Surgical correction of post-hypospadias repair urethral diverticulum and stricture using rotational flap

Purpose: We report 10 cases of successfully corrected post-hypospadias repair urethral stricture with diverticulum, which were refractory to repeated dilation and visual urethrotomy using rotational flap of the diverticular tissue. Materials and Methods: Among those who visited our clinic for voiding difficulty and post-void dribbling following hypospadias repair from February 2003 to February 2006, 10 children who were refractory to repeated urethral dilation and visual internal urethrotomy, and in whom urethral diverticulum was identified via retrograde urethrogram (RGU) and physical examination were operated using this technique. Results: The previous urethroplasties included 1 combined meatal island onlay proximal transverse island flap (MIOPTI), 2 MIOPTIs, 1 Hodgsons operation, 5 tubularized incised plate urethroplasties and 1 Thiersch-Duplay procedure; they all underwent at least 2 visual internal urethrotomies under general anesthesia and numerous urethral dilations on an outpatient basis. The location of the diverticulum were mid-penile in 6 patients, proximal penile in 2 and bulbous in 2; urethral strictures distal to the diverticulum were found in 7 and some degree of narrowing was noted in 3. A flap about twice the length of the stricture was designed in the diverticulum and by rotating the flap, the lumen of the strictured portion was expanded and the size of the diverticulum naturally reduced. No voiding difficulty was noted with only a minimal amount of post-void residual urine on follow-up. Conclusions: Rotation flap is a technique that can simultaneously solve the problems of a stricture and diverticulum by using relatively well vascularized tissue of the diverticulum. This technique is especially recommended for those children who lack healthy urethral tissue or its substitute due to repeated dilation and internal urethrotomies.