial island flap (TPIF) for proximal hypospadias with severe chordee.Methods: We retrospectively analyzed 91 cases of proximal hypospadias, who had undergone either onestage or two-stage urethroplasty. Comparisons between the two groups were made based on age, glans diameter, the length of the urethral defect, and the rate of complications.Results: There was no significant difference in age at surgery, glans diameter, and the length of urethral defect between the two groups. In the one-stage group, 18 cases of urinary fistula and one case each of glans dehiscence, urethral diverticulum, and urethral diverticulum with concurrent glans dehiscence, were reported. All patients were treated using urinary fistula repair or urethroplasty. In the novel two-stage group, no cases of urinary fistula were reported after the secondary urethroplasty. However, 4 cases showed dehiscence at the glans, 2 were treated through reoperation but the 2 other 2 patients reoperation. The success rate was 62.50% and 88.57% in the one-stage and two-stage groups, respectively (P<0.05).Conclusions: Two-stage urethroplasty using a tubularized urethral plate and TPIF can significantly reduce the incidence of urethral fistula of the proximal hypospadias with severe chordee. However, it may increase the number of operations that need to be performed on children who do not need staged surgery. Although we could not prove it through this study, we believe that the necessity of two-stage urethroplasty should be determined based on the development of the glans, the severity of penile curvature, and the length of the urethra defect.

Comparison of single-stage and two-stage transverse preputial island flap urethroplasty for severe hypospadias with long urethral defect length: A prospective multicenter study

“…In this study, urethrocutaneous stula occurred in 35 patients (35/126, 27.6%) in single-stage group but no patient in two-stage group. A prospective study of Zhu et al [23]. reported that the incidence of urethrocutaneous stula in single-stage TPIFU was 27.3% (18/66) higher than 4.5% (2/44) underwent two-stage TPIFU.…”

“…Compared with the two-stage TPIFU, single-stage procedures may reduce the cost of medical treatment and the anxiety of patients and their families, but single-stage TPIFU led to a higher incidence of postoperative complications than two-stage TPIFU [22,23]. Two-stage TPIFU takes advantage of completing part of the urethra creation in rst stage, and left stula resulting in less stimulation and better healing of distal neourethra.…”

Current perspectives in hypospadias research: A scoping review of articles published in 2021 (Review)

“…There were no new techniques described, but modifications were mentioned by different authors in hope of an improved outcome and reducing the complication rate (7)(8)(9). The majority of studies concluded that two-stage surgery leads to improved results compared with one stage (9)(10)(11)(12). The options described are modified Koyanagi technique (13)(14)(15), transverse preputial island flap urethroplasty (10,12,16), inlay (17-19), or buccal mucosa graft (20,21).…”

“…The majority of studies concluded that two-stage surgery leads to improved results compared with one stage (9)(10)(11)(12). The options described are modified Koyanagi technique (13)(14)(15), transverse preputial island flap urethroplasty (10,12,16), inlay (17-19), or buccal mucosa graft (20,21). Tunica vaginalis represents a good coverage material (22-24).…”

Proximal Hypospadias Repair by Using Longitudinal Preputial Double-Layerd Island Flap Technique

“…Pediatric hypospadias is a frequent congenital urinary system abnormality (1) . Approximately one in every 100-300 live male infants is reported to have proximal hypospadias, which is found in 20% of instances.…”