Results of Onlay Flap Versus Durham Smith in Proximal Hypospadias

Introduction: Urethroplasty was originally used for the repair of hypospadias of the mid and distal portion of the penis but since complications of the two-stage Durham Smith technique such as mega urethra and proximal anastomotic strictures became apparent, the Onlay island flap technique has been increasingly used in more severe cases of proximal hypospadias. The aim of our study was to compare the outcome of these two techniques in the surgical treatment of hypospadias. Materials and Methods: In this retrospective study, thirty -three patients underwent surgery for the treatment of hypospadias. The two- stage Durham smith repair was used for 17 cases and the onlay island flap technique was carried out on 16 patients. Data was analyzed using SPSS software version 21 and complication rates of the two procedures were compared. Results: Altogether, frequency of complications was higher in the smith technique than the onlay flap procedure without any significant difference between the two techniques (47% for Smith technique and 19% for onlay repair, P=0.141). Fistula was the most frequent complication in the two techniques (41% for Smith technique and 13% for onlay repair, P=0.117). Meatoplasty was done for meatal stricture in the smith group. Moreover, the smith technique failed completely in one case who then underwent Tubularized Inside-Plate (TIP). There was a case of chordee recurrence in the smith technique, for which a dorsal Nesbit plication was carried out. The mean days of hospitalization was more with the smith technique (7.1 days vs 5.0, P=0.016). In addition, the mean cases which required reoperation was higher in the smith group than the onlay flap (1.0 vs 0.2, P=0.025). Conclusion: The results of this study showed that the onlay flap technique had lower complications and reoperation rates than the two-stage smith technique. In addition, the onlay flap technique has fewer days of hospitalization than the smith technique, resulting in lower costs to the health system and patients.