Dual Urethral plate substitution in staged hypospadias repair: flap for the shaft and graft for the glans | ||||
| Annals of Pediatric Surgery | ||||
| Volume 20, Issue 20, 2024 PDF (1.22 MB) | ||||
| Document Type: Case Reports | ||||
| DOI: 10.21608/apsj.2024.255344.1048 | ||||
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| Author | ||||
Amr Abdelhamid AbouZeid  
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| Faculty of medicine, Ain Shams University | ||||
| Abstract | ||||
| Background: Regarding proximal hypospadias, there is worldwide trend back to two-stage repairs that involve transection of the urethral plate to prevent recurrence of chordee. However, there is an ongoing debate on the best urethral substitute: flaps versus grafts. Case presentation: We present two primary cases of penoscrotal hypospadias who underwent two-stage repair while applying a modification of combined urethral plate substitution (flap + graft) during the first stage of repair. Skin flaps with its reliable blood supply provides a secure coverage for the penile shaft, while the thinner inner preputial graft is more suitable for the glans. The first boy was 42-month-old, while the second was 14-month-old at time of the first stage. Both cases had a straight penis with no residual chordee at follow up (6 months). Both were urinating freely (with no strictures) through a distal meatus. The site of the meatus was glanular in the first case, while it was distal penile (sub-coronal) in the second case. Conclusion: The technique described in this report does not represent significant deviation from the standard/current practice for performing two-stage repair. Revisiting the buttonholing technique to re-cover the ventral shaft provides a smooth urethral plate for tubularization at second stage avoiding midline scars of the more popular Byars technique. Concomitant grafting of the under-surface of the glans represents the main modification to the standard flap technique aiming to facilitate glanular closure at the second stage. | ||||
| Keywords | ||||
| two-stage repair; proximal hypospadias; flaps; grafts; penoscrotal | ||||
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