[One-stage urethroplasty with circumferential vascular pedicle preputial island flap for perineal hypospadias].

OBJECTIVE

To report the treatment of perineal hypospadias with one-stage urethroplasty with circumferential vascular pedicle preputial island flap.

METHODS

A circumferential incision was made proximal to the corona and the urethral plate to correct chordee. A U-shaped skin incision was then made surrounding the meatus, and extended to the dorsal prepuce and parallel to the first incision. The tissue between the prepuce and dartos was dissected on the dorsum of penis to fix the prepuce as a neo urethra. After mobilizing the loop shaped skin flap through the button-hole of the pedicle, the internal and external sides of the loop were sutured to construct a new urethra. The catheter was removed 10-14 days (mean, 12.8 days) after operation.

RESULTS

Since 1997, 22 patients with perineal hypospadias were treated. Primary healing was achieved in 18 cases (81.8%). Fistula happened in 4 patients. Among them, one case with meatal stenosis was treated with dilatation. Another 3 patients were reoperated. The neo urethral flap was 3.50-18.00 cm (mean, 9.43 cm) in length. All patients were followed up for more than 6 months. Good cosmetic appearance was achieved in 72.7% (16/22) of the patients.

CONCLUSIONS

The circumferential vascular pedicle preputial island flap has advantages of good blood supply and autograft for new meatus, which allows the chordee correction and urethroplasty at one stage. It is a good method for the treatment of perineal hypospadias with severe chordee and penoscrotal transposition.