A boy with scrotal hypospadias - Transverse Island Onlay Flap urethroplasty

B.Q., 7 months old baby was brought to the our clinic with abnormal looking penis and passage of urine form underside of penis. On examination, he had a Scrotal Hypospadias with mild chordee (abnormality where the penis is bent downwards).

The baby was planned for a corrective surgery called – SINGLE STAGE URETHROPLASTY ofr which many different techniques are available. The exact technique in this case was a long Tranverse 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 2 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 more. We decided to harvest a tunica vaginalis flap for second layer coverage of the repair (see pictures). Tunica vaginalis is a covering of the testis and provides a good second layer coverage in usch severe cases improving the outcomes manyfold.

The baby was taken up for surgery and he required only one day stay in the hospital. The dressing was removed on day5 and the catheter on day12. There was no fistula or dehiscence.

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


Clinical picture showing a severe scrotal hypospadias

After degloving of penis and chordee correction- A long Transverse Island Prepucial Flap has been harvested and is being rotated ventrally c43 c44

Tunica Vaginalis Flap harvested and ready to be used for second layer coverage

Excellent second layer coverage by tunica vaginalis flap




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