Outcome of Proximal Hypospadias Repair in Children using Standard Surgical Technique with Intermediate Vascularised Flap- A Retrospective Cohort Study

Abstract

Introduction: Hypospadias is a very common congenital anomaly noted in children with reported incidence of 0.4-8.2% in 1000 live birth. Treatment of hypospadias is urethroplasty, but is a difficult procedure due to complex anatomy, nonavailability of adequate tissue for repair, prolonged postoperative course and increased incidence of complications even in experienced hands. Aim: To highlight the complications and functional outcome of various types of proximal hypospadias using standard surgical technique with intermediate vascularised flap. Materials and Methods: This was a retrospective cohort study conducted from on 31 children, between the age of 2-13 years from June 2020 to August 2020. The children had proximal hypospadias with or without chordee were operated using primary procedure Tubularised Incised Plate (TIP) and staged procedure with cover of intermediate vascularised flap. These children had peno-scrotal, proximal, mid and distal penile hypospadias with meatus placed 1.5 cm proximal from the glans tip. In all cases, an intermediate layer of vascularised flap was put to cover the neourethra. Tunica vaginalis flap was used in 27 cases and dartos flap in 4 cases. The outcomes of surgical procedure, early and late complications with follow-up results were analysed using descriptive statistics of frequency and percentage. Final functional results of the procedures and cosmesis were observed during a two-year follow-up period. Results: Out of the 31 patients, 27 patients had urethroplasty (20 staged procedures and seven TIP) with tunica vaginalis as intermediate layer. Another four patients had TIP urethroplasty with dartos as intermediate layer. Four patients of tunica vaginalis as intermediate layer had early urethrocutaneous fistula (14.8%), one patient (3.7%) required closure of fistula and another three closed spontaneously. Two patients had meatal stenosis (7.4%) and four had slight pulled up ipsilateral testis (14.8%). One patient of TIP urethroplasty with dartos as intermediate layer was reoperated for late urethrocutaneos fistula at corona glandis (25%). Conclusion: The outcome of pediatric urethroplasty was favourable with routine use of intermediate vascularised flap in proximal hypospadias repair.

Keywords

• chordee
• neourethra
• urethrocutaneous fistula
• vascularised flap