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

Abstract

Purpose To find the cut-off value of urethral defect length (UDL) to guide the choice of single‑stage or two‑stage transverse preputial island flap urethroplasty (TPIFU). Methods We prospectively collected the data of patients with severe hypospadias underwent single-stage and two-stage TPIFU at fifteen tertiary referral institutions from 2019 to 2020. The receiver operating characteristic (ROC) analyzed the cut-off value of UDL to predict postoperative complications with single-stage TPIFU. We extracted patients with long UDL (longer than the cut-off value) in the single-stage and two-stage TPIFU, comparing the postoperative complications. Results A total of 536 patients included 483 underwent single-stage TPIFU and 53 underwent two-stage TPIFU were collected. The ROC analyzed the cut-off value of UDL was 3.5 cm. 169 patients with long UDL (longer than 3.5 cm) were extracted from all 536 patients, with 126 underwent single-stage TPIFU (single-stage group) and 43 underwent two-stage TPIFU (two-stage group). In the single-stage group, complications occurred in 62 (49.2%) patients, including 34 (27.0%) with urethrocutaneous fistula, 21 (16.7%) with urethral stricture, and 25 (19.8%) with diverticulum. In the two-stage group, total complications occurred in four (9.3%), there were both two (4.7%) with urethral stricture and diverticulum, and no urethrocutaneous fistula was recorded. Conclusion Our results show that two-stage TPIFU can significantly reduce the incidence of postoperative complications for hypospadias with UDL longer than 3.5 cm, especially urethrocutaneous fistula and diverticulum.