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Hypospadias repair by skin flaps: a comparison of onlay preputial island flaps with either Mathieu’s meatal‐based or Duckett’s tubularized preputial flaps
Author(s) -
A. Ghali
Publication year - 1999
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1046/j.1464-410x.1999.00083.x
Subject(s) - preputial gland , hypospadias , medicine , surgery
Objectives To evaluate the success of different skin flaps in the one‐stage correction of primary hypospadias, with particular emphasis on comparing onlay preputial island flaps with Mathieu’s meatal‐based and Duckett’s preputial tubularized flaps. Patients and methods During a 12‐year period, 418 patients underwent single‐stage primary hypospadias repair using skin flaps, carried out by one surgeon. The surgical techniques used included Mathieu’s repair in 216 (52%), Duckett’s in 148 (35%), onlay preputial flaps in 42 (10%) and the Mustarde flap procedure in 12 (3%). The surgical results were reviewed, assessing complications and the functional and cosmetic outcome. Results At a mean follow‐up of 23 months the initial overall complication rate for flap procedures was 22%; however, after a mean of 1.4 procedures, the final success rate was 95%. The complication rate was significantly ( P <0.05) higher in patients with a proximal urethral meatus, with severe chordee or in repairs involving transection of the urethral plate. However, the complication rates were not significantly different when the patients underwent repair when aged <2 years or >2 years. Despite no significant difference in overall complication rates, onlay procedures tended to be used in more severe hypospadias than was Mathieu’s repair. Duckett’s repair caused a significantly higher overall complication rate as fistulae, strictures, meatal stenoses and tubular abnormalities than did onlay procedures. The use of double‐faced preputial island flaps resulted in an inferior cosmetic appearance than the use of single‐faced flaps, but the overall complication rates did not differ significantly between these techniques. Conclusions Hypospadias repair using skin flaps offered a reliable and durable outcome. However, complication rates were greater in patients with severe hypospadias and with techniques requiring transection of the urethral plate. The onlay preputial island‐flap technique was more widely applicable than was Mathieu’s repair and had a lower complication rate than Duckett’s procedure.