Reconstruction of the hypospadiac hooded prepuce

PURPOSE: The role of foreskin reconstruction as part of distal hypospadias repair remains uncertain. Thus, we wished to define better the indications with a view to improving the success of this cosmetic alternative. We reviewed the outcome in a group of patients who underwent foreskin reconstruction to highlight the criteria for likely success. MATERIALS AND METHODS: The records of 51 boys who underwent foreskin reconstruction from 1996 to 2001 were reviewed from a total hypospadias repair group of 223. Boys who underwent foreskin reconstruction were 4 months to 9 years old (median age 9.3 months). Surgery included a meatal advancement and glanuloplasty procedure in 22 patients, Mathieu urethroplasty in 2, King-Duplay repair in 2 and a meatotomy in 1, while in 24 with a normal glans meatus foreskin plasty was the only surgery. Cases in which the foreskin was required for chordee release and those in which the gap between the ventral aspects of the foreskin was wide were excluded from foreskin reconstruction. Also, patients were selected by intraoperative assessment of the ability to approximate the foreskin in the midline at the level of the coronal groove. If this maneuver can be performed without placing the foreskin under tension, the foreskin is considered suitable for reconstruction. All patients received regional and general anesthesia plus intraoperative antibiotics. After suitable urethroplasty the technique of foreskin reconstruction was generally similar for all types of the condition. RESULTS: The result was excellent in 36 patients (70.6%) with a normal-appearing foreskin that retracted easily. There was a good result in 8 patients (15.7%) with a satisfactory meatus at the tip of the glans and a retractable foreskin but minor foreskin deformity. Only 3 patients had a minor complication, including a fistula through the prepuce in 2 and wound infection in 1. No boy had a complication due to urethroplasty and there were no urethral fistulas. CONCLUSIONS: Our study shows that foreskin reconstruction is successful, particularly if the proximal, coronal groove portion of the prepuce can be easily approximated manually and the procedure can be combined with a range of distal repairs. We would recommend reconstruction of the prepuce if parents would prefer their son to be uncircumcised, providing that the foreskin is suitable for preservation.     

Foreskin preservation in penile surgery

PURPOSE: Most hypospadias repairs performed in the United States involve the removal of any foreskin that is not used in the repair, resulting in a circumcised penis. Occasionally, the wishes of the parents or the child are for the final appearance to be that of a normal uncircumcised penis. We report our collective experience from 4 institutions in the reconstruction of the foreskin during penile surgery. MATERIALS AND METHODS: A total of 58 patients underwent penile surgery with reconstruction of the foreskin during a 6-year period. Of the patients 49 underwent hypospadias repair, 8 underwent phalloplasty for chordee correction without hypospadias and 1 underwent reconstruction of the foreskin for a dorsal hood without hypospadias or chordee. Of the 49 hypospadias repairs 46 were distal, 2 mid shaft and 1 proximal shaft. The technique for foreskin reconstruction consisted of a multilayered reapproximation of the lateral margins of the dorsal hood after completion of the urethroplasty and glanuloplasty. RESULTS: Among 49 hypospadias repairs 2 patients had dehiscence of the reconstructed foreskin, with development of a urethral fistula in 1. Of the 58 total patients undergoing penile surgery 56 had retractable foreskin, of whom 4 required postoperative steroid application. Three patients/parents requested a secondary circumcision, 2 for an unacceptable cosmetic result and 1 based on personal preference. CONCLUSIONS: Foreskin reconstruction in association with penile surgery can be performed safely and with a low complication rate in appropriately selected patients. Cases with a higher risk of complications include those involving more proximal hypospadias and those requiring complete degloving of the penile shaft. Of the reconstructions resulting in phimosis most can be salvaged with the application of steroids.     

复杂性尿道下裂修复失败后的治疗

目的 探讨不同游离黏膜、带蒂皮瓣或二种组织拼接尿道成形术治疗复杂性尿道下裂修复失败后病例的效果.方法 采用3种游离黏膜或带蒂阴茎皮瓣尿道成形治疗尿道下裂修复失败后患者36例,其中带蒂阴茎皮瓣尿道成形7例,舌黏膜与阴茎皮瓣拼接重建尿道3例.结肠黏膜重建尿道2例,1条舌黏膜重建尿道9例,1条颊黏膜重建尿道7例,采用2条口腔内黏膜拼接重建尿道8例.阴茎用弹力绷带包扎4 d,每天用抗生素液冲洗尿道1次.结果 36例术后随访3～84个月,平均32.6个月.术后2～3周发牛尿瘘4例.术后2～3个月新尿道发生狭窄3例,其中吻合口狭窄1例.经尿道扩张5次后排尿通畅;尿道外口狭窄2例,经手术矫正后均排尿通畅,Q_(max)分别为37.3和28.7 ml/s.余者排尿通畅,尿线粗,Q_(max) 18.0～46.0 ml/s,平均26.8 ml/s.结论 舌黏膜与颊黏膜具有取材方便、创伤小的特点,较适合于尿道下裂修复失败后皮源少患者的尿道重建.     

