The island tube and island onlay hypospadias repairs offer excellent long-term outcomes: A 14-year followup

Purpose: We have used an inner preputial flap as a transverse island tube (IT) for the 1-stage repair of proximal hypospadias when the urethral plate could not be preserved and as an island onlay flap (IO) when the urethral plate could be preserved for more than 20 years at our institution. We report long-term followup and an outcome comparison of these 2 techniques. Materials and Methods: We retrospectively reviewed our records for all patients who underwent proximal hypospadias repair with either the IT or IO procedure between 1981 and 1992 by 1 surgeon (HMS). We randomly contacted these former patients to undergo a long-term followup examination, consisting of postoperative history, physical examination and uroflowmetry with post-void residual measurement. A review of patient charts was completed for perioperative complications or the need for secondary procedures. Results: Patient information could be retrieved for 73 of 125 patients who underwent penoscrotal or more severe hypospadias repair with either the IT or IO procedure during the defined interval. We were able to contact 49 of these former patients following a minimum of 10 years and 30 patients agreed to return for a long-term followup examination. The IT and IO repairs were performed on 14 and 16 boys, respectively, at a mean age of 16.8 months (range 8 to 74). At a mean followup of 14.2 years for both groups (range 144 to 253 months) 2 boys in the IT group (14.2%) and none in the IO group had a fistula requiring repair. Distal stenosis requiring meatoplasty occurred in 1 and 2 patients in the IT and IO groups, respectively. There were no urethral strictures and uroflowmetry was available for 11 patients in the IT group and 14 in the IO groups with mean maximal flow rates of 17.3 and 21.8 ml per second (p = 0.343) and mean post-void residuals of 5.0 and 2.36 ml per second, respectively (p = 0.249). Conclusions: Unlike other forms of substitution urethroplasty, vascularized flaps based on preputial skin appear to be unique in that they do not have the long-term stricture rate seen with substitution urethroplasty using nongenital skin. The IT and IO repairs provided excellent long-term cosmetic and functional results. As the IT does have a higher incidence of postoperative complications, we have continued to extend our application of the IO to more proximal hypospadias repairs with continued success.