A combined tubularized/onlay graft technique for total correction of severe hypospadias

Surgical correction of penoscrotal transposition associated with hypospadias and bifid scrotum: our experience of two-stage repair

OBJECTIVE

To assess the results of surgical correction of incomplete penoscrotal transposition and bifid scrotum using the Glenn-Anderson technique, and its impact on subsequent definitive urethroplasties and final outcome.

PATIENTS AND METHODS

We retrospectively reviewed 31 children that underwent two-stage repair for incomplete penoscrotal transposition with severe hypospadias and bifid scrotum. Patient age at stage 1 ranged from 12 to 24 months (average 16 months). The operative principle was based on achieving a normal anatomical position of the penis and scrotum using the Glenn-Anderson technique. In cases with associated scrotal or perineal hypospadias this was transformed into a penoscrotal hypospadias. Final stage urethroplasty was performed after a period of 6 months with a modified Thiersch-Duplay technique.

RESULTS

Cosmetic and functional results of the Glenn-Anderson operation were excellent. No major complications were observed. Of 31 patients, 12 (38%) had complications secondary to urethral repair.

CONCLUSION

The Glenn-Anderson technique for reconstruction of penoscrotal transposition and bifid scrotum is a simple technique, free of major complications. The purpose of this intervention is to improve the cosmetic appearance and function of the penis. A minimum period of 6 months between consecutive urethroplasties is important. The final stage guarantees good functional and cosmetic results preserving the prepuce.

Marzouk skin tag two-stage urethroplasty for the repair of complex cases of hypospadias

BACKGROUND

Cases of hypospadias with severe chordee and deficient skin, as well as those for re-do hypospadias or fistula repair, are considered complex cases. Depending on the degree of complexity of the defect, a two-stage procedure may still be advisable. The present paper describes the so-called Marzouk skin tag urethroplasty as a new two-stage procedure advisable for use in such difficult cases.

METHODS

The Marzouk skin tag urethroplasty procedure was performed on 16 complex cases. The first stage consists of urethral mobilization plus the double-buttonhole procedure (designed by the author) to form a midline ventral skin tag proximal to an advanced hypospadiac orifice. This skin tag is fashioned, 6 months later, by the author's special techniques (type I in 12 patients and type II in four patients) to form the neourethral tube and its coverage with minimal dissection.

RESULTS

The operation resulted in a straight penis with neomeatus at the glans top in all 16 cases without significant complications. Both type I and II procedures give good functional results. The type I procedure has a superior cosmetic result. The follow-up period ranged from 4 to 8 months.

CONCLUSIONS

The double-buttonhole modification can solve the problem of deficient skin and simplify a safe second-stage procedure. The Marzouk skin tag operation (types I and II) can be an additional option to be used when indicated.