Prepuce-Sparing hypospadias repair with tubularized incised plate urethroplasty

Objectives:   Modifications in surgical methods of hypospadias repair have been influenced by social considerations. Most Japanese parents wish their children to retain their foreskin during hypospadias repair. We report on short-term results of foreskin reconstruction associated with hypospadias repair.
Methods:   Of 44 tubularized incised plate urethroplasty-patients, 42 (95%) underwent foreskin reconstruction at the time of urethroplasty during the last 2 years. After the urethroplasty was completed, the foreskin was re-approximated in three layers.
Results:   Complications related to urethroplasty consisted of fistula in two patients with penoscrotal hypospadia, and mild stenosis of the glandular urethra in one patient. Complications related to foreskin reconstruction included dehiscence of the ventral foreskin in two patients. In all cases parents were well satisfied with the reconstructed prepuce.
Conclusions:   Pre-operative information about preputial reconstruction should be given to parents if they would prefer their son to be uncircumcised.     

Hypospadiac or intact foreskin graft for syndactyly repair

BACKGROUND/PURPOSE: Syndactyly is one of the most common malformations of the hands and feet. Repair may necessitate the use of a full-thickness skin graft. The prepuce is an excellent choice for grafting because of its lack of hair, elasticity, and degree of thickness. The authors report 4 cases of syndactyly repair using foreskin for grafting. METHODS: The authors reviewed 4 cases of syndactyly repaired at Children's Hospital, where foreskin was used for grafting. There was one congenital band syndrome and 3 cases of simple syndactyly. Three patients had a normal prepuce and underwent simultaneous circumcision. One patient presented with coronal hypospadias and underwent simultaneous meatal advancement and glanuloplasty. RESULTS: All patients experienced a satisfactory outcome with no graft loss and no complications. No grafts showed hair, and 3 grafts showed slight relative hyperpigmentation. Excess foreskin was available in all cases of simple syndactyly. Concominant hypospadias repair did not increase the morbidity of the surgery. CONCLUSION: The intact or hypospadiac foreskin is an excellent choice for a free graft in syndactyly repair when available.     

Unstented tubularized incised plate urethroplasty combined with foreskin reconstruction for distal hypospadias

BACKGROUND AND AIM: Urethral stent has recently been proven to be unnecessary for normal healing in an animal model of tubularized incised plate (TIP) urethroplasty. We report our experience with unstented TIP repair combined with foreskin reconstruction for distal hypospadias in children. PATIENTS AND METHODS: We retrospectively reviewed the records of 162 children consecutively treated by TIP urethroplasty for a distal or mid-shaft hypospadias without urethral stent over a 6 years period. The mean age +/- SEM at surgery was 15.7 +/- 1.2 months. A foreskin reconstruction was performed with the hypospadias repair in 136 boys (84%). One hundred thirty one children (81%) underwent this surgery as an outpatient procedure. RESULTS: With a mean follow-up of 12.4 +/- 1.0 months, urethrocutaneous fistula was observed in 9 children (5.6%), and meatal stenosis in 4 (2.5%). Postoperative urinary retention requiring suprapubic catheter insertion was observed in 4 cases (2.5%) without later complications. Cutaneous dehiscence of the reconstructed foreskin occurred in 6 children (4.4%) and phimosis in 13 (9.5%). CONCLUSIONS: Absence of urethral stent after TIP urethroplasty for distal hypospadias repair does not seem to increase postoperative complication rate. Foreskin reconstruction in distal hypospadias surgery has an acceptable complication rate.     

