Tubularized longitudinal island flap of the mucosa and skin on the dorsum of the penis in the treatment of hypospadias: experience from 176 cases.

OBJECTIVE: To report the result of the treatment of hypospadias using tubularized longitudinal island flap of the mucosa and skin on the dorsum of the penis. METHODS: Between January 1995 and December 2003, 176 patients were operated on using this technique. Among them, 124 patients had penile hypospadias, 35 had the penoscrotal form, four had the scrotal form and three patients had the perineal form. After removing the whole chordee, a longitudinal pedicle island flap of mucosa and skin was created. The flap was transposed to the ventral side of the penis by the buttonhole manoeuvre, and anastomosed to the meatus. The flap was tubularized creating a neourethra. RESULTS: The length of urethral defect varied from 1.5 to 10 cm (mean, 3.5 cm). The single longitudinal flap was used in 171 patients. The combination of a longitudinal flap and a local flap was used in five patients. Fistulae occurred in 13 patients (7.4%). Torsion of the penile axis did not occur in any patient. All children voided with a single straight urinary stream, and had a normal appearance of the meatus. CONCLUSION: The technique has a low fistula occurrence rate and a good cosmetic result.