Complications of the preputial island flap-tube urethroplasty.

OBJECTIVE: To report the long-term results of hypospadias repair using tubularized transverse preputial island flaps. PATIENTS AND METHODS: Seventy-four patients (mean age 7 years, range 2-19) underwent a transverse preputial island flap-tube repair for hypospadias. All patients had chordee, 14 had anterior, 41 mid-penile and 19 penoscrotal hypospadias. The mean (range) follow-up was 43 (14-77) months and the outcome assessed by function and cosmesis. RESULTS: The repair was functionally and cosmetically successful in 43 patients (58%) as a single-stage repair. Necrosis and sloughing of the neourethra occurred in five patients (7%), urethrocutaneous fistula in 17 (23%), strictures in seven (9%), diverticula in three (4%) and insignificant urethral misalignment was detected by urethrography in three (4%); thus the overall complication rate was 42%. All of these complications were treated successfully in one or two re-operations. CONCLUSIONS: The transverse preputial island flap-tube repair of hypospadias is a demanding technique. Even in experienced hands it has a relatively high complication rate. Every effort should be made to preserve the urethral plate during orthoplasty, minimizing the need to use tubularized preputial island flaps and expanding the application of onlay procedures.