Objective

To critically evaluate inner preputial graft (IPG) used in staged proximal hypospadias with severe chordee regarding cosmetic and functional outcomes.

Patients and methods

In this prospective study, patients with primary proximal hypospadias with moderate to severe chordee (> 30°) after penile degloving were considered candidates for staged repair between June 2011 to July 2017. After transection of the urethral plate (UP) and penile straightening, the bare shaft was covered with IPG. Tubularization of the graft was done as a second stage. Cosmetic and functional outcomes were assessed using HOSE score and uroflowmetry (UF). Additionally, factors influencing success were analyzed.

Results

In all, 38 consecutive cases were included. Native meatus was at proximal penile in 17, penoscrotal in 11, scrotal in 7, and perineal in 3 cases. Median age was 26 and 32 months at the first stage and the second stage, respectively. Preoperative testosterone was given for ten patients with a small penis and/or severe curvature. The mean follow-up was 18 ± 8.2, median 15 months. Grafts took well in all cases after the first stage except one. Cosmetic success achieved in 33 (86.8%). A total of ten complications occurred in six cases. Unplanned intervention was needed in 5/38 cases. Functionally, UF study revealed normal flow in 7/23 (30.4%), equivocal in 11/23(47.8%), and obstructed flow in 5/23(21.7%).

Conclusion

Inner preputial graft use in proximal hypospadias with moderate to severe chordee seems to have a good technical outcome and functionally mimic the normal urethral function and could be considered an ideal option for substitution urethroplasty.

中文翻译：

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使用内部皮膜前植皮术对中度至重度腱索近端尿道下裂进行两阶段修复：功能和美容效果的前瞻性评估。

目的

为了严格评估分期近端尿道下裂伴严重腱索的内膜置换术（IPG）的外观和功能结局。

患者和方法

在这项前瞻性研究中，从2011年6月至2017年7月，在阴茎脱垂后患有中度至重度腱索（> 30°）的原发性近尿道下裂的患者被视为进行阶段性修复的候选人。在横切尿道板（UP）和阴茎拉直后，裸轴上覆盖有IPG。将移植物的管状化作为第二阶段。使用HOSE评分和尿流仪（UF）评估美容和功能结局。此外，分析了影响成功的因素。

结果

总共包括38个连续病例。阴茎近端阴茎17处，阴囊11处，阴囊7处，会阴3例。在第一阶段和第二阶段中位年龄分别为26和32个月。十名阴茎小和/或严重弯曲的患者接受了术前睾丸激素治疗。平均随访时间为18±8.2，中位数为15个月。在第一阶段之后的所有情况下，嫁接都表现良好，除了一个。化妆品成功率达到33（86.8％）。六例中共发生十例并发症。5/38例需要计划外干预。在功能上，超滤研究显示正常血流为7/23（30.4％），模糊血流为11/23（47.8％），阻塞血流为5/23（21.7％）。

结论

在中度至重度腱索近端尿道下裂患者中使用preputs植入术似乎具有良好的技术效果，并在功能上模仿正常的尿道功能，可以被视为替代尿道置换术的理想选择。