Does preserving the preputial subcutaneous layer in distal hypospadias surgery harbor potential consequences for penile sensation?

purposePenile surgeries, such as circumcision and hypospadias repair, somewhat raise concerns about long-term effects on genital sensation and sexual function. This study was conducted to support a hypothesis that preserving the dorsal preputial subcutaneous tissue and adding it as a tissue onlay to the ventral hypospadias penis could provide a potential benefit in the future on penile sensation and sexual function.

methodsThe study groups consisted of 22 children who underwent tubularized incised plate urethroplasty (TIPU) distal hypospadias repair, and 24 standard circumcision cases for religious purpose between June 2022-November 2023. Dorsal subcutaneous preputial flap was used to cover the neourethra to reduce the risk of fistula formation in all TIPU repairs as described. Dorsal hood preputium specimens as full layer (after circumcision) and after dissecting its subcutaneous layer (after TIPU) were compared histopathologically for vascular and neural components, focusing on peripheral nerve endings, Meissner and Pacinian corpuscles.

resultsThere was no statistically significant difference between full dorsal skin and dissected TIPU skin in terms of the number of arteries, the number of peripheral nerves, and the number of Meissner and Pacini corpuscles.

conclusionThe structure of skin devoid of subcutaneous layer still contained the same number of neural structures as the normal skin, so the subcutaneous tissue laid ventrally probably will add no benefit for future penile sensation.