Tractament d'hipospàdies proximals en un temps quirúrgic

Background. The surgical correction of proximal severe hypospadias, particularly those associated with penoscrotal transposition (penis buried in scrotum), represents a major challenge for pediatric surgeons. A sequential approach is widely accepted, with the aim of preserving the vascularization of the neourethra and avoiding damage to the coverage of the penis. Method. Between 1997 and 2007, 88 patients with proximal severe hypospadias underwent surgical correction. After 2005, for patients with hypospadias with penoscrotal transposition, we performed a single-stage urethroplasty in association with a new cutaneoplasty. Results. Age at the time of surgery ranged from 15 to 64 months (mean 29 months). Associated malformations were present in 19 patients (21.6%), and 14 patients (16%) were premature. All patients underwent repair in one single surgical intervention. We performed Dukett-type urethroplasty in 10 patients, Onlay-type flap in 74, Onlay with oral mucosa in 2, and vesical mucosa urethroplasty in 2. The fistula rate was 17%; urethral stenosis was present in 5 patients (5.7%), and partial necrosis of the skin flap in 3 patients (3.4%) needing a re-urethroplasty. Before 2005, of the 22 patiens with penoscrotal transposition, 5 needed a new cutaneoplasty, which was associated to a dorsal Nesbitt plicature in 2 cases. After 2005, none of the 11 patients presenting with penoscrotal transposition needed a posterior cutaneoplasty. With a median follow-up is 54 months (range 1 month to 10 years), urine flow and spurt are normal in all cases, and the penis is located outside of the scrotal bag in all but one patient. We consider that the esthetic results were satisfactory in most of the cases. Discussion. In our experience, all cases of hypospadias, including those associated with buried penis, can be repaired in one single surgical intervention.