Modified double face onlay island preputial skin flap with augmented glanuloplasty for hypospadias repair.

OBJECTIVE To present and evaluate our initial results with a modified double face onlay preputial flap (DOPF) for repair of different degrees of hypospadias. MATERIAL AND METHODS From April 2004 to April 2009, 182 patients with different degrees of hypospadias (distal penile hypospadias = 122, mid penile hypospadias = 38, proximal penile hypospadias = 22) were included in our study. All patients were treated with a modified DOPF. Their age ranged from 6 months to 10 years (mean 3.03 years). Selection criteria were those cases with urethral plate<8 mm with either flat or conical glans, and non-circumcised patients. The technique of repair was to use the distally tapered inner preputial mucosa as onlay to augment the narrow urethral plate, while the outer face was tapered distally to augment the closed proximal part of the glanular wings and as skin cover. Suitable urethral catheter was inserted for 3-5 days. Follow-up duration was 27-30 months (mean 24 months). RESULTS Functional and cosmetic success was reported in 176 patients (96.6%). Six patients (3.29%) had developed complications that affected the success rate: 1 (0.5%) glanular disruption, 2 (1.09%) fistula, 1 (0.5%) urethral diverticulum and 2 (1.09%) lateral penile torsion. Three (1.6%) patients had developed minor complications with no effect on functional and cosmetic success in form of superficial epidermal loss. CONCLUSION Modified DOPF is a suitable technique for repair of different types of hypospadias as it results in satisfactory functioning and an acceptable cosmetic appearance.