الفهرس 
Normal Embryology of External GenitaliaOnly 14 pages are availabe for public view
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Abstract
Hypospadias repair still remains a mind-tackling condition that can threat even the most talented surgeons. However, the results of repair have evolved over time, and in the near future, it will settle as a slight challenge for amateurs.
We conducted a prospective study aiming to compare different forms of repair of penile hypospadias. We enrolled 60 patients in our study. Their age ranged from 1.5 to 16 years. Of the 60 candidates, 7 (12%) suffered from coronal hypospadias, 26 (43%) were subcoronal, 22 (37%) were distal penile, 3 (5%) midpenile and 2 (3%) were proximal penile hypospadias.
The cases were evenly distributed into 3 groups (20 each). The first group was managed by a longitudinal split-prepuce fasciocutaneous island onlay flap, the second group was managed by a similar but transverse flap, while the third group was managed by TIP. The distribution into these groups was not entirely random; there was some bias to repair by island onlay flaps in cases where a narrow plate and shallow glanular groove existed. Also, the onlay flap repair was favored in proximal cases of penile hypospadias.
One of the most important exclusion criteria in this study was the sacrifice of the native urethral plate; any such case was omitted. Therefore, the preservation of the urethral plate was a necessity for inclusion.
Our follow up period extended throughout a 6 month period postoperatively.
Group I results showed a 5% incidence of fistulation and 5% incidence of disruption. The overall complication rate was 35%, while the reoperation rate was 15%. The cosmetic outcome was satisfactory, and no urethral strictures were encountered.
Group II results showed a 5% incidence of fistulation and 5% incidence of disruption. The overall complication rate was 35%, while the reoperation rate was 10%. The cosmetic outcome was satisfactory, although 1 case showed penile skin discoloration. No urethral strictures were encountered.
Group III results showed a 10% incidence of fistulation and 10% incidence of disruption. The overall complication rate was 40%, while the reoperation rate was 20%. The cosmetic outcome was satisfactory, and no urethral strictures were encountered, although 1 case suffered from meatal stenosis that was manually dilated.
The results were tabulated and statistically analyzed. There was no statistical significance in the rate of complications between all 3 groups. No significant difference also existed between the use of a longitudinal and a transverse preputial flap (group I and II).
In this study, we noticed that the development of the pedicle of the longitudinal flap is much easier than the transverse flap. This meant an easier procedure, with less liability to skin ischemia and discoloration. It was also noticeable that a longitudinal flap can repair any proximal case of penile hypospadias by referring to the outer (cutaneous) surface of the prepuce.
We can explain the proximity of the results in the 3 groups together owing to the biased selection. It seems that using the most appropriate procedure to any given case rather than random blind selection will give the best result.
We also compared our results with the literature and previous studies. Our study showed similar results to most of the published data. In other cases it showed even better results. We owed this to the biased patient distribution. Another explanation would be the low percentage of proximal hypospadias cases than in other studies.
In future, we recommend that this study be extended to involve a bigger sample to provide us with ample results to signify such a comparison. We also recommend it to be performed at a multicentric level to confirm our data. It should also be extended to involve a longer follow up period. This is important to exclude the development of late complications such as urethral stricture and diverticulation, which may not emerge over 6 months of follow up. We also recommend that the comparison of proximal hypospadias cases should be performed in a separate study to those of distal anomaly. This will decrease the variables in the study, and will certify the results.