A cover flap reduces the rate of fistula after urethroplasty whatever the severity of hypospadias

World J Urol. 2021 Jul;39(7):2691-2695. doi: 10.1007/s00345-020-03489-1. Epub 2020 Oct 27.


Objective: To determine which patients should benefit from the interposition of a well-vascularized flap between the neourethra and the penile skin and if it should be performed even in mild hypospadias.

Patients and methods: A retrospective study on patients with a primary hypospadias repair was performed (2003-2017). Only patients undergoing urethroplasty based on the principle of a tubularization were selected to ensure comparable groups. Patients were assigned in two groups according to the use or not of a cover flap. Univariate analysis and adjusted logistic regression were used to evaluate the relation between postoperative complications, the severity of hypospadias, the use of flap and patients' characteristics.

Results: Three-hundred and seventy-six patients were included with anterior (59.3%), midshaft (27.4%) and posterior hypospadias (13.3%). The median follow-up was 54 months (24 months-17 years). The overall rate of fistula was 11.7% (n = 44). Comparing the outcome in children with flap (n = 217) to controls (n = 159) showed that the use of a flap reduces the rate of fistula (6.5 vs 18.9%, p < 0.001). Stratification of the study according to the phenotype reveals that the more severe the hypospadias, the more protective was the flap (OR = 2.6 for anterior, 5.5 for midpenile, 7.1 for posterior hypospadias). The flap remains nevertheless significantly effective whatever the phenotype (p < 0.05 for anterior, p = 0.01 for midpenile, p = 0.02 for posterior hypospadias).

Conclusions: The more severe the hypospadias, the more effective is the cover flap to avoid fistula. It remains nevertheless suitable even in anterior hypospadias and the use of a cover flap should not be limited to the surgery of severe phenotypes.

Keywords: Complication; Fistula; Hypospadias; Prognosis; Surgery; Surgical flap.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Fistula / epidemiology
  • Fistula / prevention & control
  • Humans
  • Hypospadias / surgery*
  • Infant
  • Male
  • Postoperative Complications / epidemiology
  • Postoperative Complications / prevention & control
  • Retrospective Studies
  • Severity of Illness Index
  • Surgical Flaps* / blood supply
  • Urethra / surgery*
  • Urologic Surgical Procedures, Male / methods