Hypospadias repair using skin flaps: analysis of 50 cases

ABSTRACT

To analyze the outcome of primary one-stage hypospadias repair using skin flaps [Mathieu, Onlay, Duckett] with particular reference to technique and current related literature. The study comprised 50 patients who underwent primary skin flap hypospadias repair with at least one year follow-up. All were operated by the authors and in the same institution during the period form 1995-2002. Their medical records were retrospectively reviewed for age, type or hypospadias, and nature of skin flap. Main related morbidity and success are reported after an average follow-up of 28.3 months. Reference to technique was also made. Majority of patients were between 2 and 4 years of age. 70% of them had distal anomaly with a mild degree of chordee. 23, 19 and 8 underwent Mathieu's Onlay's and Duckett's repair, respectively. 24% were circumcised at the time of surgery. Overall morbidity was noted in 16 patients [32%]. The commonest complications were meatal stenosis [14%] and fistula [8%]. Comparable morbidity was noted in both Mathieu's [17.4%] and Onlay's [15.8%] flaps. Unacceptable complication rate was associated with Duckett's tabularized skin flap repair. The overall success rate was markedly improved after the year 1998 with a rise from 80% at a mean of 1.22 procedures to 93.1% at a mean of 1.07 procedures. Our outcome data compared well with the literature except for Duckett's form of repair. Skin flaps have an established and valuable place in hyposadias repair. Meatus-based and onlay flaps have fairly better outcome than both grafts and tabularized flaps. Attention to technique, selection, auditing and experience are keys to better anatomical, functional and cosmetic results: