Urologists at Work TISSUE EXPANDER ENHANCED ONLAY ISLAND FLAP IN THE REPAIR OF SEVERE HYPOSPADIAS

The use of a tissue expander in the ventral aspect of the penis in a patient with penoscrotal hypospadias was first reported by Vordermark.1 To our knowledge there have been no other reports concerning the use of tissue expanders for the treatment of hypospadias. We report the successful use of a tissue expander in the repair of scrotal hypospadias in 1 adult and 2 adolescent cases. METHOD A 60 cc tissue expander was used to stretch previously relocated dorsal shaft skin in 2 adolescents (ages 13 and 15 years) and 1 adult (age 36 years) with scrotal hypospadias. In 2 cases the expander was placed after multiple failed procedures and in 1 case as an elective surgery after a first stage to straighten the phallus. In all cases the device was placed between the corpora cavernosa and dorsal skin through a coronal incision, and the injection port was placed in the subcutaneous tissue of the lower abdomen. Expansion was begun at weekly intervals 2 weeks after placement, and definitive surgery was performed after 2 months of progressive distention. Island flaps 11 to 12 cm. long were obtained and used for urethral reconstruction in an onlay fashion in 2 cases, and as a combined onlay tubularized island flap in 1 case (see figure). Partial dehiscence of the glanuloplasty was observed in 1 patient. Long-term followup has demonstrated good functional and cosmetic results in all cases. DISCUSSION