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11–14 APRIL, 2018, HELSINKI, FINLAND
11:27–11:32
S7-9 (VP)
REVERSE PEDICLE FLAP AS A BARRIER LAYER
FOR CIRCUMCISED PATIENTS WITH MEGAMEATUS
HYPOSPADIAS
Mark ZAONTZ and Christopher LONG
The Children's Hospital of Philadelphia, Urology, Philadelphia, USA
PURPOSE
Intact prepuce megameatus hypospdias is seen in approximately 5 % of all hypospadias cases.
Unfortunately, many of these children are inadvertantly circumcised at birth creating a dilemma for
obtaining good barrier layer coverage at the time of the surgical repair. Hill and Waxman et al in
1993 described a novel way to provide this coverage in the form of a reverse pedicle flap that is
presented in this video.
MATERIAL AND METHODS
Over the past 12 months, 6 circumcised boys ages ranged from 6 months – 8 years, mean
320 months) underwent hypospadias repair. The surgical technique involved the Thiersch Duplay
repair and incorporated a reverse pedicle barrier flap. This was accomplished by making a U-shaped
marking line proximal to the hypospadias meatus that was equidistant from the proximal point of the
incision, such that when the flap was procured and the skin de-epithelialized, it could easily reach
the distal glans for complete coverage over the neourethra.
RESULTS
All 6 boys had excellent results with no complications in the short term follow-up ranging from
1 month to 7 months (mean 3.7 months).
CONCLUSIONS
This "older" technique should be a part of every reconstructive pediatric urologists armamentarium
in circumstances when there is no available prepuce for barrier layer coverage over the neourethral
reconstruction. While the midline suture line tends to be longer in these instances, the cosmesis has
been excellent and is a worthwhile tradeoff for an excellent outcome. Longer term follow-up will be
needed to validate that these findings stand the test of time.
11:32–11:45
Discussion