Use of a de-epithelialized local skin flap in hypospadias repairs accomplished by tubularization of the incised urethral plate.

Objective: Snodgrass recently described a form of urethral tubularization with longitudinal incision of the urethral plate to create an elliptical meatus. To prevent fistulae, a transverse island of dorsal subcutaneous tissue was used to cover the repair. The generation of this flap may compromise blood supply to the skin that is used in the skin closure, and predispose to penile torsion. We have modified the technique to address these concerns, while accomplishing the major goal of functional success-particularly minimizing or eliminating fistulae.

Methods: Eighteen boys, aged 6 months to 6 years, with distal or midshaft hypospadias, underwent a one-stage repair using a modification of Snodgrass' technique. Rather than a transverse island flap of subcutaneous tissue, a local de-epithelialized skin flap was used to cover the urethroplasty.

Results: Sixteen patients have returned for follow-up, and all patients have an excellent cosmetic and functional result with an elliptical glanular meatus. There have been no cases of fistula or meatal stenosis.

Conclusions: Distal hypospadias repair utilizing a de-epithelialized local skin flap to cover a tubularized incised urethral plate gives an excellent cosmetic and functional result. Optimal blood supply to the ultimate skin coverage is preserved, and penile torsion is avoided.