Repair of hypospadias complications using the onlay island flap urethroplasty

Repair of hypospadias has become a routine procedure for pediatric surgeons. With refinement of the surgical techniques during the last decade, the incidence of complications has decreased substantially, but secondary procedures to correct complications remain challenging. While long used for primary hypospadias repair, onlay island flaps have not been widely considered as a secondary procedure. We reviewed 156 patients who underwent onlay island flap urethroplasty in this institution and identified six (3.8%) who underwent the procedure for correction of complications of previous hypospadias repair, including big urethrocutaneous fistula, disruption of the neourethra, and severe meatal retraction. Prior surgical procedures include the MAGPI procedure in one case, two-stage urethroplasty in two, and transverse island tube urethroplasty in three. The average age of patients at the secondary procedure was 4.6 years (range 1 to 12 years). The interval from initial surgery to secondary onlay island flap urethroplasty was greater than one year in all patients. A small fistula developed in one patient and mild meatal retraction in another patient. Preservation of the previous posterior skin strip as a urethral plate seemed to have better healing to the onlay flap that may account for the lower complication rate observed with this repair. Onlay island flap urethroplasty should be considered for correction of complications after hypospadias repair.