Classification of prepuce in hypospadias according to morphological abnormalities and their impact on hypospadias repair

PURPOSE: We investigated the morphology of the hypospadiac prepuce to develop a classification of different prepuce types in hypospadias. We also assessed the correlation between morphology and vascularization of the prepuce and their impact on results of hypospadias repair. MATERIALS AND METHODS: From September 1997 to December 2001, 174 patients 18 months to 24 years old (mean age 49 months) underwent hypospadias surgery. The prepuce morphology was analyzed by evaluation of the prepuce skin distribution, development and deformities. The development and course of blood vessels were analyzed using preputial illumination. According to morphology and blood supply, different types were compared. Of 174 analyzed cases 163 prepuces were used for urethroplasty. RESULTS: Based on the predominant morphology characteristics and abnormalities, we classified the analyzed prepuces into 6 groups of A-"monk's hood" or "1 humped" (43 cases, 24.7%), B-"cobra eyes" (80, 45.9%), C-"normal" (intact) (4, 2.3%), D-"flat" (24, 13.8%), E-"v"-shaped (16, 9.2%), and F-"collar-scarf" (7, 4.0%). Cobra eyes and monk's hood prepuces had the most favorable vascular pattern for the creation of flaps, the prepuces while the "flat" and "v"-shaped prepuces had the most unfavorable vascular pattern. Mean followup after hypospadias repair was 34 months (range 24 to 48). Complications (stenosis, fistula diverticulum) developed in 8.9% of the patients after "cobra eyes" and "monk's hood" prepuces were used for urethroplasty and in 25% when "v"-shaped and "flat" prepuces were used. CONCLUSIONS: Morphological characteristics correlated with vascularization of the hypospadiac prepuce. Underdeveloped prepuces and those with unfavorable vascular pattern used for urethroplasty had a higher percentage of complications. In severe hypospadias the anatomical features of the prepuce have greater influence on the proper choice of 1 or 2-stage repair.     

游离包皮内板或膀胱粘膜治疗尿道下裂(附56例报告)

目的：介绍采用游离包皮内板或膀胱粘膜治疗尿道下裂的方法及效果。方法：对56例尿道下裂患儿根据尿道缺损长度不同，42例采用包皮内板，14例采用膀胱粘膜行尿道成形术。结果：56例中一次手术成功49例（87.5%），7例尿瘘（12.5%），其中1例小尿瘘自行愈合，另6例分别于术后3个月行尿瘘修补术治愈，随访6个月－3年，疗效满意。结论：游离包皮内板或膀胱粘膜可以治疗各种类型尿道下裂，效果良好。     

Onlay island flap urethroplasty: variation on a theme.

The onlay island flap urethroplasty is useful in patients with distal, mid shaft and proximal hypospadias who have a well developed urethral plate and exhibit little or no curvature after release of chordee. The technique described has 2 main features: 1) use of the entire inner prepuce of the foreskin facilitates its mobilization and protects the vascular pedicle, and 2) additional soft tissue coverage is gained by removing the excess preputial mucosa not used for the neourethra. This extra soft tissue covering of the suture lines should prevent fistula formation. During the last 4 1/2 years the onlay island flap has been used for repair of hypospadias in 61 patients. The complication rate (6%) is low and compares favorably with other techniques. Further refinements in the onlay flap hypospadias repair should decrease the complication rate and widen its applicability.     

Modified Tubularized Incised Plate Urethroplasty Repair: Frenuloplasty and Long-Term Results in 155 Patients

To describe a modification of tubularized incised plate (TIP) urethroplasty which we refer to as “frenuloplasty”. We retrospectively reviewed 155 children who underwent TIP urethroplasty between June 2008 and August 2011 in our institution. In our technique, the circumcision incision went on through the mucocutaneous junction obliquely in order to form frenular wings instead of linear circumscribing incision joined the urethral plate vertically. The little triangle-shaped skin flaps between the oblique mucocutaneous incisions and urethral plate incisions were excised. The glans wings and frenular wings were re-approximated without tension after uretroplasty. The mean age of the patients was 4.63?±?3.82 years. The mean follow-up was 15.94?±?5.46 months. Location of hypospadias was distal penile in 126 patients (81.3 %) and mid-shaft in 29 (18.7 %). The following complications occurred in 21 patients (13.5 %): urethrocutaneous fistula formation in 7 (4.5 %), meatal stenosis in 14 (9 %) and no dehiscence. We suppose that there is no incompletely formed prepuce but a ventral fusion defect in the midline. Frenuloplasty reduces the necessity of ventral preputial flaps and provides satisfactory cosmetic outcomes with the appearence of normal circumcised penis.     

