COMPARISON OF HYPOSPADIAC AND NORMAL PREPUTIAL VASCULAR ANATOMY SELCUK YUCEL,* EROL GUNTEKIN, ERDAL KUKUL, GUNGOR KARAGUZEL, AKIF CIFTCIOGLU, MUSTAFA MELIKOGLU AND MEHMET BAYKARA From the Departments of Urology, Pediatric Surgery and Pathology, Akdeniz University School of Medicine, Antalya, Turkey ABSTRACT Purpose:Data about the differences between the vascularization of normal and hypospadiac prepuce are lacking. We investigated the course of the preputial arterial blood vessels in normal controls and children with hypospadias by using transillumination,arterial methylene blue injection and 3-dimensional (3-D) reconstruction of serial histological sections focusing on arte- rial vessels. Materials and Methods: Prepuce of 48 normal controls and 15 children with hypospadias was transilluminated by a front and back lighting technique and then photographed. All of the normal and 12 of hypospadiac prepuces not used for urethroplasty or penile body skin recon- struction were removed. The blood vessels of normal prepuce were also identified after arterial injection of methylene blue. Selected prepuce of normal controls and children with hypospadias was serially sectioned, and arterial and venous vessels were histologically distinguished. A 3-D computer reconstruction of the arterial system of normaland hypospadiac prepuces was per- formed. Results: We confirmed the reliability of the transillumination technique to describe the arterial vascular anatomy of the prepuce by comparing the transillumination to methylene blue injection and 3-D reconstruction of histological sections. We classified the arterial vascular anatomy of normal prepuce as 1 artery predominant (41.67%), 2 arteries predominant (25%), H-type arching artery (12.5%) and net-like arterial system (20.83%). However, hypospadiac prepuce revealed a net-like arterial system more frequently (50%). We noted that the frequency of net-like arterial system was higher in more severe hypospadiac prepuce. Conclusions: Understanding the differences between normal and hypospadiac prepuce vascu- lar anatomy is germane to hypospadias surgery.The arterial blood supply of the hypospa- diac prepuce is different than normal. A better knowledge of the vascular anatomy of the hypospadiac prepuce may improve the surgical results of hypospadias repair. K EY WORDS: penis/blood supply, hypospadias, blood vessels/anatomy and histology The blood supply of the hypospadiac prepuce is crucial for successfulhypospadias surgery.The hypospadiac prepuce can be used for neourethra reconstruction and penile body skin closure.Well vascularized flap is the main factor for a successfuloutcome ofhypospadias surgery.Although the severity of the hypospadias and macroscopic morphology of penis and prepuce generally determine the type of operative technique,the vascular anatomy of the prepuce is also pro- posed as an important factor in the decision. 1, 2 The vascular anatomy of the prepuce in normal subjects has been well studied. 3– 6 Surgical techniques to form prepu- tial flaps in normal children as well as those with hypospa- dias are mainly dependent on these classic anatomical stud- ies. 7, 8 However, to our knowledge there are scarce data about the differences in vascular anatomy between the normal and hypospadiac prepuce. 1, 2, 9, 10 Since the vascular anatomy of the normal prepuce is known,preputial vascularization in hypospadias surgery has predominantly been estimated em- pirically. A better understanding of the hypospadiac prepu- tial vascular anatomy may affect hypospadias surgery out- comes, particularly when the preputial flaps are used. This study was undertaken to compare the normal prepu- tial vascular anatomy to the hypospadiac prepuce by using transillumination, arterial methylene blue injection and 3-dimensional (3-D) reconstruction of serial histological sec- tions with depth analysis. MATERIAL AND METHODS In 48 normal and 15 hypospadiac males 18 months to 9 years old (mean age 62 months) who underwent circumcision and hypospadias repair the prepuce was transilluminated by a front and back lighting technique using endoscopic cold light and photographed. Particularly, blood vessel course and development were focused. Transillumination of the prepu- tial flap was performed in intact and degloved penis. In 48 normal and 12 hypospadiac males in whom the prepuce was not used for penile reconstruction prepuces were removed for methylene blue injection and 3-D reconstruction. During removal of the preputial flap final incision to open the circular tissue was done between the 5 and 7-o’clock positions so that the dorsal preputial tissue and its vascular supply were preserved for further study. In 1 hypospadiac and 12 normal prepuces using a 10⫻ magnification stereomicro- scope,we made an incision at the level of transition of the prepuce to the penile skin, leaving the dartos fascia and blood Accepted for publication June 18, 2004. Supported by Akdeniz University Scientific Research and Project Unit. Study was approved by committee on human research at Akdeniz University School of Medicine, Antalya, Turkey. * Correspondence: Department of Urology, Akdeniz University School of Medicine, Kampus, 07070, Antalya, Turkey (telephone: ⫹90- 242-227-4480; FAX: ⫹90-242-227-4482; e-mail: syucel@akdeniz.edu.tr). 0022-5347/04/1725-1973/0 Vol. 172, 1973–1976, November 2004 THE J OURNAL OF UROLOGY ® Printed in U.S.A. Copyright © 2004 by A MERICAN UROLOGICAL ASSOCIATION DOI: 10.1097/01.ju.0000142131.37693.05 1973