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.     

Achieving a natural glanular meatus for distal hypospadias with a narrow and shallow plate: Tubularized incised plate versus modified Barcat repair

Objectives:   Although the tubularized incised plate (TIP) repair has become the most popular surgical procedure for distal hypospadias, some authors suggest that this is not suitable for hypospadias with a narrow plate or shallow groove.
Methods:   The configuration and position of the reconstructed meatus were postoperatively analyzed in patients with distal hypospadias whose preoperative urethral plates were shallow or narrow. The findings were compared between six patients undergoing TIP repair and seven patients undergoing modified Barcat (BAVIS) repair.
Results:   Among those undergoing the TIP procedure, a slit-like meatus at the tip of the glans was achieved in one patient, a slit-like meatus at the mid portion of the glans in four patients and a round meatus at the mid portion of the glans in one patient. In those repaired by the BAVIS procedure, a slit-like meatus at the tip of glans was achieved in three patients, a round or irregularly shaped meatus at the tip of the glans in two patients, an irregularly shaped meatus at the mid portion of the glans in one patient and neourethral dehiscence in one patient.
Conclusions:   The present study confirms that a higher rate of achieving slit-like meatus but a lower rate of locating in the glans tip can be attained after TIP repair. On the other hand, there is a higher rate of locating the meatus in the glans tip but a lower rate of achieving a slit-like meatus after BAVIS repair.     

尿道板纵切在远端型尿道下裂选择Mathieu术式中的应用

目的:比较尿道板纵切联合尿道口基底血管皮瓣法(Mathieu)与尿道板纵切卷管法(TIP)治疗远端型尿道下裂疗效。方法:回顾性分析2016年8月至2019年1月72例远端型尿道下裂临床资料,21例行尿道板纵切联合Mathieu术(Mathieu-IP组),其中5例尿道板狭窄、小扁平阴茎头、浅尿道;51例行TIP术(TIP组);随访观察尿道口位置、形状、阴茎头裂开、尿瘘、狭窄、憩室,并进行分析比较。结果:Mathieu-IP组与TIP组垂直裂隙状口分别为19例(90.5%)、46例(90.2%),外观无明显差异(P>0.05);Mathieu-IP组较TIP组尿瘘发生率显著降低(P=0.048),分别为1例(4.8%)和15例(29.4%);Mathieu-IP组无尿道狭窄,TIP组12例(23.5%),Mathieu-IP组显著降低(P=0.037);Mathieu-IP组和TIP组阴茎头裂开、憩室发生率均无统计学差异(P>0.05),阴茎头裂开分别为1例(4.8%)和2例(9.8%),憩室分别为1例(4.8%)和6例(11.8%);5例尿道板狭窄、小扁平阴茎头、浅尿道患者术后均无并发症。结论:尿道板纵切用于Mathieu术修复远端型尿道下裂,可使尿道口垂直裂隙状,形成合理尿道口径,尿瘘、狭窄发生率明显降低,适用于尿道板狭窄、小扁平阴茎头、浅尿道沟患者。     

Snodgrass procedure for primary hypospadias repair

Background: In this study, the authors’ experience in adaptation of the Snodgrass technique for primary hypospadias repair, with an alternative way to create a barrier layer of dartos flap for neourethral covering, is presented. Methods: Between March 2000 and January 2001, Snodgrass urethroplasty was consecutively done on 24 boys aged between 14 months and 9 years (median: 3 years). The position of the meatus was coronal in one boy, at the distal shaft in two, at mid‐shaft in eight, at the proximal shaft in five, penoscrotal in four, scrotal in three and perineal in one. Dorsal plication was carried out in nine patients (37.5%) to correct residual ventral curvature after penile degloving. Postoperatively the neourethra was stented for 10–12 days and suprapubic diversion was used for 12–14 days. Results: Postoperative follow up ranged from 4 to 14 months (median: 8 months). All patients undergoing Snodgrass repair obtained a neourethra with a slit‐like meatus at the tip of the glans. A small urethrocutaneous fistula occurred in one patient with mid‐shaft and two with proximal‐shaft hypospadias (an overall fistula rate of 12.5%). Urethral stricture had not been encountered at the time of this report. One patient developed mild meatal stenosis and was successfully managed by simple dilatation. Conclusions: The results indicate that Snodgrass urethroplasty provides satisfactory cosmetic and functional results and is versatile in repairing almost all types of hypospadias.     

