WOFAPS 2025 8th World Congress of Pediatric Surgery

Hammou Benslimane, Fatema Hadjou Belaid, Faycel Hamidou

faculté de médecine d'Oran Algérie

Purpose:Hypospadias is classified according to the location of the division of the corpus spongiosum: distal hypospadias, where the division occurs near the glans, and proximal hypospadias, often associated with penile curvature due to tissue hypoplasia. The primary objectives of hypospadias surgery are penile straightening (orthoplasty), urethroplasty, and adequate skin coverage. The Duplay technique is commonly used in cases with minimal curvature and a well-developed urethral plate. However, its success is often compromised when the urethral plate is narrow or rigid. This study evaluates the role of the inlay graft technique in improving surgical outcomes of Duplay/Snodgrass-type urethroplasty, particularly in patients with suboptimal urethral plate width.Materials and Methods:Between 2017 and 2023, 24 patients with hypospadias underwent surgical repair using the inlay graft technique. Following penile degloving and chordee correction, a midline incision of the urethral plate (Snodgrass technique) was performed. A defatted inner preputial graft was then inlaid into the incised urethral plate. Tubularization was completed using the Duplay method. A well-vascularized dartos flap was used as a second layer to reduce the risk of fistula formation.Results:17 patients had anterior hypospadias; 7 had midshaft or posterior forms.Mean duration of 3 yearsfollow up.Outcomes: the neomeatus was apically located in all 24 cases.No cases of meatal stenosis or urethral diverticulum were observed.Urethrocutaneous fistulas occurred in 2 patients (8.3%), both requiring surgical revision.Conclusion:Hypospadias is a congenital condition associated with incomplete masculinization in 46,XY individuals. While many surgical techniques exist, complications such as urethrocutaneous fistula and meatal stenosis remain prevalent particularly in cases with narrow urethral plates. The inlay graft technique effectively addresses these challenges by augmenting the urethral plate, resulting in improved cosmetic and functional outcomes. It is especially beneficial when the urethral plate is less than 8 mm in width, making it a valuable option in carefully selected patients.