Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2021; 9(13): 2983-2993
Published online May 6, 2021. doi: 10.12998/wjcc.v9.i13.2983
Scrotal septal flap and two-stage operation for complex hypospadias: A retrospective study
Sen Chen, Zhe Yang, Ning Ma, Wei-Xin Wang, Li-Si Xu, Qi-Yu Liu, Yang-Qun Li
Sen Chen, Zhe Yang, Ning Ma, Wei-Xin Wang, Li-Si Xu, Qi-Yu Liu, Yang-Qun Li, The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
Author contributions: Chen S performed study design, data collection, data analysis, data interpretation, manuscript drafting, manuscript revision; Yang Z and Li YQ performed study design, data collection, data analysis, data interpretation, manuscript drafting, literature analysis, funds collection, manuscript revision; Ma N, Wang WX, Xu LS and Liu QY performed study design, data collection, data analysis; all authors have read and approved the manuscript.
Supported by Special Research Fund for Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. B2018009; and Beijing Municipal Science & Technology Commission-Functional Urethral Reconstruction of Hypospadias by Tissue Transplantation, No. Z161100000516015.
Institutional review board statement: This study was approved by the Medical Ethics Review Board of the Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS), and Peking Union Medical College (PUMC), No. ZX201968.
Informed consent statement: Written Informed consent was obtained from the study participants.
Conflict-of-interest statement: The authors have no conflict of interest to disclose.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yang-Qun Li, MD, Doctor, The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Badachu Road, Shijingshan District, Beijing 100144, China. liyangqundoctor@163.com
Received: September 10, 2020
Peer-review started: September 10, 2020
First decision: December 28, 2020
Revised: January 10, 2021
Accepted: February 11, 2021
Article in press: February 11, 2021
Published online: May 6, 2021
Abstract
BACKGROUND

Complex hypospadias is a surgical challenge.

AIM

To present the long-term outcomes of two-stage repair of complex hypospadias using a scrotal septal flap.

METHODS

This was a retrospective study of patients with complex hypospadias who were operated on between January 1st, 2001, and January 1st, 2019, at a single hospital using a scrotal septal flap (two-stage surgery) or prepuce flap (one-stage surgery; control group). In the scrotal group, the urethra was first repaired using oral mucosa; in the second stage, a scrotal septal flap was used as a second imper-meable layer. Maximal/average urinary flow rates after surgery were compared. All patients were followed for ≥ 6 mo (range: 6-96 mo).

RESULTS

Ninety-seven patients were included (46 in the scrotal group and 51 in the prepuce group). The maximal urinary flow rate was 15.4 ± 2.1 mL/s in the scrotal group and 14.3 ± 3.0 mL/s in the control group (P = 0.035). The average urinary flow rate was 8.4 ± 2.3 mL/s in the scrotal group and 7.5 ± 1.5 mL/s in the control group (P = 0.019). The proportion of patients achieving good therapeutic effects was higher in the scrotal group than in the control group [24 (52.2%) vs 16 (31.4%), P = 0.042; 34 (73.9%) vs 25 (49.0%), P = 0.014]. The scrotal flap two-stage surgery was independently associated with a higher maximal urinary flow rate (OR = 2.416, 95%CI: 1.026-5.689, P = 0.044) and with a higher average flow rate (OR = 2.484, 95%CI: 1.054-5.854, P = 0.038).

CONCLUSION

In complex hypospadias, a scrotal septal flap could be a versatile and reliable option for resurfacing the penis.

Keywords: Hypospadias, Oral mucosa, Scrotum, Surgical flap, Fistula, Retrospective study

Core Tip: The proportion of patients achieving good therapeutic effects for maximal and average urinary flow rates was higher in the scrotal group than in controls. The scrotal flap two-stage surgery was independently associated with higher maximal and average urinary flow rates.