Hypospadias Repair Using Transverse Preputial Island Flap (Modified Asopa Procedure)
Journal of Pediatric Nephrology,
Vol. 6 No. 3 (2018),
19 February 2019
Introduction: The modified Asopa's procedure for repair of hypospadias is well established and suited for patient characteristics for which Snodgrass urethroplasty cannot be done. We describe our experience with this procedure in 30 patients managed with this procedure highlighting the factors affecting outcome in this repair.
Materials and Methods: Data of 30 patients (age range 2.5-15 years) who underwent hypospadias repair in a tertiary care teaching institution from 2012 to 2015 with modified Asopa procedure (Hodgson XX technique) utilizing Transverse Preputial Island Flap by a single surgeon were reviewed and retrospectively analyzed according to age of patients, site of meatus, presence or absence or chordee, glans configuration and complications - fistula, glans dehiscence, meatal stenosis. These complications were further analyzed with respect to the various patient characteristics and GMS (Glans, Meatus and Shaft) score.
Results: The mean age of presentation was 5.5 years and mean follow-up period was 22 months. The mean total GMS score was 8.5; range being 11 to 5. In total, only six patients had complications (20%). The patients with low GMS score (7 or less) had no complications. The complication rate was more in proximal hypospadias repair (n= 5/24) when compared with distal hypospadias (n=1/6). There were more complications in patients with chordee (n=4/6) and those with conical glans (n=4/6).
Conclusion: Location of the meatus, presence/absence of chordee and glans configuration affect outcome in patients undergoing modified Asopa's procedure for hypospadias repair.Keywords: hypospadias; Asopa's procedure; Child; Complications; Outcome.
- Modified Asopa's Procedure
How to Cite
Asopa HS. Newer concepts in the management of hypospadias and its complications. Ann R CollSurg Engl. 1998;80:161- 168.
Backus LH, Defelice CA. Hypospadias: then and now. PlastReconstrSurg1960;25:146-68.
Dieffenbach JF. Guerision des fenlescongenitalesdela Verge, de Hypospadias. Gazhebd de med 1837;5:156.
Duckett JW, Hypospadias. In: Walsh PC, Retik AB, Stamey TA, Vaughan ED, eds. Campbell’s Urology, 6th edition. Philadelphia: WB Saunders Co, 1992:1892-1919.
Devine CJ Jr, Horton CE. A one stage hypospadias repair. F Urol 1961;85:166-72.
Hadidi AT, Men behind principles and principles behind techniques.In Hadidi AT, Azmy AF, eds. Hypospadias Surgery: An Illustrated Guide. Springer-Verlag Berlin Heidelberg 2004:19-49.
Wacksman J, The Modified Asopa (Hodgson XX) Procedure to Repair Hypospadias with Chordee. In Hadidi AT, Azmy AF, eds. Hypospadias Surgery: An Illustrated Guide. Springer-Verlag Berlin Heidelberg 2004:187-90.
Singh BP, Solanki FS, Kapoor R, Dassi V, Kaswan HK, Agrawal V et al. Factors predicting success in hypospadias repair using preputial flap with limited pedicle mobilization (Asopa procedure).Urology. 2010 Jul;76(1):92-6.
Patel RP, Shukla AR, Austin JC, Canning DA. Modified tubularized transverse preputial island flap repair for severe proximal hypospadias. BJU International 2005;95:901-4. doi:10.1111/j.1464-410X.2005.05425.x
Sowande AO, Olajide AO, Salako AA, Olajide FO, Adejuyigbe O, Talabi AO. Experience with transverse preputial island flap for repair of hypospadias in Ile-Ife, Nigeria. Practitioners Section 2009;6(1):40-3.
Duckett JW Jr. Transverse preputial island flap technique for repair of hypospadias. UrolClin N Amer1980;7:423-30.
Duckett JW. The island flap technique for hypospadias repair. UrolClin North Am 1981;8:503-8.
Elder JS, Duckett JW. Urethral reconstruction following an unsuccessful one-stage hypospadias repair. World J Urol 1987;5:19-6.
Erol A, Baskin LS, Liu YW, Liu WH. Anatomical studies of the urethral plate: why preservation of the urethral plate is important in hypospadias repair. BJU International (2000);85:728-34.
Ghali AM. Hypospadias repair by skin flaps: A comparison of onlay preputial island flaps with either Mathieu’s meatal-based or Duckett’stubularized preputial flaps. BJU Int. 1999;83:1032- 1038.
Ozturk H, Onen A, Otçu S, et al. The outcome of one-stage hypospadias repairs. J Pediatr Urol. 2005;1:261-266.
Imamog˘lu MA, Bakirtas¸ H, Tuygun C, et al. Clinical experiences with different one-staged surgical methods for primary hypospadias cases. IntUrolNephrol. 2002;33:107-112.
Hollowell JG, Keating MA, Snyder HM 3rd, et al. Preservation of the urethral plate in hypospadias repair: extended applications and further experience with the onlay island flap urethroplasty. J Urol 1990;143:98–100.
Chin TW, Liu CS, Wei CF. Hypospadias repair using a double onlay preputial flap. PediatrSurgInt2001;17:496–8.
Wiener JS, Sutherland RW, Roth DR, et al. Comparison of onlay and tubularized island flaps of inner preputial skin for the repair of proximal hypospadias. J Urol 1997;158:1172–4.
Barroso U Jr, Jednak R, Spencer Barthold J, et al. Further experience with the double onlay preputial flap for hypospadias repair. J Urol 2000;164:998–1001.
Emir L, Germiyanoglu C, Erol D. Onlay island flap urethroplasty: a comparative analysis of primary versus reoperative cases. Urology 2003;61:216–9.
Demirbilek S, Kanmaz T, Aydin G, et al. Outcomes of one-stage techniques for proximal hypospadias repair. Urology 2001; 58:267–70.
Bhat A. Extended urethral mobilization in incised plate urethroplasty for severe hypospadias: A variation in technique to improve chordee correction. J Urol. 2007;178:1031-1035.
Palmer LS, Palmer JS, Franco I, et al. The “long Snodgrass”: Applying the tubularized incised plate urethroplasty to penoscrotal hypospadias in 1-stage or 2-stage repairs. J Urol. 2002;168:1748- 1749
Braga LH, Pippi Salle JL, Lorenzo AJ, et al. Comparative analysis of tubularized incised plate versus onlay island flap urethroplasty for penoscrotal hypospadias. J Urol. 2007;178:1451-1456
SujijantararatP, Chaiyaprasithi B. Comparative Outcome Between Transverse Island Flap Onlay and Tubularized Incised Plate for Primary Hypospadias Repair. Asian J Surg. 2009 Oct;32(4):229-33. doi: 10.1016/S1015-9584(09)60399-7.
Snodgrass W, Lorenzo A. Tubularized incised-plate urethroplasty for proximal hypospadias. BJU Int2002;89:98–100.
Patel RP, Shukla AR, Snyder HM 3rd. The island tube and island onlay hypospadias repairs offer excellent long- term outcomes: a 14-year follow-up. J Urol 2004; 172: 1717–19.
Elder JS, Duckett JW, Snyder HM. Onlay island flap in the repair of mid and distal penile hypospadias without chordee. J Urol 1987; 138: 376–9.
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