Proximal division of the urethral plate in XXXX repair.

@entity5 @entity1 @entity5331 @entity2650
PURPOSE: We describe a new technique for @entity5 repair in which the urethral plate is divided proximally at the time of the first stage. MATERIALS AND METHODS: A total of 14 @entity1 with proximal @entity2650 associated with severe chordee were operated on using a new staged technique. At the time of the first stage the urethral plate was divided proximally at the level of the hypospadiac meatus. In 8 of 14 @entity1 the intact plate was then incised and tubularized with the Snodgrass technique. In 6 @entity1 the plate was tubularized at the time of the second stage. Correction of chordee was accomplished with dorsal plication and/or corporal body grafting. Byar's flaps were used to fill in the residual gap between the proximal hypospadiac meatus and the newly tubularized neourethra. The transposed flaps in the area of the @entity5331 were then tubularized at the second stage. RESULTS: Followup ranged from 6 months to 3 years. Complications included a proximal pinpoint fistula and diverticulum in 1 case. An additional @entity1 also had formation of a mild diverticulum that has not required surgical revision. No @entity1 have had any evidence of distal urethral stricture formation. CONCLUSIONS: Proximal division of the urethral plate and application of the Snodgrass procedure to the staged repair of @entity2650 have resulted in improved functional and cosmetic results. The major advantage of this new technique is preservation and use of the native urethral plate in the glans and subcoronal area. When complications occur with this technique, they are less severe compared to those of the traditional staged approach.
