Distal hypospadias repairing with foreskin reconstruction

Objective To evaluate the efficacy of foreskin reconstruction for distal hypospadias during tubularized incised plate (TIP) repairing. Methods From November 2017 to April 2018, 64 children with distal hypospadias underwent stented TIP urethroplasty. Foreskin reconstruction (n=28) and circumcision (n=36) were performed and compared with regards to operative duration and postoperative complications. Results The operative duration was [(109.9±2.2) vs. (143.8±3.0)] min in foreskin reconstruction and circumcision groups respectively (P<0.0001). Urethroplasty complications occurred in 4(11.1%) circumcision children (fistula, n=1; glans dehiscences, n=2; meatal stenosis, n=1) versus 2(7.1%) after prepucioplasty (fistula, n=1; meatal stenosis, n=1) (P=0.688). Skin complications included preputial dehiscences (n=2, 7.1%) in foreskin reconstruction group and penile torsion (n=1, 2.8%) in circumcision group (P=0.577). The reoperative rate was 10.7% (3/28) in foreskin reconstruction group including fistula repair (n=1) and circumcision (n=2) for foreskin dehiscence versus 8.3% (3/36) in circumcision group including fistula repair (n=1) and glansplasty (n=2) (P=0.746). No significant inter-group differences existed in urethroplasty and skin complications or reoperative rate. Conclusions During TIP repairing, foreskin reconstruction is a time-saving procedure with similar complication and reoperative rate to traditional technique. Prepuce preservation may hide most penile malformations and provide valuable local tissues for dealing with potential complications. Foreskin reconstruction is a surgical alternative for distal hypospadias using TIP repair based upon prepuce appearance and parental preference. Key words: Hypospadias; Foreskin; Postoperative complications