Combined Mathieu and Snodgrass urethroplasty for hypospadias repair: A prospective randomized study

Objectives: To evaluate the outcomes of combined Mathieu and Snodgrass urethroplasty for distal hypospadias repair and to compare them with the two techniques separately. Methods: Between January 2006 and February 2009, patients with distal hypospadias were prospectively randomized to undergo one of the three following urethroplasty techniques: Mathieu urethroplasty, Snodgrass urethroplasty or a combination of the two. Operative time, intraoperative, early and late postoperative complications were reported for each procedure. Results: 101 patients were included in this study. The Mathieu technique was used for 30 patients, Snodgrass repair was carried out in 37 patients and 34 patients underwent the combined technique. Operative time ranged from 43 to 120 min. Eight patients developed urethrocutaneous fistulae. Meatal stenosis was encountered in five cases. Thirty‐seven patients had rounded meatus, while a slit‐like urethral opening was found in 64 cases. Conclusions: In our hands, the combined Mathieu and Snodgrass urethroplasty technique provided a better cosmetic outcome than the Mathieu technique with no incidence of meatal stenosis as seen with the Snodgrass technique.     

Modified foreskin reconstruction for distal hypospadias and chordee without hypospadias

Abstract:   Although foreskin reconstruction was established for hypospadias surgery in Europe two decades ago, it appears to introduce an extra risk of postoperative complications. We modified foreskin reconstruction in order to reduce the complications caused by its use. After correction of penile curvature and urethroplasty, the inner mucosal layer of the foreskin was separated from the outer skin layer. The approximation of each layer in the midline was limited and transverse adaptation was added to the remaining portion. We carried out the modified foreskin reconstruction for 11 patients and no patients developed postoperative complications. After the foreskin reconstruction, the glans, which was concealed by the reconstructed foreskin, was easily exposed by retracting the foreskin.     

Primary and salvage urethroplasty using Mathieu meatal-based flip-flap technique for distal hypospadias

BACKGROUND: Numerous surgical procedures have been attempted for correction of distal hypospadias. The Mathieu procedure was employed in this study for secondary cases as well as primary cases. METHODS: The length of the skin flap is determined by measuring the distance from the meatus to the glans tip and then the ventral meatal-based skin flap is incised. The proximal skin flap is flipped and anastomosed to the distal urethral plate. Additionally, subcutaneous tissue of the flipped flap is sutured to cover the original suture lines completely. RESULTS: The Mathieu urethroplasty was successful in one stage in 13 of the 16 primary repair cases (81%). Twelve of the 13 (92%) who underwent a secondary Mathieu procedure were successfully repaired with no problems. An overall success rate of 86% was achieved at the first operation for both primary and secondary cases. In the remaining 14% of the cases, success was achieved with only one additional procedure. CONCLUSIONS: The Mathieu flip-flap procedure is feasible for relatively short urethral defects if the ventral penile skin demonstrates adequate mobility and there is no chordee. Even in patients who require revisional hypospadias surgery, the Mathieu procedure can give excellent functional and cosmetic results.     

