PAPS PaperReinforcing the ventral penile shaft with pedicled fat/connective tissues before urethroplasty lowers the risk for post-urethroplasty complications in hypospadias

PurposeCHARGE is our technique for reinforcing the ventral penile shaft with pedicled pericordal/scrotal fat, pedicled perimeatal connective tissue, or a combination of these at the time of initial hypospadias surgery. Such pedicled grafts “charge” poorly developed urethral plates and thin ventral foreskin prior to urethroplasty to improve compromised vascular perfusion that could prevent post-urethroplasty complications (post-UPC).MethodsWe reviewed post-UPC in 179 staged hypospadias repair patients (1997-2015). CHARGE, adopted routinely in 2010 was used in 39 patients (C-group), not indicated in 7 because ventral connective tissue was thick, and not used in 133 (NC-group). Initial hypospadias surgery included foreskin degloving with or without chordectomy, dorsal plication, tunica albuginea incision, or a combination of these.ResultsSubject demographics were similar. NC had significantly more post-UPC than C (25 versus 0; p < .01) comprising stenosis (n = 14), fistula (n = 7), diverticulum (n = 2), and wound infection (n = 2) that developed after a mean of 0.7 ± 0.2 years (range: 1 day-2.8 years). Extra time taken for CHARGE was less than 15 minutes in all cases. Mean follow-up after urethroplasty (years) was significantly shorter in C (1.5 ± 1.0 versus 5.7 ± 3.8) (p < .01), but almost double the time taken to develop post-UPC.ConclusionCHARGE would appear to prevent post-UPC.Level of evidenceRetrospective Comparative Study - Level III