Comparison of Outcome and Success Rate of Onlay Island Flap and Dorsal Inlay Graft in Hypospadias Reconstruction: A Prospective Study

BACKGROUND: Chordee correction, urethroplasty, and tissue reconstruction are performed to correct and retain standard functionality of the penis in hypospadias. Conventional reconstruction techniques, such as onlay island flap and the dorsal inlay graft, can be performed based on the classification of hypospadias. However, the outcomes and complication rates have not been widely studied. Thus, we aimed to provide preliminary evidence regarding the efficacy and safety of both approaches in hypospadias reconstruction. PATIENTS AND METHODS: A prospective study with two time evaluations of 14 and 180 days post-operatively was performed at the Urology outpatient clinic from October 2014 to September 2019. A proportion comparison of success rate, time to the complication, operation time, catheterization duration, uroflowmetry parameter post-surgery, and mean scores comparison of PPPS were measured as the intended outcomes. RESULTS: In a total of 59 pediatric hypospadias, patients who had undergone reconstruction are included in this study. Higher subjects’ age and severe chordee severity were more common in the dorsal inlay graft group (age=7.50 [1–26] months; severe chordee 45.8%) compared to the onlay island flap group (age=4.0 [1–67] months; severe chordee 31.4%), both groups showed similar satisfaction regarding meatal shape and position (P=0.618), glands shape (P=0.324), penile skin shape (P=0.489), and general cosmetic appearance (P=0.526). Complication occurrence and time to complication duration of both groups were also not statistically significant (P=0.464 and P=0.413). There are no significant differences in Q(max), Q(mean), voided volume, and PVR of both groups (P=0.125, 0.136, 0.076, 0.260, respectively). Significant differences in operation times and catheterization duration are found in this study (P<0001). CONCLUSION: Outcome evaluation regarding functional, complication and patient satisfaction comparing onlay flap and dorsal inlay graft for hypospadias patients is scarce. This study found that both procedures can be considered safe with comparable incidence of complications.