Results of Onlay Flap Versus Durham Smith in Proximal Hypospadias

Leili Mohajerzadeh, Ahmad Khaleghnejad Tabari, Haleh Noroozi, Saran Lotfollahzadeh, Khashayar Atqiaee Atqiaee



Background:The onlay island flap urethroplasty was first described in the repair of mid and distal penile hypospadias. Since then, this technique has been increasingly used in more severe cases of hypospadias, because of the complications of two-stage Durham smith, mainly mega urethra and proximal anastomotic strictures. The aim of this study was to compare the outcome of these two techniques.

Methods:This study was aanalytic retrospective study. Thirty -three patients underwent surgical treatment for hypospadias. Two stage Durham smith performed in 17 cases, and the onlay island flap technique used in 16 patients.The data entered in SPSS software version 21 and compared the complication rate in two procedures.Results: Altogether, frequency of complications was higher in smith technique than onlay flap procedure without any significant difference between the two techniques (47% for Smith technique and 19% for onlay repair; P=0.141).Fistula was the most frequent complication in two techniques (41% for Smith technique and 13% for onlay repair; P=0.117). The meatoplasty done formeatal stricture in the smith group. Moreover, smith technique was complete failure in one case who had undertaken Tabularized Inside-Plate (TIP). There was one case of chordee recurrence in smith technique that a dorsal Nesbit plication also was necessary. The mean days of hospitalization was more than smith technique (7.1 days vs 5.0, P=0.016). In addition, the mean of reoperation was higher in smith than onlay flap (1.0 vs 0.2, P=0.025).Conclusions:The results of this study showed that that onlay flap technique had lower complicationsand reoperationthan two-stage smith technique. In addition, onlay flap technique has fewer days of hospitalization than smith technique, resulting in lower costs to the health system and patients.



Onlay island flap; two-stage Durham smith; ProximalHypospadias; complications

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