Tubularized incised plate urethroplasty for proximal hypospadias

OBJECTIVES: Numerous surgical procedures have been used to correct distal hypospadias. Among them, the tubularized incised plate urethroplasty (Snodgrass procedure) has become a mainstay for the repair of distal hypospadias. We applied the procedure to proximal hypospadias. METHODS: Three patients with proximal hypospadias underwent a tubularized incised urethral plate urethroplasty. The location of the meatus was proximal penis in one, penoscrotal margin in one and scrotum in one. A perimeatal incision was made and the two paramedian incisions were extended to the tip of the glans. The skin of the penile shaft was dissected free to the penoscrotal junction and bands of fibrous tissue were excised until the corpus spongiosum proximal to the meatus was completely exposed inside the scrotum. The urethral plate was then incised in its midline from the tip of the glans to the hypospadiac meatus and was tubularized without tension. The neourethra was covered with a pedicle of subcutaneous tissue dissected from the dorsal skin or the scrotal skin to avoid fistula formation. RESULTS: The tubularized incised urethral plate urethroplasty was carried out successfully in one stage on three patients with proximal hypospadias. CONCLUSIONS: The Snodgrass procedure is suitable for correcting hypospadias in patients with a healthy urethral plate. It is also suitable in patients with proximal hypospadias.     

带蒂联合包皮瓣Ⅰ期修复尿道下裂

目的 探讨带蒂联合包皮瓣Ⅰ期修复尿道下裂的优点.方法 回顾分析采用带蒂联合包皮内外板皮瓣法Ⅰ期尿道下裂成形术54例的临床疗效.结果 术后一次成功43例,8例发生尿瘘,5例自愈,3例再次手术而愈,另有3例尿道狭窄,扩张后痊愈.结论 采用带蒂联合包皮内外板皮瓣法治疗尿道下裂,取材方便、易成活、并发症少、疗效确切,便于临床应用和推广.     

Spongioplasty and separation of the corpora cavernosa for hypospadias repair

OBJECTIVE: To describe a surgical method (a modified Duplay technique), and its results, for hypospadias repair, developed to avoid the common complication of fistula. PATIENTS AND METHODS: The urethroplasty was modified so that it no longer comprises a simple approximation of the urethral plate with no dissection. The inferior surface of the corpora cavernosa is exposed as far as the lateral border and to the end of the glans, allowing tension- free suturing of urethral tissues, with a lengthening effect of the intermediate plane. This corrects chordee and especially the 'bucket-handle' glans, and protects the reconstructed urethra and proximal urethra. The study included 51 children who had their hypospadias repaired over a 9-month period (mean age at surgery 20.6 months, range 1-11 years); 14 had coronal, three anterior penile juxta-coronal, 23 anterior penile, four medium penile, five posterior and two penoscrotal hypospadias. RESULTS: All children were followed and no fistula was apparent in any with anterior hypospadias; two fistulae occurred after repair of the posterior form. The risk of fistula is therefore reduced (two in 51). CONCLUSION: This technical modification can be used to treat all forms of distal hypospadias (glanular, glanulo-preputial, and anterior penile). It was also used for several cases of more severe hypospadias. These good results must be confirmed in a larger series of patients.     

Tube-onlay-tube tunica vaginalis flap for proximal primary and reoperative adult hypospadias

PURPOSE: We describe the surgical technique of and report the results in the first 20 patients who underwent combined onlay-tube construction of a tunica vaginalis flap. MATERIALS AND METHODS: We repaired 20 cases of proximal primary (8) and repeat (12), adult hypospadias using a tube-onlay in 4, an onlay-tube in 3, a tube-onlay-tube in 9 and an onlay-tube-onlay in 4. In 15 patients contralateral tunica vaginalis was used as a blanket wrap. Three to 6 months postoperatively after obtaining informed consent retrograde urethrography, cystourethroscopy, uroflowmetry and urethral biopsy were done in 20, 17, 10 and 13 patients, respectively. RESULTS: No fistula or diverticulum developed. Complications occurred in 3 patients (15%), including urethral stricture, meatal stenosis and urethral stricture, and meatal regression and urethral stricture in 1 each. All strictures occurred in the distal urethra in reoperative cases. At long-term followup there was no recurrent stricture or meatal stenosis after internal urethrotomy and dilation. Urethral biopsy in all 13 patients showed a stratified epithelium indistinguishable from native urethra. The reasons for delayed presentation include perceiving hypospadias as a normal variation (paribor or cut by angels), losing hope for a cure after multiple failed repairs, being told by urologists that repair is futile and pressure by wives for cosmetic or fertility reasons. CONCLUSIONS: The place of tunica vaginalis in hypospadias surgery is more than coverage for urethroplasty. It can be successfully used for substitution urethroplasty. As an extension to the principles of the onlay flap and the concept of urethral plate preservation, combined onlay-tube constructions of tunica vaginalis, including a tube-onlay-tube flap, are successfully applicable to proximal hypospadias, especially in reoperative cases. Urothelialization of the tunica vaginalis occurs within months of surgery.     

