Observational retrospective study on acquired megalourethra after primary proximal hypospadias repair and its recurrence after tapering.
BACKGROUND
Acquired megalourethra (AMU) after repair of proximal hypospadias can be a serious complication. An observational retrospective study of its incidence among different types of repair was performed.


METHODS
Clinical charts of patients operated on for proximal hypospadias were reviewed.


METHODS
all primary hypospadias operated in 1991-2004, with the meatus positioned in proximal penile, scrotal or perineal position.


RESULTS
Of 770 hypospadias cases treated, 130 (16%) were proximal. Seventy-two patients (55%) were treated using preputial flaps: 36 with a tubularized preputial island flap (TIF) and 36 an onlay island flap (OIF). Fifty-eight patients (45%) underwent staged repairs: Belt-Fuquà (BF) in 18 and Bracka procedure in 40 cases. After a mean follow up of 16 years (range 6-19) the overall incidence of complications for each technique was: TIF 36%; OIF 33%; BF 25%; two-stage Bracka 7.5%. The most common complication encountered was neo-urethral fistula. AMU occurred in only 5 cases, none with associated distal urethral stenosis, all in the TIF and OIF groups, and all successfully treated by reduction re-do urethroplasty.


CONCLUSIONS
A very small number of the patients operated using preputial island flaps techniques developed AMU. None of the staged repairs developed AMU, and this is the preferred choice in proximal hypospadias when the urethral plate requires division and/or substitution. All cases of AMU resolved after urethral tapering.
Pediatric Urology Unit, Ospedale Maggiore-Policlinico, Via della Commenda 10, 20122 Milan, Italy. santiago.vallasciani@gmail.com
S
S
Vallasciani
A
A
Berrettini
L
L
Nanni
G
G
Manzoni
G
G
Marrocco
D000293:Adolescent; D000328:Adult; D002648:Child; D004108:Dilatation, Pathologic; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D013524:Surgical Flaps; D014521:Urethra / Q000473:pathology*; D013520:Urologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D055815:Young Adult