Objective: To explore the application value of staged urethroplasty by tubularization of the reconstructed urethral plate using the preputial island flap in the treatment of severe hypospadias.
Methods: From May 2014 to February 2019, 91 children with severe hypospadias received one- or two-stage urethroplasty by tubularization of the reconstructed urethral plate with the preputial island flap. We compared the patients' age, glans diameter, length of the straightened urethral defect, and incidence rates of postoperative urethral fistula, urethral diverticulum, glans dehiscence and urethral stricture between the two groups of patients.
Results: The 56 patients in the one-stage group were aged 7－144 (21.92 ± 13.37) months old, the urethral defect 3－5 (3.565 ± 0.528) cm in length and the glans 1.0－1.4 (1.195 ± 0.083) cm in diameter, and the 35 in the two-stage group aged 7 －153 (24.78 ± 13.59) months, the urethral defect 3－5 (3.857 ± 0.696) cm in length and the glans 0.8－2.5 (1.206 ± 0.389) cm in diameter. There were no statistically significant differences in age, glans diameter and the length of urethral defect between the two groups. In the one-stage group were found 18 cases of postoperative urinary fistula, 1 case of glans dehiscence, 1 case of urethral diverticulum, and 1 case of both urethral diverticulum and glans dehiscence, all cured by repeated urinary fistula repair/urethroplasty. No urinary fistula occurred in the two-stage group postoperatively except 4 cases of glans dehiscence, of which 2 were cured by repeated repair and the other 2 refused reoperation. The success rate was significantly higher in the two-stage than in the one-stage urethroplasty group (88.57% vs 62.50%, P < 0.05).
Conclusions: Two-stage urethroplasty by tubularization of the reconstructed urethral plate with the preputial island flap can significantly reduce the incidence of urethral fistula in patients with severe hypospadias, but may increase the number of operations in those who do not need staged surgery. The necessity of two-stage urethroplasty can be determined according to the development of the glans, the degree of penile curvature, and the length of urethra defect.
Keywords: two-stage surgery; urethroplasty; hypospadias.