'Pseudospongioplasty' in the repair of a urethral diverticulum

OBJECTIVES: To describe a technique for repairing urethral diverticula which includes neourethral reconstruction and increasing the mechanical support of the neourethra. PATIENTS AND METHODS: Between February 1995 and May 2000, 267 patients with proximal hypospadias underwent a one-stage penile skin longitudinal flap urethroplasty. The overall postoperative complication rate was 20%; a diverticulum formed in 24 patients (9%) and in all it was repaired. Diverticulectomy was carried out by de-epithelialization of excess diverticular skin, so that two subcutaneous vascularized tissue wings could be created. After re-establishing distal urethral patency and neourethral closure, the de-epithelialized diverticular wings were folded and overlapped to form a mechanical support for the neourethral ventral wall; this procedure was termed 'pseudospongioplasty'. RESULTS: There were no recurrences of diverticulum or any fistula formation. The only complication was urethral stenosis in two cases, which was successfully resolved by internal urethrotomy. CONCLUSION: Re-establishing patency and providing mechanical support are essential when repairing a urethral diverticulum. Our technique with pseudospongiosal tissue reconstruction during the repair represents a good alternative or addition to other techniques.     

One-stage repair of moderately severe hypospadias using a transverse preputial tubularized island flap

BACKGROUND: Transverse preputial tubularized island flap (TPTIF) urethroplasty has been used for the repair of moderately severe hypospadias since Duckett described the procedure in 1980. In spite of the excellent results reported by Duckett, subsequent studies showed high complication rates. A TPTIF procedure modified to reduce the complication rate is presented. METHODS: Between 1996 and 1997, 13 boys with moderately severe hypospadias were repaired with the TPTIF procedure. Patient age ranged from 10 months to 3 years with an average age of 23 months. To prevent urethrocutaneous fistula, the neourethra was constructed with a two-layer closure and the portion of anastomosis was wrapped between the native urethra and the neourethra with the tissue of the corpus spongiosum. RESULTS: The moderately severe hypospadias was repaired without complication in 12 of 13 patients. A urethrocutaneous fistula developed at the midshaft of the penis in one patient. No meatal stenosis, urethral stricture or diverticulum developed. CONCLUSION: Transverse preputial tubularized island flap urethroplasty provided excellent cosmetic and functional results for moderately severe hypospadias, and postoperative complications could be decreased by the two-layer closure of the neourethra and application of the wrapping technique of the proximal anastomosed portion with corpus spongiosum tissue.     

Prior circumcision does not complicate repair of hypospadias with an intact prepuce

PURPOSE: Hypospadias concealed by an intact prepuce is a concern to practitioners performing newborn circumcision, especially given reports that foreskin removal may complicate urethroplasty. However, distal hypospadias repair today less often relies on skin flaps, and some patients may have circumcision interrupted for suspected urethral anomalies when none is present. We evaluated outcomes in consecutive males with hypospadias and an intact prepuce to compare results of urethroplasty in those with vs without prior circumcision. MATERIALS AND METHODS: A retrospective review of consecutive patients with hypospadias and an intact prepuce was performed. Patients circumcised before the urethral defect was recognized comprised group 1, while those presenting without circumcision comprised group 2. In all cases urethroplasty was accomplished by urethral plate tubularization without skin flaps, with coverage of the neourethra by a dartos flap. RESULTS: A total of 63 patients with hypospadias and an intact prepuce were operated on by one of us (WTS). Followup was at least 6 weeks for 36 of these patients, who comprised the study. There were no differences in age or followup among the 26 patients in group 1 compared to the 10 patients in group 2. The only complication was a fistula detected 4 years after surgery in a patient in group 1. CONCLUSIONS: Prior circumcision did not complicate subsequent hypospadias repair in males whose urethral anomaly was concealed by an intact prepuce. While circumcision should not be performed in newborns with obvious penile defects, it can be done in those with a normal foreskin without concern for the occasional discovery of hypospadias with an intact prepuce.     