阴茎包皮岛状皮瓣一期修复阴茎阴囊型和会阴型尿道下裂

目的探讨阴茎包皮岛状皮瓣一期修复阴茎阴囊型和会阴型尿道下裂的手术方法. 方法 1997 年～2003年,对31例尿道下裂患儿,其中阴茎阴囊型21例、会阴型10例,按照尿道下裂的不同病理解剖,进行阴茎包皮岛状皮瓣设计、移位和尿道成形修复手术.阴茎包皮岛状瓣最长7.5 cm,宽1.5～1.8 cm. 结果修复后阴茎外形良好,不臃肿、无扭曲,尿道开口达到正常解剖部位,排尿正常或接近正常.术后发生尿瘘11例,其中阴茎阴囊型6例、会阴型5例,经修补后痊愈. 结论阴茎包皮岛状皮瓣一期修复阴茎阴囊型和会阴型尿道下裂是一种实用、有效的手术方法.     

Tubularized incised plate urethroplasty for megameatus intact prepuce hypospadias variant: First reported case in Indonesia

Introduction and importanceMegameatus intact Prepuce (MIP) is a rare variant of hypospadias characterized by a wide meatus with a normally conformed prepuce, no chordee, and usually no effects in micturition or sexual physiology. However, quality of life and psychosexuality may be affected.Case presentationA 6-year-old-boy was referred by a general practitioner to the hospital due to an abnormality of the urethral meatus. The patient did not have any complaints. A large external urethral orifice at the ventral area of the coronal glans was discovered. The prepuce was normally-conformed, and there weren’t any signs of chordee. The patient was diagnosed with an MIP hypospadias variant and underwent a tubularized incised plate (TIP) urethroplasty. During the follow-up, one week after the procedure, the patient did not have any complaints. Physical examination showed excellent anatomical and functional outcome based on the cosmetic appearance resembling a normal penis and urinary stream.Clinical discussionAwareness regarding this abnormality is necessary as MIP is often not diagnosed until circumcision. Even though MIP patients are usually asymptomatic, surgery should still be considered based on aesthetic and psychosexual reasons. TIP urethroplasty was chosen for this patient based on the clinical findings of this patient. TIP procedure for MIP patients could result in an excellent penile performance and function with a very low complication rate.ConclusionTIP urethroplasty is able to fulfil satisfactory cosmetic and functional outcomes for the MIP hypospadias variant. Awareness of the disorder should be increased to prevent potential psychosexual disturbances.     

Tubularized incised-plate urethroplasty for secondary hypospadias surgery

PURPOSE: Reoperation for failed hypospadias has been considered to be seriously bothersome because abundant penile skin does not tend to remain for urethroplasty or for penile shaft skin coverage. In this study, the tubularization of incised urethral plate was employed for those who had no excessive penile skin after failure of hypospadias repair. METHODS: Five patients with hypospadias underwent tubularized incised-plate urethroplasty as salvage surgery. The surgical techniques necessary for the performance of the reoperation were not different from those for the primary repair. The urethral plate was incised sufficiently deeply in its midline from the tip of the glans to the regressed meatus. The incised urethral plate was tubularized without tension over a catheter of an appropriate size. RESULTS: Four of those who underwent secondary tubularized incised-plate urethroplasty were successfully repaired without complications. A urethrocutaneous fistula occurred at the corona in the remaining patient. CONCLUSIONS: The absence of preputial skin in reoperative cases makes tubularized incised-plate urethroplasty the ideal option, although the series was small and postoperative duration is still short. In addition, this procedure can give excellent functional and cosmetic results even in patients who require revisional hypospadias surgery.     

The modified Koyanagi repair for severe proximal hypospadias

OBJECTIVE: To report the method and results of a modified one-stage Koyanagi repair (urethroplasty with a parameatal-based and fully extended circumferential foreskin flap) to preserve the vascularity to the peripheral portion of the neourethra, in the repair of severe hypospadias. PATIENTS AND METHODS: Using a skin-incision line as in the original Koyanagi repair, a circumferential incision is made approximately 5 mm proximal to the corona and the urethral plate incised as for repair of chordee. A U-shaped skin incision is then made surrounding the meatus, extended to the dorsal prepuce for approximately 8 mm and parallel to the first incision. The tissue between the prepuce and dartos is dissected on the dorsal side to fix the prepuce as a neourethra to the dartos and to maintain blood supply. After mobilizing the loop-shaped skin flap through the button-hole of the pedicle, the internal and external sides of the loop are sutured to construct a neourethra. Twenty patients (aged 10 months to 9 years) with severe proximal hypospadias underwent the one-stage modified Koyanagi repair. RESULTS: The repair was successful after the initial procedure in 14 patients, but urethrocutaneous fistulae developed in three and meatal stenosis in three. The overall success rate was thus 70%. CONCLUSIONS: There were fewer complications than reported with the original Koyanagi repair, suggesting that the attempted vascular preservation of the neourethra was effective.     

