Preservation of the Urethral Plate in Hypospadias Repair: Extended Applications and Further Experience with the Onlay Island Flap Urethroplasty

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Abstract
The onlay island flap urethroplasty, a variant of the transverse preputial (tubularized) island flap, was originally described for repair of anterior hypospadias. However, many case of mid and proximal hypospadias have a well developed urthreal plate and exhibit little or no chordee after release of skin tethering. Patients with this combinations of findings are ideal candidates for onlay island flap urethroplasty regardless of initial meatal position. During the last 5 years the onlay island flap has been used for repair and mid to posterior hypospadias in 31 patients (38% of the cases). These are variants that formerly would have required more extensive urethroplasty. Because of the technical advantages of the onlay island flap this alteration in technique selection has resulted in fewer complications. When applied to mid and posterior hypospadias the onlay island flap maintained a significantly lower complication rate (10%) compared to other standard techniques. Preservation of the urethral plate in hypospadias repair is a principle with significant implication to an extended variety of hypospadias.