Repair of hypospadias with severe chordee using a long, wide, U-shaped flap that preserves ventral penile tissues intact for second-stage urethroplasty.
OBJECTIVE
The aim of the study was to report a new technique for repairing hypospadias with severe chordee (HSC).


METHODS
Our new technique involves making a long, wide, U-shaped incision on the ventral penis from the coronal sulcus to very distal to the meatus and dissecting to create a flap (U-flap). During dissection, the urethra is divided just proximal to the meatus. After release of chordee, the U-flap is returned to the ventral penile shaft and sutured in place. A buttonhole made distally in the U-flap is anastomosed to the cut end of the urethra to create a neomeatus. Snodgrass urethroplasty is performed 6 to 18 months later. We have treated 11 patients with HSC (mean age, 22.3 months) using this technique.


RESULTS
Postoperatively, all U-flaps were viable. The neomeatus appeared to be more proximal because the penis was straighter. Urethroplasty using the central part of the U-flap was uncomplicated by scar tissue and successful in all cases. After a mean follow-up of 15.7 months, all patients have satisfactory penises without stenosis or diverticulum, although 1 had fistula.


CONCLUSIONS
Our U-flap technique allows the ventral penis to be preserved intact without scarring for second-stage urethroplasty and as a result is well suited for treating HSC.
Yamataka
Atsuyuki
A
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo 113-8421, Japan. yama@med.juntendo.ac.jp
Shimotakahara
Akihiro
A
Miyano
Go
G
Hayashi
Yutaka
Y
Takahashi
Tsubasa
T
Lane
Geoffrey J
GJ
Kawashima
Kazunari
K
Okawada
Manabu
M
D002675:Child, Preschool; D002921:Cicatrix / Q000517:prevention & control; D006801:Humans; D007021:Hypospadias / Q000150:complications / Q000601:surgery*; D007223:Infant; D008297:Male; D010413:Penis / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D014521:Urethra / Q000601:surgery*