Comparative Outcomes of Preputial Buttonhole Flap and Byars Flap Techniques in Hypospadias Repair: A Cohort Study

Background: Hypospadias, a common congenital anomaly, is characterized by incomplete development of the urethral spongiosum and ventral prepuce. Surgical repair aims to achieve a functional penis, enabling upright urination and sexual intercourse, while also prioritizing aesthetic outcomes. Despite advancements in surgical techniques, the optimal approach for skin coverage in hypospadias repair remains debated. Methods: This study compared two skin coverage techniques in hypospadias repair: The inner preputial buttonhole flap and the Byars flap. All 40 patients underwent urethroplasty using the Snodgrass technique, with 20 patients receiving a preputial buttonhole flap and the remaining 20 receiving a Byars flap as a waterproof layer. Postoperative outcomes, including urethral fistula, meatal stenosis, and the need for repeat surgery, were evaluated over a minimum follow-up period of six months. Data were analyzed using SPSS software. Results: The mean age of the patients was 26.1 ± 8.5 months No significant differences were observed between the two techniques in terms of urethral fistula, meatal stenosis, or reoperation rates (P > 0.05). Conclusions: The preputial buttonhole flap may offer advantages over the Byars flap in neourethra coverage for distal hypospadias, particularly in reducing fistula formation. However, further studies with larger sample sizes are needed to validate these findings and establish definitive recommendations.