title: Repair of hypospadias with severe chordee using a long, wide, U-shaped flap that preserves ventral penile tissues intact for second-stage urethroplasty.
abstract: 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.
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo 113-8421, Japan. yama@med.juntendo.ac.jp
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
authors.forename: Akihiro
authors.initials: A
authors.lastname: Shimotakahara
authors.forename: Go
authors.initials: G
authors.lastname: Miyano
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Tsubasa
authors.initials: T
authors.lastname: Takahashi
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Kazunari
authors.initials: K
authors.lastname: Kawashima
authors.forename: Manabu
authors.initials: M
authors.lastname: Okawada
mesh_terms: 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*