Vascularization of the hypospadiac prepuce and its impact on hypospadias repair

PURPOSE: Only sparse data are available on the blood supply of the hypospadiac prepuce. We investigated the development and course of the preputial blood vessels, and applied the results of this study to surgery for hypospadias. MATERIALS AND METHODS: In 157 patients who underwent hypospadias surgery from October 1996 to December 2000 the prepuce was illuminated by a front and back lighting technique using endoscopic cold light and then photographed. Its blood vessel course and development were schematically presented. In 65 patients in whom the prepuce was not used for urethroplasty or penile body skin reconstruction the specimen was removed and its blood vessels were identified after injection with gelatin and Indian ink. The results of the 2 methods were compared. RESULTS: Based on the predominant blood vessels we classified preputial vascularization in hypospadias cases into groups, including 1-1 blood vessel predominant in 43%, 2-2 blood vessels predominant in 12%, 3-an H-like form with communication between 2 well developed blood vessels in 14% and 4-a net-like form with no predominant blood vessels in 29%. After comparing the results of the illumination technique versus specimen study in the same preputial tissue the illumination method was confirmed to be precise and easy to perform. CONCLUSIONS: Vascularization of the prepuce is crucial for hypospadias repair. Identification with high precision is achieved by the illumination technique. This method helps create the best vascularized flaps, whether longitudinal, oblique or spiral.