Korean J Urol.  2014 Nov;55(11):750-755. 10.4111/kju.2014.55.11.750.

Urethroplasty by Use of Turnover Flaps (Modified Mathieu Procedure) for Distal Hypospadias Repair in Adolescents: Comparison With the Tubularized Incised Plate Procedure

• Bae SH
• Lee JN
• Kim HT
• Chung SK

• KMID: 2069918
• DOI: http://doi.org/10.4111/kju.2014.55.11.750

Abstract

PURPOSE
The purpose of this study was to examine whether urethroplasty with a turnover flap, as an alternative method of distal hypospadias repair in adolescents, improves the outcome of surgery.
MATERIALS AND METHODS
Between January 2004 and December 2013, a total of 38 adolescents (aged 11-17 years) underwent distal hypospadias repair with either the tubularized incised plate (TIP) procedure (n=25) or the turnover flap procedure (n=13). The turnover flap procedure was performed with a proximal, ventral penile flap that was turned over to cover the urethral plate. Patient demographics, perioperative outcomes, complications, and postoperative uroflowmetry in each surgical group were analyzed retrospectively.
RESULTS
The patient demographics were similar in the two groups. There were no significant differences in perioperative outcomes between the groups, including mean operative time, duration of hospital stay, and urethral catheterization. The number of patients with at least one complication, including wound dehiscence, urethrocutaneous fistula, meatal stenosis, and urethral stricture, was lower in the turnover flap group (1/13, 7.7%) than in the TIP group (11/25, 44%, p=0.030). The incidence of meatal stenosis was lower in the turnover flap group (0/12, 0%) than in the TIP group (6/25, 24%). In postoperative uroflowmetry, the plateau-shaped curve rate was lower in the turnover flap group (1/12, 8.3%) than in the TIP group (5/19, 26.3%); the peak flow was higher (p=0.030).
CONCLUSIONS
The turnover flap procedure is clinically useful for repairing adolescent distal hypospadias because it offers lower complication rates and better functional outcomes than TIP.

Keyword

Adolescent; Complications; Hypospadias

MeSH Terms

Adolescent
Child
Follow-Up Studies
Humans
Hypospadias/*surgery
Male
Reconstructive Surgical Procedures/*methods
Retrospective Studies
*Surgical Flaps
Suture Techniques/*instrumentation
Time Factors
Treatment Outcome
Urethra/*surgery
Urologic Surgical Procedures, Male/*methods
Wound Healing

Figure

• 

  FIG. 1 Images of the turnover flap technique: (A) preoperative, (B) 2 weeks after surgery, (C) 3 months after surgery.

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