Further experience with the double onlay preputial flap for hypospadias repair

Purpose: Severe hypospadias can be safely and reliably repaired in 1 stage using island flaps of preputial skin. However, problems with conventional t echniques include penile asymmetry resulting from rotation of the vascular pedicle around 1 side of the penile shaft and at times doubtful viability o f the Byars flaps used for ventral skin coverage. We describe how some of t hese problems can be resolved using the double onlay preputial flap for hyp ospadias repair. Materials and Methods: We reviewed the records of 47 children who underwent I-stage double onlay preputial nap hypospadias repair at our institution b etween June 1994 and July 1998. Patient age ranged from 6 months to 9 years (mean 12.2 months). The urethral meatus was at the midshaft in 12 patients (25%), penoscrotal in 30 (64%) and perineal in 5 (11%). Chordee repair req uired dorsal plication in 29 patients, 7 of whom required an additional ven tral incision of the tunica albuginea and tunics vaginalis autograft with p reservation of the urethral plate to complete the repair. Scrotal transposi tion and bifid scrotum were repaired at the time of hypospadias repair in 9 patients. Results: Followup was 3 to 47 months (mean 15.2 months). Complications requ iring reoperation occurred in 12 patients (25%). In 8 (17%) boys a fistula developed, of whom 6 had perineal and 2 had penoscrotal hypospadias. Fistul a closure was required in all patients. Successful closure was achieved wit h 1 procedure in 6 patients, required an additional fistula repair in 1 and remains to be determined in I. Diverticula, meatal recession and persisten t penile curvature requiring repeat dorsal plication occurred in 4 (9%), 2 (4%) and 2 (4%) patients, respectively. Revision for a bulky ventral skin s trip was required in I boy (2%). All complications occurred in patients wit h the more proximal hypospadias. Conclusions: The double onlay preputial flap technique for hypospadias repa ir offers good cosmetic and functional results. Given the high incidence of penoscrotal and perineal hypospadias (75%) in our series complication rate s are comparable or better than those of other techniques.