Y-to-I wrap: Use of the distal spongiosum for hypospadias repair

Purpose: Rather than resecting the distal spongiosum lateral to the open ur ethra for hypospadias, we mobilized this tissue with the urethral plate awa y from the corpora cavernosa, subsequently wrapping it around various types of urethroplasty to prevent fistula formation. Materials and Methods: The distal spongiosum was preserved and used for cov erage in 25 hypospadias repairs in I year. We initially applied it in this manner when the distal spongiosum persisted as a pillar of healthy erectile tissue but later when the distal tissue appeared more fibrous in nature. T he wrap was used to cover various types of urethroplasty, including advance ment in 6 cases, tubularization in 10, flip-flap repair in 6 and an island onlay pedicle graft, in 3. Results: All patients have at least 1 year of followup. There has been no f istula formation or residual chordee. In 1 patient minor meatal retraction did not require a secondary procedure. Cosmetic results have been good. Conclusions: A distal wrap of corpus spongiosum may be used res avoid fistu la formation without causing residual or recurrent curvature. It re-creates a nearly normal urethra in some cases.