ABSTRACT
Objective: This study was carried out to evaluate the cosmetic and functional results of this new technique for repair of hypospadias. Patients and technique: 28 patients (2-22 years) with distal penile hypospadias were included in the study. Eleven of them had had a failed previous repair. An unhealthy urethral plate and/or thin ventral penile skin were found in 17 patients. The technique follows the steps of the island onlay preputial flap or dorsal penile fasciocutanous flap except in that the length of the flap is; at least; 1 cm longer than the length of the urethral plate. The proximal part of the flap is used for urethral reconstruction. The distal free part of the flap is reflected back to be sutured to the edges of the glanular wings and the penile skin. The urethral stent is removed after 5 days. The patients were followed monthly up to 6 months. Results: In 26 patients an excellent cosmetic appearance of both the penile shaft and glans was achieved with a slit-like or elliptic neo-meatus resulting in a good urine stream satisfying both the patients and their parents. Partial disruption of one side of the suture line and urethrocutanous fistula was reported in one patient each. These two complications were corrected surgically with good results. Conclusion: We conclude that this new technique that we named distally folded onlay flap is easy and versatile with excellent cosmetic and functional results and a low rate of complications when used for the repair of distal and mid-shaft hypospadias in either virgin or redo cases. It should also be considered as a salvage procedure when other techniques are no feasible options