A comparative study of distal hypospadias repair combined with preputioplasty vs repair using conventional circumcision technique
Keywords:Distal penile hypospadias, Preputioplasty, Circumcision, Preputial hood.
Background: Hypospadias is one of the most common congenital anomalies characterised by underdevelopment of the ventral anatomical structures of the penis including skin, urethra, corpora spongiosum and prepuce and urethral opening can occur anywhere from the perineum to the ventral aspect of penis. This study evaluated and compared short-term cosmetic and functional outcomes and complications of distal hypospadias repair combined with preputioplasty with the repair using circumcision. Materials & Methods: Patients were divided in two groups with 25 patients in either group. Group A patients underwent urethroplasty with circumcision whereas Group B patients were offered preputioplasty as an additional procedure. Clinical examination included location of the urethral meatus on the ventral aspect of the penis, presence or absence of associated chordee, stretched penile length, penile circumference, glans girth, depth of the navicular fossa or glans groove, urethral plate width, status of the preputial hood and testicular examination. Post-operatively, penis was examined for the location and shape of the neo-meatus, any complications in the form of meatal stenosis, urethrocutaneous fistula, preputial dehiscence and phimosis. Results: Both the groups were comparable with respect to the age at presentation and status of the urinary stream. Distal penile hypospadias predominated in both the groups and it was present in 21 patients in group A and 24 patients in group B. Rest of the babies had sub-coronal hypospadias. Preputial hood and navicular fossa/glans groove were good in either group. Mean stretched penile length in group A was 5.14 cm and it was 4.78 cm in group B children (p value- 0.141). Mean penile circumference of group A and group B patients ware 3.88 cm and 3.68 cm respectively (p value- 0.139). Girth of the glans and mean urethral plate width were also comparable (p values- 0.258 and 0.621 respectively). Final meatal appearance was slit shaped and wide in 22 patients in group A and 21 patients in group B. Urethro-cutaneous fistula was observed in two babies in group A and a single child in group B. One of the children was noted to have preputial dehiscence after two weeks. Prepuce was retracting well in 24 children during the 3rd follow up whereas one patient developed phimosis and thus results of the preputioplasty as an adjunct procedure were found to be satisfactory. Conclusion: Preputioplasty is a safe procedure and should be offered to all children undergoing single-stage distal penile hypospadias repair as it provides a near normal penile appearance at the cost of additional approximately 8% foreskin related complication rate.