Correction of proximal hypospadias with severe chordee with a new technique using vertical preputial double-layered island flap

Background: Hypospadias is a common genitourinary anomaly affecting every 1/300 male newborn. Numerous operative techniques have been reported for the repair of hypospadias. Patients and methods: A vertical preputial double-layered island flap technique for correction of perineal and penoscrotal hypospadias with or without penoscrotal transposition and with severe chordee with the utilization of both the foreskin and the hind skin of the prepuce was performed and completed with glanuloplasty using one-stage or two-stage technique. A total of 40 patients with perineal and penoscrotal hypospadias with or without penoscrotal transposition and with severe chordee were managed with this technique. Results: All corrected patients showed accepted cosmetic outcome without penile rotation or remaining gross ventral curvature. Fistulas were seen in 5% of patients at the site of anastomosis between the flap and the hypospadic meatus, and 2.5% of them needed surgical closure. Conclusion: The vertical preputial double-layered island flap technique corrects proximal hypospadias with severe chordee in one stage and can be performed in all patients with reasonable outcomes.