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Urogenital Reconstruction, Penile Hypospadias: Follow-up

Author: Fabio Santanelli, MD, PhD, Associate Professor of Plastic Surgery, University of Rome; Chief of Unita Operativa Dipartimentale di Chirurgia Plastica, Azienda Ospedaliera, Sant'Andrea, Rome
Coauthor(s): Francesca Romana Grippaudo, MD, Assistant Professor, Unit of Plastic Surgery, 2nd Medical Faculty, Sapienza University of Rome, Italy
Contributor Information and Disclosures

Updated: Jun 30, 2008

Outcome and Prognosis

Functional results obtained with one-stage correction of hypospadias in terms of overall success rate, incidence of fistulas or stenosis, and mean hospitalization time have proved to be superior than those obtained with multistage procedures, and the prognosis is good.

The use of a well-nourished and innervated flap with a long and pliable pedicle is the reason for the high success rate reported in the literature when using one-stage reconstruction.

Glanuloplasty and residual preputial trimming are always associated with urethral repair and allow the reconstruction of a cosmetically acceptable glans with a neomeatus at the tip, closed during intercourse, and with a final appearance close to a normal circumcised penis.

The different techniques of preputial flap (Duckett, Standoli, Scuderi, Koyanagi) allow good functional results in primary hypospadias or in physically disabled patients where prepuce is no longer available and the flap can be harvested from the dorsal preputial skin.5,7,8,6

Future and Controversies

Several problems are related to the older multistage techniques. Repeated surgery, high percentage of fistulas and strictures of the urethra, extensive scarring, and the presence of hairs in the neo-urethra were the most frequent complaints.

One-stage hypospadias repairs offer the advantages of a single procedure using unscarred tissue performed when the patient is younger than school age.

 


More on Urogenital Reconstruction, Penile Hypospadias

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Follow-up: Urogenital Reconstruction, Penile Hypospadias
Multimedia: Urogenital Reconstruction, Penile Hypospadias
References
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References

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  4. Toksu E. Hypospadias: one-stage repair. Plast Reconstr Surg. Apr 1970;45(4):365-9. [Medline].

  5. Duckett JW Jr. Transverse preputial island flap technique for repair of severe hypospadias. Urol Clin North Am. Jun 1980;7(2):423-30. [Medline].

  6. Koyanagi T, Nonomura K, Kakizaki H, et al. Experience with one-stage repair of severe proximal hypospadias: operative technique and results. Eur Urol. 1993;24(1):106-10. [Medline].

  7. Standoli L. Vascularized urethroplasty flaps. The use of vascularized flaps of preputial and penopreputial skin for urethral reconstruction in hypospadias. Clin Plast Surg. Jul 1988;15(3):355-70. [Medline].

  8. Scuderi N, Campus GV. A new technique for hypospadias one-stage repair. Chir Plast. 1983;7:103-109.

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  14. Duckett JW. MAGPI (meatoplasty and glanuloplasty): a procedure for subcoronal hypospadias. Urol Clin North Am. Oct 1981;8(3):513-9. [Medline].

  15. Ghali AM, el-Malik EM, al-Malki T, et al. One-stage hypospadias repair. Experience with 544 cases. Eur Urol. Nov 1999;36(5):436-42. [Medline].

  16. Hayashi Y, Kojima Y, Mizuno K, et al. The modified Koyanagi repair for severe proximal hypospadias. BJU Int. Feb 2001;87(3):235-8. [Medline].

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  19. Santanelli F. Distally based turnover flap and preputium plasty for distal hypospadias repair: a preliminary report. Ann Plast Surg. Nov 1992;29(5):413-6. [Medline].

  20. Santanelli F. Vertical preputial flap with double skin island for correction of hypospadias with severe recurvatum. Ann Plast Surg. Sep 1994;33(3):305-12. [Medline].

  21. Santanelli F, D'Andrea F, Savanelli A, et al. Reconstruction of hypospadias with a vertical preputial island flap. A follow-up study of 127 patients. Scand J Plast Reconstr Surg Hand Surg. 1990;24(1):67-73. [Medline].

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Further Reading

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Keywords

hypospadias repair, urogenital reconstruction, penile hypospadias, penile reconstruction, urethroplasty, hypospadias, epispadias, bifid clitoris, bladder exstrophy, hidden penis, penile curvature, urethral hypoplasia, urethra reconstruction, urethra repair, urethral repair, urethra surgery, hypospadias malformation

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Contributor Information and Disclosures

Author

Fabio Santanelli, MD, PhD, Associate Professor of Plastic Surgery, University of Rome; Chief of Unita Operativa Dipartimentale di Chirurgia Plastica, Azienda Ospedaliera, Sant'Andrea, Rome
Fabio Santanelli, MD, PhD is a member of the following medical societies: American Society of Plastic and Reconstructive Surgery, European Association of Plastic Surgeons, and International Confederation for Plastic and Reconstructive Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Francesca Romana Grippaudo, MD, Assistant Professor, Unit of Plastic Surgery, 2nd Medical Faculty, Sapienza University of Rome, Italy
Francesca Romana Grippaudo, MD is a member of the following medical societies: International Confederation for Plastic and Reconstructive Surgery
Disclosure: Nothing to disclose.

Medical Editor

Dennis P Orgill, MD, PhD, Associate Professor, Harvard Medical School; Director, Burn Center, Brigham and Women's Hospital
Dennis P Orgill, MD, PhD is a member of the following medical societies: American Burn Association, American Medical Association, American Society for Reconstructive Microsurgery, Massachusetts Medical Society, and Plastic Surgery Research Council
Disclosure: Kinetic Concepts, Inc. Grant/research funds Principle Investigator; Marine Polymers  Grant/research funds Principle Investigator; Naval Blood Research Lab Grant/research funds Principle Investigator

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

 
 
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