Results of Onlay Flap Versus Durham Smith in Proximal Hypospadias

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



Introduction: Urethroplasty was originally used for the repair of hypospadias of the mid and distal portion of the penis but since complications of the two-stage Durham Smith technique such as mega urethra and proximal anastomotic strictures became apparent; the Onlay island flap technique has been increasingly used in more severe cases of hypospadias. The aim of our study was to compare the outcome of these two techniques in the surgical treatment of hypospadias.

Material and Methods: In this retrospective study, thirty -three patients underwent surgery for the treatment of hypospadias. The two- stage Durham smith repair was used for 17 cases and the onlay island flap technique was carried out on 16 patients. Data was analyzed using SPSS software version 21 and complication rates of the two procedures were compared.

Results: Altogether, frequency of complications was higher in the smith technique than the 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 the two techniques (41% for Smith technique and 13% for onlay repair; P=0.117). Meatoplasty was done for meatal stricture in the smith group. Moreover, the smith technique failed completely in one case who then underwent Tabularized Inside-Plate (TIP). There was a case of chordee recurrence in the smith technique; for which a dorsal Nesbit plication was carried out. The mean days of hospitalization was more with the smith technique (7.1 days vs 5.0, P=0.016). In addition, the mean cases which required reoperation was higher in the smith group than the onlay flap (1.0 vs 0.2, P=0.025).

Conclusions: The results of this study showed that the onlay flap technique had lower complications and reoperation rates than the two-stage smith technique. In addition, the onlay flap technique has fewer days of hospitalization than the 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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Ellsworth P, Cendron M, Ritland D, et al: Hypospadias repair in the 1990s. AORN J 1999;69(1):148-53, 55-6, 59-61.

Kallen B, Bertollini R, Castilla E, et al: A joint international study on the epidemiology of hypospadias. Acta Paediatr Scand Suppl 1986;324:1-52.

Sheldon CA, Duckett JW: Hypospadias. Pediatr Clin North Am 1987;34(5):1259-72.

Bracka A: A long-term view of hypospadias. Br J Plast Surg 1989;42(3):251-5.

King PA, Barker A: The management of hypospadias. Aust N Z J Surg 1987;57(9):651-3.

DeLair SM, Tanaka ST, Yap SA, et al: Training residents in hypospadias repair: variations of involvement. J Urol 2008;179(3):1102-6.

Demirbilek S, Kanmaz T, Aydin G, et al: Outcomes of one-stage techniques for proximal hypospadias repair. Urology 2001;58(2):267-70.

Holland AJ, Abubacker M, Smith GH, et al: Management of urethrocutaneous fistula following hypospadias repair. Pediatr Surg Int 2008;24(9):1047-51.

Castanon M, Munoz E, Carrasco R, et al: Treatment of proximal hypospadias with a tubularized island flap urethroplasty and the onlay technique: a comparative study. J Pediatr Surg 2000;35(10):1453-5.

Mohajerzadeh L, Mirshemirani A, Rouzrokh M, et al: Evaluation of Onlay Island Flap Technique in Shallow Urethral Plate Hypospadiasis. Iran J Pediatr 2016;26(1):e660.

Javid L, Pansota MS, Ahmad I, et al: Comparison between tubularised incised plate urethroplasty and onlay island flap repair in mid and proximal penile hypospadias. J Pak Med Assoc 2014;64(4):415-8.

Kagantsov IM: Comparison of the results of correction of medium and proximal hypospadias using onlay island flap and tubularized incised plate methods in children. Urologiia 2013(5):89-91.

Singal AK, Dubey M, Jain V: Transverse preputial onlay island flap urethroplasty for single-stage correction of proximal hypospadias. World J Urol 2016;34(7):1019-24.

Chandrasekharam VV: Single-stage repair of hypospadias using longitudinal dorsal island flap: Single-surgeon experience with 102 cases. Indian J Urol 2013;29(1):48-52.

Xiao D, Nie X, Wang W, et al: Comparison of transverse island flap onlay and tubularized incised-plate urethroplasties for primary proximal hypospadias: a systematic review and meta-analysis. PLoS One 2014;9(9):e106917.



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