title: Preputioplasty associated with urethroplasty for correction of distal hypospadias: a prospective study and proposition of a new objective scoring system for evaluation of esthetic and functional outcome.
abstract: OBJECTIVE
  Most surgical procedures for correction of hypospadias involve the removal of foreskin resulting in a circumcised penis. We report our experience and the medium-term results in the reconstruction of the foreskin during the correction of distal hypospadias.
  
  
  METHODS
  Between January 2007 and December 2011, 445 patients aged between 8 and 120 months underwent surgical correction of hypospadias. In 354 out of 445 patients, we performed the reconstruction of the foreskin. Urethroplasty was performed according to either the TIPU (tubularized incised urethral plate urethroplasty; Snodgrass) technique (233/354, 66%) or MAGPI (meatal advancement glanduloplasty incorporated) procedure (121/354, 34%). In 91 out of 445 patients urethroplasty was performed using classic TIPU technique and they were circumcised. The cosmetic and functional results were evaluated using the Hypospadias Objective Penile Evaluation (HOPE) scoring system.
  
  
  RESULTS
  At a 12 months follow-up, 300 patients (84.7%) had retractable foreskin while 54 patients (15.3%) required postoperative steroid application. We had a total complication rate of 8.7%. As for preputioplasty, 16 patients (4.5%) had partial or total dehiscence of the reconstructed foreskin, one patient was circumcised for persistent phimosis (0.2%). As for urethroplasty complications, we recorded 11 fistulas (3.1%) and three stenosis (0.9%). The complication rate of the control group of circumcised patients was of 3.3% (2 fistulas [2.1%] and 1 stenosis [1.2%]).
  
  
  CONCLUSIONS
  Our experience shows that foreskin reconstruction can be performed successfully in selected patients with distal hypospadias. However, preputioplasty add an additional 4.7% complication rate. As for the complications of urethroplasty, it seems that preputioplasty does not increase the incidence of complications on the urethra reconstruction. We propose a new objective scoring system (modified HOPE score) for evaluation of esthetic and functional outcome.
authors.affiliation: Department of Pediatrics, Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy. Electronic address: ciroespo@unina.it.
authors.forename: Ciro
authors.initials: C
authors.lastname: Esposito
authors.affiliation: Department of Pediatrics, Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Savanelli
authors.affiliation: Department of Pediatrics, Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Escolino
authors.affiliation: Department of Pediatrics, Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Ida
authors.initials: I
authors.lastname: Giurin
authors.affiliation: Department of Pediatrics, Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Iaquinto
authors.affiliation: Department of Pediatrics, Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Alicchio
authors.affiliation: Department of Pediatrics, Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Agnese
authors.initials: A
authors.lastname: Roberti
authors.affiliation: Department of Pediatrics, Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Settimi
mesh_terms: D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004954:Esthetics; D005500:Follow-Up Studies; D052816:Foreskin / Q000601:surgery*; D006801:Humans; D007021:Hypospadias / Q000175:diagnosis / Q000601:surgery*; D007223:Infant; D007558:Italy; D008297:Male; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D014945:Wound Healing / Q000502:physiology*
keywords: Circumcision; Fistula; Hypospadias; Penis; Preputioplasty