Hypospadias Repair Using Skin Flaps: Analysis of 50 Cases

Objective: To analyze the outcome of primary one-stage hypospadias repair using skin flaps (Mathieu, onlay, Duckett) with particular reference to technique and current related literature. Patients and methods: The study comprised 50 patients who underwent primary skin flap hypospadias repair with at least one year follow-up. All were operated by the authors and in the same institution during the period from 1995 to 2002. Their medical records were retrospectively reviewed for age, type of hypospadias, and nature of skin flap. Main related morbidity and success are reported after an average follow-up of 28.3 months. Reference to technique was also made. Results: Majority of patients were between 2 and 4 years of age. 70% of them had distal anomaly with a mild degree of chordee. 23, 19 and 8 underwent Mathieu’s, Onlay’s and Duckett’s repair, respectively. 24% were circumcised at the time of surgery. Overall morbidity was noted in 16 patients (32%). The commonest complications were meatal stenosis (14%) and fistula (8%). Comparable morbidity was noted in both Mathieu’s (17.4%) and Onlay’s (15.8%) flaps. Unacceptable complication rate was associated with Duckett’s tubularized skin flap repair. The overall success rate was markedly improved after the year 1998 with a rise from 80% at a mean of 1.22 procedures to 93.1% at a mean of 1.07 procedures. Our outcome data compared well with the literature except for Duckett’s form of repair. Conclusion: Skin flaps have an established and valuable place in hypospadias repair. Meatus-based and onlay flaps have fairly better outcome than both grafts and tubularized flaps. Attention to technique, selection, auditing and experience are keys to better anatomical, functional and cosmetic results.