Staged transverse preputial island flap urethroplasty for some proximal hypospadias with moderate-to-severe chordee

Abstract

Background We aimed to assess the outcome of staged transverse preputial island flap (TPIF) urethroplasty for repairing certain cases of primary proximal hypospadias with moderate-to-severe chordee in children. Methods Nighty-two consecutive boys who underwent either one-stage or staged TPIF urethroplasty for the repair of proximal hypospadias with moderate-to-severe chordee between August 2015 and December 2019 were evaluated retrospectively. Patients were divided into two groups: one-stage TPIF urethroplasty group (n = 44) and staged TPIF urethroplasty group (n = 48). We noted and compared the postoperative complications, including urethrocutaneous fistula, urethral diverticula, residual penile curvature, and urethral stricture in both groups. Results Both groups were followed up for 1–5 years, with an average of 3 years. No cases of residual or recurrence of penile chordee were reported in either group. In Group A, 9 patients (9/44, 20.4%) had postoperative urethrocutaneous fistula, and all patients underwent urinary fistula repair or urethroplasty. In Group B, postoperative urethrocutaneous fistula occurred in 2 cases (2/48, 4.1%), and one patient developed a urethrocutaneous fistula after the first operation, which was successfully repaired during the second operation. A urethrocutaneous fistula occurred in 1 case after completion of the second-stage operation; urethral fistula repair was performed successfully 6 months later. There were 2 cases of urethral stricture in Group A (2/44, 4.5%) and none in Group B. There were 6 cases of urethral diverticulum in Group A (6/44, 13.6%) and no cases of urethral diverticulum in Group B. The operative success rates were 61.3% and 95.8% in Group A and Group B, respectively (P < 0.001). Conclusions Compared with one-stage TPIF urethroplasty, staged TPIF urethroplasty in the treatment of certain cases of primary proximal hypospadias with moderate-to-severe chordee resulted in fewer postoperative fistulas, urethral strictures and urethral diverticula. The staged TPIF urethroplasty procedure was effective in reducing the operation difficulty and complication rate of hypospadias, improving the curative effect of complex hypospadias and having good clinical application value.

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

“…Lin et al compared the single-stage TPIFU and two-stage TPIFU for primary proximal hypospadias with moderatetosevere chordee with nine patients (9/44, 20.4%) had urethrocutaneous stula in single-stage TPIFU, two patients (2/48, 4.1%) in two-stage TPIFU. They also found two-stage TPIFU resulted in fewer postoperative urethral strictures and diverticulum [22]. Compared with the single-stage group, the two-stage group showed a signi cantly lower incidence of urethrocutaneous stula, which could be attributed to the following factors: the postoperative urethral secretions can be drained from openings at both ends of the penis without any retention in the new urethra, and drainage of urine from the penile stula could reduce the stimulation of urine owing into the new urethra in the glans and the coronal sulcus, inducing better healing of the distal neourethra and a lower incidence of urethrocutaneous stula.…”

“…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.…”

“…The overall complication rate was only 7.1%, with two patients developing a stula and one with a diverticulum requiring a secondary procedure. Twostage TPIFU have been reported constantly since then, with complication rates of 4.2%-14.7% [21,22].…”

Genotype–phenotype correlations, surgical selections, and postoperative complications of 5α-reductase 2 deficiency in 69 children with hypospadias

“…Lin et al . 22 compared one-stage TPIF urethroplasty with staged TPIF and found that the staged TPIF postoperative complication rate of fistula, strictures, and diverticula was much lower than that of one-stage TPIF.…”

Grafts vs. flaps: a comparative study of Bracka repair and staged transverse preputial island flap urethroplasty for proximal hypospadias with severe ventral curvature

“…Staged transverse preputial island flap urethroplasty (STPIF), first reported by Chen et al, is a newly adapted method using flaps based on the traditional transverse preputial island flap (TPIF) ( 10 ). STPIF has been shown to reduce the difficulty of surgery and the complication rate in proximal hypospadias treatment ( 11 ). Thus, both Bracka repair and STPIF are noteworthy 2-stage methods, and both have achieved encouraging results in the cure of hypospadias using grafts and flaps, respectively.…”