V575: TWO STAGE COMPLEX HYPOSPADIA REPAIR WHEN URETHRAL PLATE HAS TO BE DIVIDED: VENTRAL CORPOROPLASTY USING A TUNICA VAGINALIS FLAP
VideoIntroduction and Objectives
Treatment of posterior hypospadia is an ongoing debate. One stage repair is still our preference but in some circumstances, penile curvature remains even after urethral plate division. We wanted to demonstrate our strategy of ventral corporoplasty associated with tunica vaginalis flap to reconstruct the corporal body in a two-stage strategy for proximal hypospadia surgery.
We present the video of a 4 years old boy referred for primary repair. We degloved the penis and defined the urethral plate before deciding to section it. The assessment of residual curvature after complete urethral plate division and transverse superficial cuts in albuginea forced us to perform a ventral incision of corporal body to elongate the ventral surface of the penis. We gained access to the scrotum and defined a tunica vaginalis flap. This flap was then used to reconstruct the defect in corpora and penile skin was remodelled to cover the penis, keeping the meatus in proximal place. A second surgery was scheduled for s 6 months interval.
Patient had an uneventful follow-up, we left an indwelling catheter for 7 days. Penile aspect is very satisfactory with no residual curvature.
The tunica vaginalis is an attractive alternative for ventral corporoplasty in hypospadia repair and has the advantage of prompt disposability, autologous use and does not represent a extra cost for treatment. We acknowledge the need of long term follow-up in adolescence to evaluate sexual function and quality of erections in the long setting.