91 / 330
91
19–22 APRIL, 2017, BARCELONA, SPAIN
11:53–11:56
S8-4 (PP)
SHOULD A COVER FLAP BE USED SYSTEMATICALLY
FOR URETHROPLASTY WHATEVER THE SEVERITY
OF HYPOSPADIAS? A COMPARATIVE STUDY
ON 344 PATIENTS
Nicolas KALFA
1
, Mohamed Sami SFAR
1
, Margot OLLIVIER
1
, Sarah GARNIER
1
,
Amandine COFFY
2
, Paula BORREGO
1
, Christohpe LOPEZ
1
and Charles SULTAN
3
1) Hôpital Lapeyronie, CHU de Montpellier, Service de Chirurgie et Urologie Pédiatrique, Montpellier, FRANCE
- 2) Université de Montpellier, Université Montpellier I, Institut Universitaire de Recherche Clinique, Montpellier
Cedex 5, FRANCE - 3) Hôpital Arnaud de Villeneuve, CHU de Montpellier et Université Montpellier 1, Département
d’Endocrinologie Pédiatrique, Montpellier, FRANCE
PURPOSE
Interposition of a well-vascularized tissue between the penile skin and neourethra has been advo-
cated to prevent urethro-cutaneous fistula in hypospadias repair. We aimed to evaluate the benefit
of this technique according to the severity of hypospadias to determine in which phenotype it should
be performed.
MATERIAL AND METHODS
A retrospective database on patients with a primary hypospadias repair was performed from
2009 to 2015. Only patients undergoing urethroplasty based on the principle of a tubularization
of the urethral plate were selected to ensure comparable groups. Patients were assigned in two
groups according to the use or not of a cover flap.
RESULTS
Three-hundred-and-forty-four patients were included with anterior(57,8%), midshaft(25,3%) and
posterior hypospadias(16,9%). Group 1 (n=172 with flap) and group 2 (n=172 without) were
compared. The overall rate of fistula was reduced with flap (7,55% vs 17,44%, p=0,0056). When
stratifying the results according to the severity of hypospadias, it appeared that the flap efficacy was
not homogeneous(p=0,021). The risk of fistula was significantly decreased for severe hypospadias
only(11.3% vs 42.8%, p=0.01). Whereas the severity of phenotype increases the risk of fistula
without coverage(p=0.02), the protective effect of flap mitigates this risk: the rate of fistula is no
longer different in anterior, mid-penile and posterior hypospadias(p=0,53). The multivariate analysis
confirmed that only the severity of hypospadias and the covering of the urethroplasty influence the
risk of fistula.
CONCLUSIONS
The more severe the hypospadias is, the more effective the cover flap is. Even if covering ante-
rior hypospadias remains debated, the severe phenotype should systematically benefit from this
technique.
11:56–12:08
Discussion