Simultaneous defatting with hypospadias repair to correct inconspicuous penis

To investigate the clinical outcome of simultaneous defatting with hypospadias repair to correct inconspicuous penis. From May 2016 through September 2018, 49 boys with inconspicuous penis associated to hypospadias were managed with defatting technique simultaneously with hypospadias repair. The 49 boys included primary hypospadias repair in 37 boys and redo hypospadias repair in 12. In primary repair group, the boys aged 12 to 66 months with a mean of 26 months. TIP urethroplasty was used in 31 boys with distal hypospadias. Duckett urethroplasty was used in 2 scrotal hypospadias associated with Klinefelter Syndrome, and in 1 chordee without hypospadias, urethral tethering variant. Chordee correction was done in 3 chordee without hypospadias, fascial dysgenesis variant. In redo hypospadias group, the boys aged from 20 to 88 months with a mean of 41 months. Stage II hypospadias was achieved in 8 boys, fistula repair in 1, diverticulum repair in 2, and repair for inconspicuous penis only in 1. Penile appearance and complications of hypospadias repair were followed up. The boys were followed up for 3 to 28 months with a mean of 12 months. In primary repair group, 1 boy complained of inconspicuous penis in standing, supine, and sitting positions. Five boys were noted with inconspicuous penis in sitting position. The rest 31 boys reported acceptable penile appearance in all the positions. Fat necrosis was noted in 1 boy after surgery, surgical site infection with urethrocutaneous fistula in 1, scrotal hemangioma in 1, testicular ascending in 2 with one of them noted with spontaneous descending 8 days after surgery. Glans dehiscence was noted in 2 boys, and fistula in 3 after TIP urethroplasty. Fistula was noted in the boy with urethral tethering after Duckett urethroplasty. In redo hypospadias group, inconspicuous penis was noticed in all the positions in 2 boys, and penile appearance was reported to be significantly better after defatting, including inconspicuous penis only in sitting position in 4 boys and nice penile appearance in all the positions in 6. No fat necrosis, infection, nor testicular ascending was noted in redo group. Urethrocutaneous fistula was noted in 1 boy with stage II hypospadias repair after a Byar I technique. Defatting technique could be included in hypospadias repair surgery in selected cases to achieve better penile appearance, and associated with insignificant risk of urethroplasty complications.