THE SPLIT PREPUCE IN-SITU ONLAY HYPOSPADIAS REPAIR

Purpose: We describe the surgical technique and report the results of the first 100 patients who underwent a modification of the onlay hypos padias repair, which we refer to as split prepuce in situ onlay repair . Materials and Methods: We treated 100 boys with a mean age of 11 mon ths at surgery who had coronal to mid shaft hypospadias with split pre puce in situ onlay hypospadias repair. The operative technique varies from that of the standard onlay procedure by preserving the whole bloo d supply of the half of the prepuce used for the island onlay flap, an d using its abundant subcutaneous tissue to cover completely the sutur e lines used to create the neourethra. Results: Only 5 complications r equired reoperation, including 1 hematoma evacuation and 4 urethrocuta neous fistulas. No patient had meatal stenosis, urethral stricture, me atal retraction or acquired urethral diverticulum necessitatiug reoper ation. A good cosmetic result was obtained in all cases. Conclusions: Split prepuce in situ onlay hypospadias repair is applicable in virtua lly all cases of coronal to mid shaft hypospadias. It optimizes the bl ood supply to the island flap and provides well vascularized coverage of the neourethra, resulting in a decreased complication rate.