A STRATEGY FOR REPAIRING MODERATELY SEVERE
HYPOSPADIAS USING ONLAY URETHROPLASTY VERSUS
YUTARO HAYASHI, YOSHIYUKI KOJIMA, AKIHIRO NAKANE, TETSUJI MARUYAMA,
Objectives. Moderately severe hypospadias can be repaired by a simple onlay island ﬂap procedure with
penile dorsal plication in most patients. However, when the penile curvature could not be corrected, and the
urethral plate could not be preserved by the procedure, a combined procedure of onlay and tubularized
island ﬂap is subsequently needed.
Methods. Onlay urethroplasty was performed to repair hypospadias in 39 patients with hypospadias.
However, the combined procedure (onlay-tube-onlay urethroplasty) was performed on 6 patients who had
severe penile curvature even after skin degloving.
Results. Hypospadias was repaired successfully without complications in 30 (90.9%) of the 33 patients by
conventional onlay urethroplasty alone. Of the 6 patients who underwent onlay-tube-onlay urethroplasty, 1
patient developed ﬁstula and 1 developed meatal stenosis, for a success rate of 66.7%. The complications
in all patients were later resolved.
Conclusions. We recommend switching to onlay-tube-onlay urethroplasty when the attempt to repair
moderately severe hypospadias by the simple onlay procedure has to be abandoned, and the urethral plate
needs to be divided.
61: 1019–1022, 2003. © 2003, Elsevier Inc.
rethroplasty with a vascularized skin ﬂap in-
stead of a free preputial graft
has been the
mainstay for the repair of hypospadias for the past
two decades. In particular, the island ﬂap from the
is feasible for urethroplasty
because the inner prepuce of the foreskin is a hair-
less area. The onlay preputial ﬂap procedure,
which uses the dorsal skin and preserves the ure-
thral plate, has been used for repairing hypospa-
dias without chordee.
On the other hand, the tu-
bularized preputial ﬂap procedure has been used
after correcting the penile curvature by removing
the urethral plate.
Recently, however, the onlay
preputial ﬂap procedure was used for the repair of
proximal, as well as distal, hypospadias when the
penile curvature could be corrected by dorsal pli-
That is, tubularized island ﬂap urethro-
plasty is now used only when the attempt to correct
the penile curvature by the onlay procedure fails.
The urethral plate is dissected to release the chor-
dee and correct the curvature. Then, a neourethra
is made from the tubularized preputial ﬂap. Re-
cently, we have been using the onlay procedure
with the urethral plate preserved for those with
penile hypospadias or penoscrotal hypospadias as
the main procedure. However, when we ﬁnd intra-
operatively that the penile curvature cannot be cor-
rected by the dorsal plication, deﬁned here as a
curvature of greater than 60°, we divide the ure-
thral plate at the severest part of the curvature.
This releases the chordee. Then, we perform ure-
throplasty with the tubularized island ﬂap where
the urethral plate is absent, and urethroplasty with
the onlay island ﬂap is performed at both ends of
the divided urethral plate.
MATERIAL AND METHODS
From January 1999 to March 2002, we used the onlay ure-
throplasty procedure to repair hypospadias in 39 patients.
We made a circumferential subglandular skin incision dor-
sally and a perimeatal incision on the ventrum. The penile skin
From the Department of Urology, Nagoya City University Med-
ical School, Nagoya, Japan
Reprint requests: Yutaro Hayashi, M.D., Department of Urol-
ogy, Nagoya City University Medical School, 1 Kawasumi, Mi-
zuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
Submitted: August 26, 2002, accepted (with revisions):
November 27, 2002
© 2003, E
ALL RIGHTS RESERVED