Role of buck's fascia repair with glanuloplasty in hypospadias surgery

Abstract

Background: Hypospadias is one of the most common congenital anomalies, occurring in approximately 1 in 200 to 1 in 300 live births. Urethrocutaneous fistula (UCF) formation is a most common postoperative complication of all types of hypospadias repairs. Various soft tissue reinforcements have been used as an intermediate layer to cover the neourethra. We have found that Buck’s fascia over the corpora spongiosum, is the most important layer for covering neourethra, is easily available, results in restoration of near-normal anatomy, involves minimum dissection hence preservation of vascularity, and along with a glanuloplasty achieves excellent and predictable results. We have previously published our results and are using exclusively this technique for distal hypospadias. We thus conducted this study to find the short and long term results of this technique in a larger group of patients.

Aims and objectives: To see the outcome of this technique in terms of complications like fistula formation, meatal stenosis, residual chordee, etc.

Follow up of these patients and observe urinary flow rates and cosmesis.

Materials and methods: This was a retrospective and prospective study conducted in the department of pediatric surgery SKIMS from 2014 to 2019. All patients of distal hypospadias with minimal or no chordee were included in the study. Patients with proximal hypospadias with severe chordee were considered for a staged repair and were excluded from the study. In the retrospective group, all the records were obtained from the medical records department. Patients whose record were incomplete were excluded. After tubularization of urethral plate, Buck’s fascia overlying the spongiosum was used to cover the suture line. Glanuloplasty was done without creating glanular wings. Catheter was kept in place for 7 days. Patients were followed up weekly for two weeks and then monthly for atleast 6 month and complications noted.

Results: 250 patients of distal penile hypospadias underwent Snodgrass with bucks fascia repair. They were regularly observed for post op complications.166 patients underwent uroflowmetry after acquiring toilet training. Average age was 3.8 years (min 1 years and max 16 years) . Average operating time was 50 minutes with reduced incidence of post-operative edema and pain. Complication rate was 5 % with 7 (3%) patients had post op UCF, 4 (1.6%) mild meatal narrowing, and 2 (0.8%) had mild urethral stricture. Later two responded to urethral calibration. Reoperation rate was 3% only. Cosmetic satisfaction was 98%. Among 166 patients undergoing uroflowmetry 18% revealed obstructive flow with Qmax below 5^th percentile but were without symptoms.

Conclusion: Snodgrass urethroplasty withBuck’s fascia as second layer with glanuloplasty is good option in hypospadias surgery with less complications, operative time and good long term results.