AN INVESTIGATION INTO THE ROLE OF WATERPROOFING IN A 2-STAGE HYPOSPADIAS REPAIR

In our unit a two-stage procedure, using a full thickness preputial gr aft, has been adopted as the method of choice for the repair of hyposp adias proximal to the coronal sulcus. In 1993 an audit was undertaken to establish our complication rate for this procedure. Twenty-two cons ecutive patients who completed a two-stage repair between January 1988 and December 1993 were studied. An unacceptably high fistula rate was identified (63%, 14/22 cases). Consequently our technique was modifie d by transposing a vascularised flap of preputial areolar tissue over the urethral suture line, at the time of urethroplasty. A second group of 22 consecutive patients, operated upon between January 1994 and Ju ly 1997, were subsequently investigated and a dramatic improvement in the fistula rate was demonstrated (4.5%, 1/22 cases). These cases repr esent a subgroup of almost 200 cases, which the senior author has mana ged over the last 10 years. The senior author undertook or supervised the surgery in all 44 cases, which were the focus of this study, and t he introduction of a waterproofing layer represents the only change in technique.