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DOI: 10.4103/0970-0358.105963
The forked flap repair for hypospadias
Publikationsverlauf
Publikationsdatum:
21. November 2019 (online)
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ABSTRACT
Context: Despite the abundance of techniques for the repair of Hypospadias, its problems still persist and a satisfactory design to correct the penile curvature with the formation of neourethra from the native urethral tissue or genital or extragenital tissues, with minimal postoperative complications has yet to evolve. Aim: Persisting with such an endeavor, a new technique for the repair of distal and midpenile hypospadias is described. Materials and Methods: The study has been done in 70 cases over the past 11 years. The "Forked-Flap" repair is a single stage method for the repair of such Hypospadias with chordee. It takes advantage of the rich vascular communication at the corona and capitalizes on the established reliability of the meatal based flip-flap. The repair achieves straightening of the curvature of the penis by complete excision of chordee tissue from the ventral surface of the penis beneath the urethral plate. The urethra is reconstructed using the native plate with forked flap extensions and genital tissue relying on the concept of meatal based flaps. Water proofing by dartos tissue and reinforcement by Nesbit′s prepucial tissue transfer completes the one stage procedure. Statistical Analysis: An analysis of 70 cases of this single stage technique of repair of penile hypospadias with chordee, operated at 3 to 5 years of age over the past 11 years is presented. Results and Conclusion: The Forked Flap gives comparable and replicable results; except for a urethrocutaneous fistula rate of 4% no other complications were observed.
- 1 Baskin LS, Duckett JW. Dorsal tunica albuginea plication for hypospadias curvature. J Urol 1994;151:1668-71.
- 2 Nesbit RM. Operation for correction of distal penile ventral curvature with or without hypospadias. J Urol 1967;97:720-2.
- 3 Cheng EY, Kropp BP, Pope JC 4 th , Brock JW 3 rd . Proximal division of the urethral plate in staged hypospadias repair. J Urol 2003;170:1580-3.
- 4 Caesar RE, Caldamone AA. The use of free grafts for correcting penile chordee. J Urol 2000;164:1691-3.
- 5 Snodgrass WT. Re: Skin graft for 2-stage treatment of severe hypospadias: Back to the future? J Urol 2003;170:193-4.
- 6 Mustarde JC. Reconstruction of anterior urethra in hypospadias by buried skin strip method; a simplified and improved technique. Br J Plast Surg 1954;7:166-74.
- 7 Cheng EY, Vemulapalli SN, Kropp BP, Pope JC 4 th , Furness PD 3 rd , Kaplan WE, et al. Snodgrass hypospadias repair with vascularized dartos flap: The perfect repair for virgin cases of hypospadias? J Urol 2002;168:1723-6.
- 8 Rushton HG, Belman AB. The split prepuce in situ onlay hypospadias repair. J Urol 1998;160:1134-6.
- 9 Asopa HS. Newer concepts in the management of hypospadias and its complications. Ann R Coll Surg Engl 1998;80:161-8.
- 10 Devine CJ Jr, Horton CE. A one stage hypospadias repair. J Urol 1961;85:166-72.
- 11 Hodgson NB. A one-stage hypospadias repair. J Urol 1970;104:281-3.
- 12 Duckett JW Jr. Transverse preputial island flap technique for repair of severe hypospadias. Urol Clin North Am 1980;7:423-30.
- 13 Furness PD 3 rd , Hutcheson J. Successful hypospadias repair with ventral based vascular dartos pedicle for urethral coverage. J Urol 2003;169:1825-7.
- 14 Baskin LS, Duckett JW, Ueoka K, Seibold J, Snyder HM 3 rd . Changing concepts of hypospadias curvature lead to more onlay island flap procedures. J Urol 1994;151:191-6.
- 15 Jayanthi VR. The modified Snodgrass hypospadias repair: Reducing the risk of fistula and meatal stenosis. J Urol 2003;170:1603-5.
- 16 Snodgrass W, Koyle M, Manzoni G, Hurwitz R, Caldamone A, Ehrlich R. Tubularized incised plate hypospadias repair: Results of a multicenter experience. J Urol 1996;156:839-41.