Treatment of severe scrotal hypospadias with onlay-type urethroplasty using mouth mucosa

Failure in repairing severe hypospadias complicated with fistula and cutaneous retraction is often associated with lack of subcutaneous tissue and skin providing protection to the neourethra. We report the results of treatment in 6 patients with scrotal hypospadias with severe deviation and scarce dorsal prepuce. A neourethra was created by the onlay technique applying an oral mucosa graft and preserving in all cases the dorsal preputial skin for the island cutaneous flap. All patients had hypospadias without previous repairs excepting one of them, who had had one first time hypospadias repair in other hospital. Patients age ranged between 2 years and 3 months, and 4 years (mean: 2 years and 9 months). In all cases, hypospadias was scrotal type with severe deviation and scarce dorsal prepuce. All patients had prior hormone stimulation with dehydrotestosterone 3%. Surgical repair was performed in one-stage. Urethroplasty included preservation of the urethral plate, oral mucosa graft to provide ventral coverage, and island cutaneous flap with the dorsal preputial skin. In all cases, the chord was dissected behind the urethral plate. In 3 patients a dorsal Nesbit plication was necessary to obtain a complete straighten penis. Results in all 6 cases were satisfactory. Only one patient had a small leakage at the previous neomeatus. The other five patients are asymptomatic. Follow-up ranges from 6 months to 2 years. We conclude that urethroplasty in association with a well vascularized island flap of dorsal preputial skin decrease the incidence of fistulae. In patients with severe hypospadias with scarce dorsal prepuce urethroplasty should be completed with oral mucosa grafts preserving dorsal preputial skin for the ventral cutaneous plasty.     

Tubularized incised-plate urethroplasty for hypospadias reoperation

OBJECTIVE: To review our preliminary results of tubularized incised-plate (TIP) urethroplasty for reoperative hypospadias repair. PATIENTS AND METHODS: The study comprised 15 patients, of whom eight had undergone a previous repair by techniques that included incision into the midline of the urethral plate, while in the remaining seven the midline of the plate had been left undisturbed. The meatus at reoperation was subcoronal or on the distal shaft in all but one boy, who had a midshaft hypospadias. All had previously undergone one attempt at hypospadias repair, except for one patient presenting after two failed 'meatal advancement and glanuloplasty incorporated' procedures. The TIP repair was undertaken as described for primary surgery, except that the dorsal dartos flaps for interposition between the neourethra and skin closure were available less often. RESULTS: TIP resulted in a functional neourethra and a cosmetically normal meatus in 13 of the 15 patients. One boy healed with a slightly rounded meatus and the other had wound dehiscence; fistulae developed in another two boys, giving three patients with complications. The fistulae occurred in boys whose original surgery did not include urethral plate incision, while the dehiscence was in a patient with partial excision of the plate during previous tubularized preputial flap repair. CONCLUSIONS: TIP urethroplasty can potentially be used for hypospadias reoperation. Previous incision of the urethral plate was not a contraindication in these selected cases in which the plate appeared supple. However, TIP repair should be avoided in repeat hypospadias surgery if the plate has been resected or is obviously scarred.     

Is primary adult hypospadiatic prepuce different from healthy prepuce in terms of microvascular density and androgen-estrogen-progesterone receptors?

This study aims to determine the histological data such as microvessel density, nerve density, and the androgen, oestrogen and progesterone receptor density in the prepuce of primary distal hypospadias cases in adulthood, compared to that of healthy individuals in the same age group. Between 2014 and 2019, we prospectively evaluated adult hypospadias and adult circumcision patients. A total of 28 patients were included: Group 1 (18 patients) primary distal hypospadias and Group 2 (10 patients—control group) healthy individuals who had a previous circumcision request for social/religious reasons. The prepuce of healthy individuals that were excised after the circumcision and the excised parts excluded from the prepuce that was used in reconstruction during the repair of hypospadias, were shaped and stored to be able to perform a study by the pathology clinic. Histopathological findings on adult distal hypospadias cases showed that the microvascular density and inflammation in the prepuce with hypospadias were found to be increased compared to the healthy prepuce and the density of androgen and oestrogen receptors was similar in both groups. Unlike childhood studies, in this study with adults, the progesterone receptor was detected in both groups and found to be significantly lower in the hypospadias group.     

