A prospective study comparing modified foreskin reconstruction versus circumcision with tubularized incised plate urethroplasty for distal and mid penile hypospadias

Background In Asian countries and the Hispanic populations, parents of many hypospadias patient demands prepuce to be saved. Foreskin reconstruction is a technique for achieving the nearly natural appearance of hypospadias penis. In most distal and selected mid-penile hypospadias it may be performed. Numerous specialists, however, support circumcision for the concern that foreskin reconstruction may endanger the repair of urethroplasty leading to the risk of formation of fistulas. Aim To evaluate the surgical complications and outcome of modified foreskin reconstruction (MFR) versus circumcision with tubularized incised plate urethroplasty for distal and mid penile hypospadias. Methods This prospective comparative study included 80 children with distal and mid penile hypospadias treated from 2017 to 2019 in tertiary referral hospital. Group 1, n Z 40 underwent TIPU and MFR, and Group 2 included 40 patients for TIPU with circumcision. Results In group 1, patients ranged from 2.2 to 6.5 years (mean 4.6 1.52 years) and in group 2 ranged 2.6-7 years (mean 4.59 1.43 years). Specific to group 1 preputial edema was seen in 29 patients at 2nd weeks, completely disappeared by 8thweek. Retraction of prepuce was possible in 18 patients by 21 days and all but one by 6 months Foreskin wound gaping was seen in 1 at day 12 postoperatively and was repaired subsequently. Meatal stenosis was seen in one in both group, responded to urethral dilation by 6 weeks. Three patients from group 1 and 2 from group 2 developed urethral fistula which was subsequently closed. The complication rate was not statistically significant. Secondary phimosis was not seen in this study. A wide preputial opening was achieved during reconstruction in all patients in group 1. Discussion One of the notable features, the absence of the prepuce, makes the patient conscious of the surgical procedure they had undergone. The specific complication of the preputial reconstruction is the presence of a non-retractile prepuce at the end of the surgery, secondary phimosis, preputial wound gaping, and dehiscence. In some patients, the distal portion of the prepuce becomes narrow, after vertical reconstruction. To prevent phimosis, the technique was improvised by taking transverse sutures in the distal part combined with midline approximation of the foreskin. This widens the preputial ring enabling smooth retraction of the reconstructed prepuce. Conclusions TIPU with MFR is an effective procedure for distal and selected mid penile hypospadias without increasing urethroplasty complications.