COMPARISON OF ONLAY AND TUBULARIZED ISLAND FLAPS OF INNER PREPUTIAL SKIN FOR THE REPAIR OF PROXIMAL HYPOSPADIAS

Purpose: Transverse island flaps of inner preputial skin have provided a reliable technique for the repair of proximal hypospadias. The flap may be used to create a neourethra by tubularizing the nap after uret hral transection or applying the flap as an onlay patch onto an intact urethral plate. We retrospectively analyzed our experience with these 2 techniques to compare outcomes. Materials and Methods: During II ye ars 132 patients underwent hypospadias repair by a single surgeon usin g an onlay (58) or tubularized (74) island flap technique. Surgical re sults were reviewed retrospectively. Results: At a mean followup of 20 .3 months the overall complication rate was 36% for tubularized and 31 % for onlay repair, and fistula rates were 14 and 17%, respectively. D espite similar fistula rates tubularized repairs tended to have larger fistulas that required more complex repair (p = 0.0147). In 9 patient s who underwent tubularized repair diverticula developed, whereas no d iverticula developed after onlay repair (p = 0.0162). The rates of ure thral stricture, wound infection, residual chordee and cosmetic compli cations were not statistically significantly different between repairs , The use of double faced repair in 30 patients provided no difference in outcome in comparison to the overall study cohort. Conclusions: Hy pospadias repair using transverse island flaps offers reliable and dur able outcomes. While overall complication rates were not greatly diffe rent between tubularized and onlay flap repairs, onlay repair tended t o result in fistulas of smaller size and diverticula did not develop.