Parameatal based flip flap urethroplasty as a salvage procedure for management of graft fibrosis following first stage of staged free graft hypospadias repair

Abstract

Introduction: Graft fibrosis following the first stage of a free graft staged hypospadias repair is a difficult scenario where the management has traditionally been to excise the graft and replace it with a new graft. However, still the risk of recurrent fibrosis remains making it difficult to proceed to the second stage and tubularising a fibrosed graft practically ensures a breakdown. Herein, we present our way of using parameatal based flip flap urethroplasty as a salvage procedure in this situation.

Patients and methods: This video is a step by step description of the parameatal based flip flap urethroplasty technique used in our center in patients who returned with graft fibrosis following first stage repair with a graft. Operative details and post-operative management in an index case are described.

Results: We have utilized this technique in 5 patients who had developed graft fibrosis after the first stage of a free graft staged repair. One patient had a small urethrocutaneous fistula which was subsequently closed. At a median follow-up of 34 months, all patients are voiding well from the glanular tip.

Conclusions: Our experiences demonstrates that Parameatal based flip flap urethroplasty can be an effective salvage technique for managing graft fibrosis following the first stage of a free graft staged hypospadias repair. This technique leverages available local tissue, even in complex scenarios where previous repairs and grafting have failed. The satisfactory outcomes in these complex cases highlight its potential as a valuable tool for pediatric urologists.

Keywords: Cripple; Graft fibrosis; Hypospadias; Parameatal flip-flap; Reoperative; Salvage.