ESPU Congress 2018 - Abstract Book

75 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