title: Soft tissue interposition is effective for protecting the neourethra during hypospadias surgery and preventing postoperative urethrocutaneous fistula: a single surgeon's experience of 243 cases.
abstract: OBJECTIVE
  Soft tissue interposition (STI) during hypospadias repair (HR) purportedly prevents postoperative urethrocutaneous fistula (PUF) by supporting the neourethra. We report our experience.
  
  
  METHODS
  Data from 243 hypospadias patients treated by a single surgeon from 1997 to 2014 by urethroplasty (UP) with STI (n = 229; UP + STI) and UP without STI (n = 14; UP-STI) were collated prospectively and compared for incidence of PUF. Re-operative UP were excluded.
  
  
  RESULTS
  Hypospadias was distal (n = 55), mid-shaft (n = 59), proximal/penoscrotal (n = 109), scrotal (n = 15), and perineal (n = 5). UP was single-staged in 86, multi-staged in 157; mean age at UP was 3.1 ± 2.4 years. Soft tissue used for STI was prepucial inner dartos fascia (inner dartos: n = 88), ventral dartos fascia (ventral dartos: n = 15), pedicled external spermatic fascia (ESF: n = 84), adipose tissue surrounding the spermatic cord (pericordal: n = 9), scrotal adipose tissue (n = 8), or a combination of tissues (combined: n = 25). Mean follow-up was 6.4 ± 4.6 (range 0.6-16.8) years. Overall incidence of PUF was 10/243 (4.1 %); 7/229 (3.1 %) for UP + STI and 3/14 (21.4 %) in UP-STI (p < 0.05); incidence versus type of hypospadias was 1/55 for distal (1.8 %), 3/59 for mid-shaft (5.1 %), 5/109 for proximal/penoscrotal (4.6 %), 0/15 for scrotal (0 %), and 1/5 for perineal (20 %); incidence versus type of STI was 7/88 for inner dartos, 0/15 for ventral dartos, 0/84 for ESF, 0/9 for pericordal adipose tissue, 0/8 for scrotal adipose tissue, and 0/25 for combined. All PUF were repaired successfully. Satisfaction with penile cosmesis was acceptable (10.3 %) or good (89.7 %) without any testicular complications or scrotal deformity.
  
  
  CONCLUSIONS
  STI, especially ESF, would appear to effectively prevent PUF in HR.
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan, sseo@juntendo.ac.jp.
authors.forename: Shogo
authors.initials: S
authors.lastname: Seo
authors.forename: Takanori
authors.initials: T
authors.lastname: Ochi
authors.forename: Yuta
authors.initials: Y
authors.lastname: Yazaki
authors.forename: Manabu
authors.initials: M
authors.lastname: Okawada
authors.forename: Takashi
authors.initials: T
authors.lastname: Doi
authors.forename: Go
authors.initials: G
authors.lastname: Miyano
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Koga
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
mesh_terms: D002675:Child, Preschool; D005402:Fistula / Q000517:prevention & control; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D010413:Penis / Q000601:surgery*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014521:Urethra; D014548:Urinary Fistula / Q000517:prevention & control*