Preservation of the thin distal urethra in hypospadias repair

PURPOSE: We report our experience with preserving the thin distal urethra lacking corpus spongiosum for the treatment of hypospadias. MATERIALS AND METHODS: From January 1997 to October 1999 we treated primary hypospadias in 77 boys with a mean age of 4 years 10 months. After degloving the penile skin a segment of thin distal urethra lacking corpus spongiosum was noted in 18 patients (23.4%) with a mean age of 3 years 5 months. The thin distal urethra was preserved and incorporated as part of urethroplasty (group 1). The procedure was primarily completed by tubularized incised plate urethroplasty. We also performed tubularized incised plate urethroplasty in 31 boys (40.3%) with a mean age of 5 years 2 months who had normal coverage of the corpus spongiosum of a hypospadiac urethra (group 2). We compared the results of treatment in these 2 groups. The remaining 28 patients (36.4%) treated with other methods were excluded from study. RESULTS: In group 1 the distance from the original meatus to the urethra covered by healthy corpus spongiosum was 4 to 20 mm. (mean 8.2). If the thin distal urethra had been excised, the urethral meatus would have been relocated more proximal in these boys. Mean followup in groups 1 and 2 was 9.9 and 7.6 months, respectively. Postoperatively there were 2 (11.1%) urethrocutaneous fistulas in group 1 and 4 (12.9%) in group 2. Tubularized incised plate repair was successful in all 10 cases (100%) of distal hypospadias in group 2, and in 15 of 18 (83.3%) and 17 of 21 (81%) of proximal hypospadias cases in groups 1 and 2, respectively. There was no statistically significant difference in the success rate of hypospadias repair in the groups. CONCLUSIONS: We noted a significantly thin distal urethra in 23.4% of our cases of primary hypospadias. Mean length of the thin distal urethra was 8.2 mm. Preserving the thin distal urethra may simplify the operative procedure without compromising the surgical results of tubularized incised plate urethroplasty.     

Current concepts in hypospadias surgery

Abstract:   Anatomical anomalies in hypospadias are an abnormal ventral opening of the urethral meatus, abnormal ventral curvature of the penis and abnormal distribution of the foreskin around the glans with a ventrally deficient hooded foreskin. The techniques of hypospadias surgery continue to evolve. The current standard of care for hypospadias repair includes not only a functional penis adequate for sexual intercourse and urethral reconstruction offering the ability to stand to urinate, but also a satisfactory cosmetic result. Tubularized incised plate repair has been the mainstay for distal hypospadias. In cases of proximal hypospadias, one-stage repairs such as the Duckett repair or the Koyanagi repair have been well established, while two-stage repairs remain important alternatives. Whether dorsal plication or ventral lengthening should be used to correct penile curvature is still controversial, and long-term results are required. Efforts have been made in this decade to improve cosmetic appearance, constructing a slit-like meatus or performing foreskin reconstruction, and to prevent onerous complications.     

