The modified pyramid hypospadias procedure: repair of megameatus and deep glanular groove variants.
We present our experience with the pyramid hypospadias repair in 37 patients with distal or subcoronal hypospadias. We also describe a significant modification (in the 7 most recent patients) of Duckett's original procedure that minimizes the risk of ventral fistula formation. This modification involves the creation of a vascularized second-layer tissue flap. We incorporated the modified pyramid hypospadias repair into the general surgical approach to subcoronal hypospadias. Our operative approach permits the delayed selection of either a perimeatal-based flap, preputial flap or a modified pyramid type repair after release of the shaft skin. In 35 patients the repair achieved excellent results, while only 2 had urethrocutaneous fistulas. No patient who underwent the modified repair suffered fistula formation. Our surgical technique is applicable to a number of variants of subcoronal hypospadias and maximizes repair options.
Division of Urology, Children's Hospital Medical Center, University of Cincinnati, Ohio.
G A
GA
Hill
J
J
Wacksman
A G
AG
Lewis
C A
CA
Sheldon
D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D008297:Male; D010413:Penis / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D015607:Stents; D013524:Surgical Flaps / Q000379:methods*; D013536:Suture Techniques; D014521:Urethra / Q000601:surgery*