Double Onlay Preputial Flap for Proximal Hypospadias Repair

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Abstract
We describe a new technique for primary repair of proximal hypospadias. The double onlay preputial flap combines the principles of onlay urethroplasty and the double face preputial flap, namely preservation of the urethral plate and use of a total preputial flap. Common problems of classic onlay urethroplasty, including rotation and asymmetry of the penile shaft when the preputial flap is brought laterally around the shaft and the viability of the Byars flaps after dissecting the pedicle for the onlay flap, are avoided with this technique by passing the penis through a buttonhole incision in the pedicle of the total preputial flap. Onlay urethroplasty is performed using a secondary flap outlined from the total preputial flap. The remainder of the total preputial flap tissue is used to cover the ventral skin defect. Since June 1994, 18 patients 6 months to 9 years old (median age 10 months) underwent primary hypospadias repair with the double onlay preputial flap technique, representing 15 percent of all repairs performed. Complications included a urethrocutaneous fistula, persistent chordee, a recessed meatus and a urethral diverticulum in 1 patient each. In all cases complications were corrected surgically with minor procedures. No patient had urethral stricture. Functional and cosmetic results were satisfactory in all patients. This technique yields good functional and cosmetic results for proximal hypospadias repair.