Reoperation Frequency after Transverse Preputial Island Flap Urethroplasty in Treating of Severe Hypospadias: A Single Center Study

Abstract Background: Considering the continuing debate on the best technique to treat serve hypospadias, the reoperation frequency after Transverse Preputial Island Flap Urethroplasty (TPIFU) is lacking. In the present study, we reported our clinical outcomes of severe hypospadias treated with one-staged TPIFU and analyzed the operation frequency. Methods: We retrospectively analyzed the clinical data of severe hypospadias patients who underwent one-stage TPIFU from December 2018 to December 2019. A stepwise approach was used to manage the curvature. Severe hypospadias was defined as the residual curvature was > 30° after degloving. Urethroplasty complications included fistula, urethral stricture, and diverticulum. The short-term cure was identified as no complications occurring for 12 months after the date of last-time surgery. The reoperation rate and operation frequency of TPIFU were analyzed. Results: A total of 136 patients who underwent one-stage TPIFU were included in the study. The follow-up after primary urethroplasty ranged from 22 to 50 months. The median age at primary surgery was 22.5 months (range from 13 to 132 months). After primary TPIFU surgery, 53(39%) patients accepted reoperation handling with complications. Among them, 24 patients (17.6%) developed fistula, 17 patients (12.5%) developed urethral stricture and 11 patients (8.1%) developed diverticulum. After the second surgery, 5/17 patients remained fistula, 5/17 patients remained urethral stricture, and 7/17 patients remained diverticulum. Overall, 61% (85 patients) met the cured standard after the primary operation, and the two operations cure rate was 87.5% (119 patients). 91.2% (124 patients) were cured in three operations.Conclusions: The present study provides a novel perspective to evaluate the surgery technique through the surgery number to cure the patients, rather than simply comparing the complication rate. Our result demonstrated that the complication rates of primary TPIFU were relatively high, but the cure rate after two or three operations was acceptable.