A boy with scrotal hypospadias – Transverse Island Onlay Flap urethroplasty

B.Q., a 7-month-old baby, was brought to our clinic with an abnormal-looking penis and passage of urine from the underside of the penis. On examination, he had a scrotal hypospadias with mild chordee (an abnormality where the penis is bent downwards).

A boy with scrotal hypospadias – Transverse Island Onlay Flap urethroplasty was planned for corrective surgery. This specific case involved a single-stage urethroplasty, for which many different techniques are available. The exact technique in this case was a long transverse island flap urethroplasty.

This is the appropriate age (6-9 months) for such surgeries as the final results are very good both cosmetically and functionally at such a young age. We chose to give two doses of hormones before surgery to improve the outcome after single-stage surgery.

Since this was a very severe hypospadias, the chances of failure were higher. We decided to harvest a tunica vaginalis flap for second-layer coverage of the repair (see pictures). The tunica vaginalis is a covering of the testis and provides good second-layer coverage in such severe cases, improving the outcomes manyfold.

The baby was taken up for surgery and required only a one-day stay in the hospital. The dressing was removed on day 5 and the catheter on day 12. There was no fistula or dehiscence.

At the 3-month follow-up, he had a normal-looking circumcised penis with a urethral opening at the top of the glans.