Operative techniques and long-term outcomes of hypospadias repair in the absence of preputial skin after neonatal circumcision

PurposeTo present the results of hypospadias repair in the absence of preputial skin following neonatal circumcision, and the analyses of surgical techniques and predictors of procedural success.MethodsRecords of all children who underwent hypospadias repair between 10/1999 and 12/2018 were retrospectively reviewed. All of those who underwent neonatal circumcision prior to surgery were included. Patients with any prior penile reconstruction surgery and those with the megameatus intact prepuce variant were excluded. The primary endpoint was the need for reoperation.ResultsA total of 69 patients with a history of neonatal circumcision underwent surgical reconstruction of hypospadias during the study period. Their mean age at surgery was 14 months (interquartile range [IQR] 9,22). Forty-five cases (65%) involved distal hypospadias, and ventral curvature was present in 24 (35%). Dartos flaps were harvested from the dorsal aspect in 37/58 (64%) patients and from the ventral aspect in 21/58 (36%). Twenty-two patients (22/69, 32%) required reoperation after a median follow-up of 9 years (IQR 6,13). Indications for revision surgery included urethral fistula (n = 16, 22%), meatal stenosis (n = 5, 7%), and skin redundancy (n = 1). Ventral curvature (odds ratio [OR] 3.5, p = 0.02) and higher grades of hypospadias. (OR 3.3, p = 0.03) had a higher probability of reoperation (univariate logistic regression).ConclusionHypospadias repair following neonatal circumcision in the absence of preputial skin is a challenging reconstruction. The reoperation rate in our cohort was 30%, similar to reoperative hypospadias surgery. Parents of newborns diagnosed with hypospadias should be encouraged to refrain from pre surgical neonatal circumcision.Level of evidenceTreatment study, level IV     

微创钨针在横形包皮岛状皮瓣法尿道下裂一期修复术中的应用

目的 总结微创钨针在横形包皮岛状皮瓣管状尿道成形法尿道下裂一期修复术的应用方法及术后效果。方法 我科2013年5月至2019年10月收治的其中226例尿道下裂患者,年龄6月~26岁（平均3.8岁）,其中阴茎体型119例,阴茎阴囊型83例,阴囊型及会阴型24例。术中应用微创钨针进行阴茎矫直、阴茎包皮脱套、横形包皮岛状皮瓣的切取及解剖等操作,将成形的横形包皮岛状皮瓣缝合成管状尿道,对各型尿道下裂进行一期尿道重建术。结果 术后7~8天拔除硅胶尿管排尿后,共发现12例伤口愈合不良、尿外渗及尿瘘形成。全部病例随访3月~2年,共发现尿瘘及尿道部分裂开24例,尿道外口狭窄2例,尿道（吻合口）狭窄3例,尿道憩室1例,阴茎下弯复发2例,总的并发症发生率为32/226（14.2%）。结论 在尿道下裂一期修复手术中,合理应用微创钨针的电切及电凝功能的优势特点,可精细分离解剖横形包皮岛状皮瓣,可安全有效获取尿道再造所需要的血运良好的包皮瓣等组织,有利于提高手术效率、减轻组织的损伤,可促进组织愈合、降低术后并发症。     

Y形阴囊皮瓣修复小儿重度尿道下裂12例报告

目的:探讨Y形阴囊皮瓣治疗小儿重度尿道下裂的适用范围和疗效。方法:背侧包皮不充裕的重度尿道下裂患儿12例,包括阴囊型7例,会阴型5例;合并阴茎阴囊不全转位11例,完全转位1例。年龄11个月～12岁,平均4.2岁。采用Y形阴囊皮瓣成形尿道并同期纠正阴茎阴囊转位。结果:平均随访2年,术后阴茎伸直及外观满意,尿道口位置正常。发生尿瘘4例(33.3%),尿道狭窄1例(8.3%),手术总成功率达58.3%。结论:Y形阴囊皮瓣适用于背侧包皮少的小儿重度尿道下裂的治疗,且能同期纠正阴茎阴囊转位,疗效肯定。