De-epithelialized rotational foreskin flap (DERFF) as a coverage for urethroplasty in mid and distal shaft hypospadias surgery.

Hypospadias is a common pediatric urologic anomaly with a prevalence of 1/300 male births. There are over 300 different surgical techniques and modifications to repair this anomaly, reflecting surgeon dedication to optimizing surgical outcomes and minmizing complications of hypospadias repair. Urethrocutaneous fistula (UCF) is the commonest complication of hypospadias repair, with a reported incidence of 4-50 % based on hypospadias severity and surgical technique. Vascularized flap coverage of the urethroplasty is essential to minimize the risk of fistula formation. We are presenting a novel technique using De-Epethelialized Rotational Foreskin Flap (DERFF) coverage, which provides three-layer coverage of the reconstructed urethra to decrease the risk of UCF after mid shaft to coronal hypospadias repair. We performed this technique on 63 patients with a median age of 9 (6-142) months. After a median follow-up (52 pts.) of 3.4 (range 0.3-40.3, IQR = 3.1-16) months, no UCF, urethral dehiscence, UTIs or SSI were observed. Two patients had meatal stenosis. This technique can be used in most hypospadias cases (coronal, distal and mid shaft) which are about 80 % of total number of hypospadias cases to reduce the risk of UCF. It is safe, feasible and reproducible.