Laser tissue soldering for hypospadias repair: results of a controlled prospective clinical trial

PURPOSE: Laser tissue soldering has been shown to provide safe and effective tissue closure by creating an immediate leak-free anastomosis with minimal scar formation. We compared the results of laser tissue soldering and conventional suturing for hypospadias repair. MATERIALS AND METHODS: A consecutive group of 138 boys 4 months to 8 years old (mean age 15 months) was divided into a standard suturing (84) and a sutureless laser (54) hypospadias repair group. Urethral repair was defined as simple (Thiersch-Duplay or Snodgrass) and complex (onlay island flap or tube) in 101 and 37 cases, respectively. Laser tissue soldering was performed with 50% human albumin solder doped with 2.5 mg./ml. indocyanine green dye using an 808 nm. diode laser at 0.5 W. In the laser group sutures were used for tissue alignment only. At surgery neourethral and penile length, operative time for neourethral construction and the number of sutures or throws were measured. Postoperatively patients were examined for complications of wound healing, stricture or fistula. RESULTS: Mean patient age, urethral defect severity, type of repair, neourethral length and stenting time plus or minus standard error of mean were not significantly different in the 2 groups. Mean operative time was a fifth as long for laser tissue soldering in simple and complex hypospadias repair compared to controls (1.5 +/- 0.1 and 5.1 +/- 0.3 versus 8.5 +/- 0.8 and 26.7 +/- 1.7 minutes, respectively, p <0.001). The mean number of sutures used for tissue alignment in the laser group for simple and complex repair was significantly less than in controls (3.0 +/- 0.2 and 8.2 +/- 0.6 versus 8.5 +/- 0.8 and 23.2 +/- 1.5, respectively, p <0.001). All patients were followed a mean of 12 months (minimum 6, maximum 22). The complication rate was 4.7% in the laser group and 10.7% in controls with fistula in 2 of 54 cases, and fistula and meatal stenosis in 7 and 2 of 84, respectively. CONCLUSIONS: These preliminary results indicate that laser tissue soldering for hypospadias repair may be performed in almost sutureless fashion and more rapidly than conventional suturing. The ease of the laser technique and the lower complication rate in the laser group indicate that laser tissue soldering is an acceptable means of tissue closure in hypospadias repair.     

Tubularized incised plate urethroplasty: expanded use in primary and repeat surgery for hypospadias

PURPOSE: We evaluated the impact of tubularized incised plate urethroplasty on primary and repeat hypospadias repair. MATERIALS AND METHODS: We retrospectively reviewed the medical records of all boys who underwent hypospadias repair at our institution during a recent 3-year period. The level of the hypospadias defect, technique of repair, primary repair versus reoperation, age at surgery and complications were recorded. RESULTS: A total of 520 hypospadias repairs were done from May 1996 through June 1999. We began to perform tubularized incised plate urethroplasty in November 1996. During the ensuing consecutive 32 months 181 primary and 25 repeat hypospadias repairs were done using this technique. Mean patient age at surgery was 22 months (range 3 months to 30 years). During the 6 months immediately before we began to use this method the Mathieu flip-flap procedure was the most commonly performed technique, accounting for 38% of all hypospadias repairs. In contrast, during the last 6 months reviewed tubularized incised plate urethroplasty accounted for 63% of all repairs, including 41 of 65 primary operations (63%) and 4 of 6 reoperations (67%), while no Mathieu procedures were performed. Postoperative followup was 6 to 38 months for tubularized incised plate repair. Overall meatal stenosis and a urethrocutaneous fistula developed in 1 and 14 boys, respectively (7% complication rate). CONCLUSIONS: Tubularized incised plate urethroplasty has become the preferred technique of primary and repeat hypospadias repair at our institution. The technique has few complications as well as proved success and versatility that continues to expand its applicability and popularity.     

尿道下裂手术方式的选择

尿道下裂手术以达到：阴茎下曲完全纠正、阴茎头呈圆锥状、尿道外口位于或接近阴茎头、外观满意，能站立排尿，能进行正常性生活为目的。力求下曲矫直和尿道成形一次完成。尽管手术方式多达300余种，但各种尿道成形效果都不尽满意。保留尿道板能提高尿道成形成功率、减少并发症。尿道成形可取材自身移植物，而更多取材于阴茎包皮，要不烦于精细，提高手术技巧。作者推荐远端尿道下裂首选TIP术式，近端尿道下裂应当选择Duckett术式或OIF术式。     

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.