Modified Transverse Preputial Island Flap urethroplasty for hypospadias in children - A short-term outcome in 42 cases

Abstract

Proximal hypospadias with severe chordee presents a significant surgical challenge, with higher complication rates than distal variants. While single-stage urethroplasty offers advantages in cost and recovery, complication rates remain a concern. This study evaluates a modified Transverse Preputial Island Flap Urethroplasty (TPIFU) technique aimed at reducing complications and improving outcomes. Methods: A retrospective analysis was conducted over 20 months (May 2023–December 2025) at a tertiary center. Forty-two boys with mid or proximal hypospadias underwent single-stage TPIFU. Modifications included oblique proximal anastomosis, wide slit meatoplasty, 10-day catheterization, and neourethral fixation to corpora. Patients were followed at 1, 3, and 6 months postoperatively. Complications such as meatal stenosis, urethrocutaneous fistula (UCF), stricture, diverticula, and torsion were recorded. Results: The mean age was 3.67 ± 1.7 years. Hypospadias was proximal in 71.43% and midshaft in 28.57% of cases. Chordee correction was required in 92.86%. The mean neourethral length was 3.78 ± 1.1 cm. Postoperative complications occurred in 21.43%: UCF in 16.6%, meatal stenosis in 14.29%, and stricture in 4.76%. No diverticula, residual chordee, or penile torsion were noted. All UCFs were successfully repaired. The mean follow-up was 9 months. Conclusion: Single-stage modified TPIFU is effective for proximal hypospadias with severe chordee. The described modifications potentially reduce complications and eliminate the need for a staged repair. Longer-term studies with larger cohorts are warranted to validate these findings.