1221 THE SINGLE STAGE DORSAL INLAY SKIN GRAFT FOR COMPLEX HYPOSPADIAS REOPERATIONS: LONG-TERM FOLLOW-UP
2010-03-23

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery IV1 Apr 20101221 THE SINGLE STAGE DORSAL INLAY SKIN GRAFT FOR COMPLEX HYPOSPADIAS REOPERATIONS: LONG-TERM FOLLOW-UP Christian Schwentner, Joerg Seibold, Daniela Colleselli, Jens Mundhenk, David Schilling, Arnulf Stenzl, and Christian Radmayr Christian SchwentnerChristian Schwentner Tuebingen, Germany More articles by this author , Joerg SeiboldJoerg Seibold Tuebingen, Germany More articles by this author , Daniela ColleselliDaniela Colleselli Tuebingen, Germany More articles by this author , Jens MundhenkJens Mundhenk Tuebingen, Germany More articles by this author , David SchillingDavid Schilling Tuebingen, Germany More articles by this author , Arnulf StenzlArnulf Stenzl Tuebingen, Germany More articles by this author , and Christian RadmayrChristian Radmayr Innsbruck, Austria More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.744AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite quite high success rates for primary hypospadias repair, some patients still require multiple sessions for ultimate cosmetic and functional reconstruction. We report our experience with single stage dorsal inlay urethroplasty using skin grafts for complex hypospadias reoperations. METHODS 35 patients (mean age 13.8 +/- 8.28 years) with failed previous hypospadias surgery (mean 4.2 +/- 4.09 times) were included. Indications comprised fistulas, strictures, diverticula, and repair breakdown. The urethral plate had been removed or was severely scarred in all patients. After excision of fibrotic tissue a free penile or groin skin graft was sutured and quilted to the corpora cavernosa guaranteeing sufficient blood supply. The neourethra was tubularized and covered with a tunica vaginalis or dartos flap followed by a glanuloplasty in a single stage. Pre- and postoperative voiding cystograms, urethral ultrasound as well as flow measurements were performed in all patients. Clinical outcome was considered a failure when postoperative instrumentation was needed. RESULTS Penile skin was used in 31 and inguinal skin in 4 cases, respectively. The average graft length was 4.87 +/-2.54 cm. 20 patients required glanuloplasty with a skin graft extended to the tip of the glans. Initial graft healing was successful in all cases. There was no case of postoperative urinary tract or wound infection involving the inlay. Additionally, we did not note complications from the graft donor sites. After a mean follow up of 77.73 +/- 18.26 months 5 patients underwent redo surgery leaving a complication rate of 14.3 %. Urethral stricture of the proximal anastomosis was the most frequent finding. Single internal urethrotomy was sufficient for 2 boys whereas 2 finally required another urethroplasty using the same technique. CONCLUSIONS This single stage approach using dorsal inlay skin grafts is a reliable method to create a substitute urethral plate for tubularization. Complication rates are equivalent to those of staged strategies with the advantage of only one hospital stay. Residual penile skin should be used as a graft donor site to optimize the outcome if available. Given the excellent long term follow-up, this approach represents a safe option for hypospadias reoperations even if the urethral plate or midline penile skin is grossly scarred. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e473 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Schwentner Tuebingen, Germany More articles by this author Joerg Seibold Tuebingen, Germany More articles by this author Daniela Colleselli Tuebingen, Germany More articles by this author Jens Mundhenk Tuebingen, Germany More articles by this author David Schilling Tuebingen, Germany More articles by this author Arnulf Stenzl Tuebingen, Germany More articles by this author Christian Radmayr Innsbruck, Austria More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...