One-stage repair of proximal hypospadias with severe chordee by in situ tubularization of the transverse preputial island flap: Beyond the Abstract

Although more pediatric urologists prefer staged repair for proximal hypospadias with severe chordee right now, we still stick to one stage repair by transverse preputial island flap initially reported by Dr. Duckett. We believe this will benefit children and their families with less surgery and anaesthesia, less cost and shortened waiting time.

During our practice, we realized the vascularization is one of the most important factors to prevent the complications especially the urethral stricture. Thus, we made some modification in our Duckett approach initially by making spatulated anastomoses on both ends of flap with native meatus proximally and glanular urethral plate distally. This was a very efficient strategy. Since then, we hardly have had urethral stricture on both anastomoses except a few strictures inside the neourethra. In the re-operated cases, the stricture appeared along the dorsal wall of the neourethra where the suture line of the tubularized flap was placed against the tunica albuginea of the corpora cavernosa. We assumed this was possibly due to the less vascularization of both the sutured tissue and the tunica albuginea. An inversion of the flap in order to transfer the suture line ventrally and wrap it with the well-vascularized flap pedicle may solve this problem. In our series of 32 patients, the short term outcome was satisfactory. The occurrence of the urethral stricture decreased without increasing urethrocutaneous fistulae. 

At last we can understand the Duckett’s procedure is a highly experience-demanding maneuver with a long learning curve. We hope this publication would arouse the enthusiasm for it again in hypospadias repair, and hope more attention would be paid on vascularization of neo-urethera and its relation with stricture. 

Written By: Fang Chen, M.D., Ph.D, Shanghai Children's Hospital

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