SHOULD A COVER FLAP BE USED SYSTEMATICALLY FOR URETHROPLASTY WHATEVER THE SEVERITY OF HYPOSPADIAS?

You have accessJournal of UrologyPediatrics: Hypospadias and Penile Surgery (MP65)1 Apr 2020MP65-04 SHOULD A COVER FLAP BE USED SYSTEMATICALLY FOR URETHROPLASTY WHATEVER THE SEVERITY OF HYPOSPADIAS? Benoit Teissier*, Sami Sfar, Margot Ollivier, Sarah Garnier, Paula Borrego, Christophe Lopez, Cyril Amouroux, Francoise Paris, and Nicolas Kalfa Benoit Teissier*Benoit Teissier* More articles by this author , Sami SfarSami Sfar More articles by this author , Margot OllivierMargot Ollivier More articles by this author , Sarah GarnierSarah Garnier More articles by this author , Paula BorregoPaula Borrego More articles by this author , Christophe LopezChristophe Lopez More articles by this author , Cyril AmourouxCyril Amouroux More articles by this author , Francoise ParisFrancoise Paris More articles by this author , and Nicolas KalfaNicolas Kalfa More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000940.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Interposition of a well-vascularized tissue between the penile skin and the neourethra has been advocated to prevent urethro-cutaneous fistula in hypospadias repair. Since some previous studies do not include comparable phenotypes and lack control groups, it remains unclear when a cover flap should be used. The aim of this case control study was to evaluate the impact of urethral covering with a vascularized tissue according to the severity of hypospadias and to determine which patients should benefit from this technique. METHODS: A retrospective comparative study on patients with a primary hypospadias repair was performed (2011-2017). Only patients undergoing urethroplasty based on the principle of a tubularization were selected to ensure comparable groups. Patients were assigned in two groups according to the use or not of a cover flap. The cover layer used the deepithelialized foreskin or a vaginal flap according the available tissue. RESULTS: 366 patients were included with anterior (58,2%), midshaft (25,9%) and posterior hypospadias(15,9%). The median follow-up was 47 months (24 months - 6 years) Outcomes with (n=194) and without flap (n=172) were compared. The overall rate of fistula was reduced with flap (p=0,002, see table). Whereas the severity of hypospadias is a risk factor for fistula without flap (p=0.02), it is no longer when uretroplasty is covered (p=0.32). When stratifying the results according to the severity of hypospadias, the flap significantly reduces the risk of fistula in each group but its effectiveness is not homogeneous. The risk of fistula is dramatically reduced in posterior forms (OR:5.85) but midpenile and anterior hypospadias still benefit from this technique (OR 3.69 and 3.37 respectively). CONCLUSIONS: The more severe the hypospadias is, the more effective the cover flap is. But all forms of hypospadias - included minor forms - benefit from this technique with a significant reduction of the fistula risk. A cover flap should be used systematically in all hypospadias repairs. Source of Funding: National Center of Reference for Rare Disease Constitutive South for Genital Defects © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e974-e974 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benoit Teissier* More articles by this author Sami Sfar More articles by this author Margot Ollivier More articles by this author Sarah Garnier More articles by this author Paula Borrego More articles by this author Christophe Lopez More articles by this author Cyril Amouroux More articles by this author Francoise Paris More articles by this author Nicolas Kalfa More articles by this author Expand All Advertisement PDF downloadLoading ...