Two-layer versus one-layer closure in transverse island flap repair of posterior hypospadias

Despite its prevalence for more than two decades, one-stage repair of moderately severe hypospadias is still associated with a high complication rate. A retrospective study of 103 cases of posterior hypospadias treated exclusively with the Duckett transverse island flap procedure was conducted to analyze factors that might affect the morbidity. The latter included the age of the patients, the anatomical variants of the hypospadias, the suture materials and the technique used, the length of the urethral tube, and the methods and duration of urinary diversion. The fistula rate was 24% ( 25 103), and the overall complication rate was 31% ( 32 103). The patients in the glanular-subcoronal-penile variant had a significantly lower overall complication rate than those in the penoscrotal-scrotal variant (21% versus 39%, P < .05). The patients with a neourethra shorter than 3 cm also had significantly less complications than those with a neourethra longer than 3 cm (25% versus 47%, P < .05). The only procedural factor that makes a difference is the method of skin closure to form the neourethra. Two-layer closure resulted in a significantly lower fistula rate and overall complication rate than one-layer closure (13% versus 34% and 15% versus 45%, P < .025 and P < .005, respectively). The study confirms the value of two-layer closure in the transverse island flap repair of posterior hypospadias.