title: Transverse preputial onlay island flap urethroplasty for single-stage correction of proximal hypospadias.
abstract: OBJECTIVE
  Transverse preputial onlay island flap urethroplasty (TPOIF) was described initially for distal hypospadias, but has seen extended application for proximal hypospadias. We describe a set of modifications in the technique and results in a large series of proximal hypospadias.
  
  
  METHODS
  All children who underwent TPOIF repair for proximal hypospadias (proximal penile, penoscrotal and scrotal) from June 2006 to June 2013 by a single surgeon were prospectively followed till June, 2014. A standard technique and postoperative protocol were followed. Salient points to be emphasized in the technique: (1) dissection of the dartos pedicle till penopubic junction to prevent penile torsion, (2) incorporation of the spongiosum in the urethroplasty, (3) midline urethral plate incision in glans (hinging the plate), (4) Dartos blanket cover on whole urethroplasty.
  
  
  RESULTS
  Out of 136 children with proximal hypospadias, 92 children who underwent TPOIF formed the study group. Out of 92 children, 48 (52 %) children required a tunica albuginea plication for chordee correction. In total, 16 (17 %) patients developed 24 complications and 11 children (12 %) required second surgeries: fistula closure in 7 (with meatoplasty in 5), glansplasty for glans dehiscence in 2 and excision of diverticulum in 2. Two children required a third surgery. Only 5 children had a noticeable penile torsion (less than 30 degree), and 7 had a patulous meatus.
  
  
  CONCLUSIONS
  Transverse preputial onlay island flap urethroplasty can deliver reliable cosmetic and functional outcomes in proximal hypospadias.
authors.affiliation: MITR Hospital, Kharghar, Navi Mumbai, India. arbinders@gmail.com.|Hypospadias Foundation, Kharghar, Navi Mumbai, India. arbinders@gmail.com.|Division of Pediatric Urology, MGM Institute of Health Sciences, Kamothe, Maharashtra, India. arbinders@gmail.com.|One Vision Health and Research Foundation, Navi Mumbai, India. arbinders@gmail.com.
authors.forename: Arbinder Kumar
authors.initials: AK
authors.lastname: Singal
authors.affiliation: MITR Hospital, Kharghar, Navi Mumbai, India.|Hypospadias Foundation, Kharghar, Navi Mumbai, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Dubey
authors.affiliation: Hypospadias Foundation, Kharghar, Navi Mumbai, India.|One Vision Health and Research Foundation, Navi Mumbai, India.|Case Western Reserve (MetroHealth) Program, Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Viral
authors.initials: V
authors.lastname: Jain
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D052816:Foreskin / Q000601:surgery*; D006801:Humans; D007021:Hypospadias / Q000473:pathology / Q000601:surgery*; D007223:Infant; D008297:Male; D011446:Prospective Studies; D013524:Surgical Flaps; D014521:Urethra / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods
keywords: Hypospadias; Onlay island flap; Proximal hypospadias; Urethroplasty