Two-stage tubularized transverse preputial island flap and two-stage urethral plate reconstruction procedures in the treatment of severe hypospadias

Objective To compare the treatment efficacy of severe hypospadias between two-stage urethral plate reconstruction procedure and two-stage tubularized transverse preputial island flap procedure. Methods From 2010 December to 2014 December, we retrospectively analyzed 82 cases with severe hypospadias, using two-stage urethral plate reconstruction and two-stage tubularized transverse preputial island flap urethroplasty, respectively. Their mean age in the first operation was 2.4 years, ranged from 2 to 3 years. Hypospadias were penoscrotal type in 32 cases, perineal type in 50 cases. In group A, 42 cases, including penoscrotal type in 15 cases, perineal type in 27 cases, with urethral plate reconstruction procedure underwent two-stage urethroplasty. The transected ventral penile urethral plate and to strip the ventral fibrous tissue were needed in correction of chordee of penis. The patients in group A were underwent the second urethroplasty with urethral plate reconstruction procedure 6-12 months later. In group B, 40 cases, including penoscrotal type in 17 cases, perineal type in 23 cases, who underwent one stage operation in the correction of chordee of penis, only with tubularized preputial island flap forming the part of the urethra. The patients in group B were underwent the second urethroplasty 6 ~12 months later. Results Patients were followed up for 1 to 5 years, mean 3.5 years. No recurrence of penis chordee was noticed. In group A, 6 cases (14.3%) had postoperative fistula. The second fistula repairing was perform 6 to 12 months after the second stage operation. However, still 3 cases were noticed the fistula recurrence, which was cured after the fourth operation. In group B, 3 cases (7.5%) developed fistula, which appeared in the second urethroplasty (P<0.01). They were all treated after the second repairing procedure. In group A, 4 cases were noticed urethral stricture, the urethral stricture rate was 9.5%.The stricture occurred 1 to 3 months after the second operation. After dilation and indwelling catheter, 3 cases resolved the problem. Another case still found the recurrence after 2 months, which the one stage urethral plication and second urethral reconstruction were considered to treat this patient. In group B, 1 cases of urethral stricture, the urethral stricture rate was 2.5% (P<0.01). After dilation and indwelling catheter, this case resolved the problem. In group A, 3 cases had urethral diverticulum, which occurred at a rate of 7.1%, whereas without urethral diverticulum occurred in group B (P<0.01). Those patient with urethral diverticulum accepted the diverticulum removing procedure 3 to 6 months after the second stage procedure. One case was found the urethral fistula, which was treated one year later. The success rate of operation was 69.0% in group A, the success rate of the operation was 90.0% in group B. The difference of the success rate between two groups was statistically significant (P<0.01). Conclusions With respect to two-stage urethral plate reconstruction procedure in treatment of severe hypospadias, there were the low complication rates of postoperative urinary fistula, urethral stricture and diverticulum in two-stage tubularized transverse preputial island flap procedure. Urethral meatus could be done at the glans of the penis. In addition, the two-stage tubularized transverse preputial island flap procedure provides a good opportunity to practice to master complex hypospadias operation. Key words: Hypospadias; Two-stage procedure; Urethroplasty