Objective To critically evaluate inner preputial graft (IPG) used in staged proximal hypospadias with severe chordee regard- ing cosmetic and functional outcomes.
Patientsandmethods Inthisprospectivestudy,patientswithprimaryproximalhypospadiaswithmoderatetoseverechordee (> 30°) after penile degloving were considered candidates for staged repair between June 2011 to July 2017. After transec- tion of the urethral plate (UP) and penile straightening, the bare shaft was covered with IPG. Tubularization of the graft was done as a second stage. Cosmetic and functional outcomes were assessed using HOSE score and uroflowmetry (UF). Additionally, factors influencing success were analyzed.
Results In all, 38 consecutive cases were included. Native meatus was at proximal penile in 17, penoscrotal in 11, scrotal in 7, and perineal in 3 cases. Median age was 26 and 32 months at the first stage and the second stage, respectively. Preoperative testosterone was given for ten patients with a small penis and/or severe curvature. The mean follow-up was 18 ± 8.2, median 15 months. Grafts took well in all cases after the first stage except one. Cosmetic success achieved in 33 (86.8%). A total of ten complications occurred in six cases. Unplanned intervention was needed in 5/38 cases. Functionally, UF study revealed normal flow in 7/23 (30.4%), equivocal in 11/23(47.8%), and obstructed flow in 5/23(21.7%).
Conclusion Inner preputial graft use in proximal hypospadias with moderate to severe chordee seems to have a good techni- cal outcome and functionally mimic the normal urethral function and could be considered an ideal option for substitution urethroplasty.
Keywords Hypospadias · Proximal · Severe chordee · Graft · Outcome