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Wood D, Wilcox D. Hypospadias: lessons learned. An overview of incidence, epidemiology, surgery, research, complications, and outcomes. Int J Impot Res 2023; 35:61-66. [PMID: 35352016 DOI: 10.1038/s41443-022-00563-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022]
Abstract
Hypospadias is a common condition and familiar, though sometimes challenging territory for the pediatric urologist. This review is a summary of hypospadias incidence, epidemiology, surgery, research, and complications intended for the non-specialist. It outlines the history, the principles of surgery for hypospadias, and the long-term outcomes.
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Affiliation(s)
- Dan Wood
- University of Colorado, Aurora, CO, USA. .,Center for Childrens' Surgery Children's Hospital Colorado, Aurora, CO, USA.
| | - Duncan Wilcox
- Center for Childrens' Surgery Children's Hospital Colorado, Aurora, CO, USA
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de Neve-Enthoven NGM, Callens N, van Kuyk M, Verhaak CM, van der Ende J, Drop SLS, Cohen-Kettenis PT, Dessens AB. Sexual Self-Concept in Women with Disorders/Differences of Sex Development. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2213-2229. [PMID: 35362786 PMCID: PMC9192466 DOI: 10.1007/s10508-021-02188-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/27/2021] [Accepted: 10/09/2021] [Indexed: 06/14/2023]
Abstract
Many women born with disorders or differences of sex development (DSD) report sexual problems, in particular women who have undergone extensive genital reconstruction. Examining cognitions and emotions that hinder or promote sexuality may facilitate understanding these sexual problems and may contribute to the development of specific interventions. In this study, sexual self-concept, body image, and sexual functioning were investigated in relation to genital surgery. To conduct the study, the women's Sexual Self-Concept Scale was translated to Dutch. Evaluation of psychometric properties was conducted in a sample of healthy Belgian and Dutch women participating in an anonymous web-based survey (N = 589, Mdn age, 23 years). The resulting three-factor structure corresponded largely to that of the original version. Compared to control women, women born with a DSD who were included in the Dutch DSD study (N = 99, Mdn age, 26 years) described themselves as being less interested in sex and less sexually active. These women also harbored more negative emotions and cognitions regarding their sexuality and were less satisfied with their external genitalia. In women with a DSD, sexual self-concept was associated with compromised outcomes on sexual functioning and distress. Women who were in a steady relationship, and/or had been sexually active in the past 4 weeks had a more positive sexual self-concept, took a more active role in their sexual relationship, experienced more sexual desire and arousal and less sexual distress than women who were not involved in a partner relationship. Findings in this study indicate that cognitions and emotions related to sexual self-concept play a role in sexual functioning of women with a DSD. A cognitive behavioral counseling approach with focus on coping and exploration of their own sexual needs could prove useful in this group.
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Affiliation(s)
- Nita G M de Neve-Enthoven
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center Rotterdam-Sophia Children's Hospital, Sh-1058, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - Nina Callens
- Department of Pediatric Endocrinology, University Hospital Ghent and Ghent University, Ghent, Belgium
| | - Maaike van Kuyk
- Department of Medical Psychology, Radboud University Medical Center-Amalia Children's Hospital Nijmegen, Nijmegen, The Netherlands
| | - Chris M Verhaak
- Department of Medical Psychology, Radboud University Medical Center-Amalia Children's Hospital Nijmegen, Nijmegen, The Netherlands
| | - Jan van der Ende
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center Rotterdam-Sophia Children's Hospital, Sh-1058, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - Stenvert L S Drop
- Department of Pediatrics, Division of Pediatric Endocrinology, Erasmus MC-Sophia Rotterdam, Rotterdam, The Netherlands
| | - Peggy T Cohen-Kettenis
- Department of Medical Psychology and Center of Expertise on Gender Dysphoria Amsterdam, UMC-Free University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Arianne B Dessens
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center Rotterdam-Sophia Children's Hospital, Sh-1058, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics, University Ghent, Ghent, Belgium.
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Marcou M, Bobbe SM, Wullich B, Hirsch-Koch K. Urethral Plate Characteristics in Cases of Non-proximal Hypospadias May Not Be Associated With a Higher Risk of Complications When a Two-Stage Repair Is Applied. Front Pediatr 2022; 10:900514. [PMID: 35874589 PMCID: PMC9304744 DOI: 10.3389/fped.2022.900514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/15/2022] [Indexed: 12/04/2022] Open
Abstract
PURPOSE To investigate whether a two-stage repair of distal- and mid-shaft hypospadias (non-proximal hypospadias) could eliminate the risk factors resulting from adverse urethral plate characteristics and eventually reduce complication rates. METHODS We retrospectively reviewed all cases of primary surgical repair of non-proximal hypospadias performed in our center between 2009 and 2018. In all cases where adverse urethral plate characteristics were found, such as meatal stenosis, a shallow urethral groove, a thick web of tissue between the native meatus and the urethral groove or in the presence of a very "thin," skin-like distal urethra, a two-stage repair was routinely undertaken. In cases of native meatal stenosis, a meatotomy, and meatoplasty were performed. In cases of a very "thin" distal urethra we incised the skin proximally up to the point of a normal urethral fold and a meatoplasty was performed at that point. Hypospadias repair was then performed in a second operation, 3-6 months following the first procedure. Urethroplasty, both in cases of a single-stage repair and in cases of a two-stage repair, was always performed using the Thiersch-Duplay technique. Patients with a follow-up of less than 12 months were excluded from this study. RESULTS Over a period of 10 years, 208 boys underwent primary surgical repair of non-proximal hypospadias. Eighty-nine of the 208 patients (42.8%) underwent single-stage hypospadias repair. Two-stage repair of the hypospadias was required in 119 (57.2%) of the patients. The overall complication rate was 3.4% in the group operated in a single stage and 7.6% in the group that required a two-stage repair (p = 0.09). The most frequent complication reported was urethrocutaneous fistula (p = 0.31), followed by meatal stenosis (p = 0.37), urethral stricture (p = 0.08) and wound dehiscence (p = 0.16). There was no significant difference between the complication rates of the two groups. CONCLUSION Patients with distal hypospadias and poor urethral plate characteristics repaired in a two-stage approach have comparable low-complications to those with favorable urethral plate characteristics repaired in a single-stage.
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Affiliation(s)
- Marios Marcou
- Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Sarah-Magdalena Bobbe
- Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany.,Clinic of Urology, Dr. Lubos Kliniken Bogenhausen, Munich, Germany
| | - Bernd Wullich
- Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Karin Hirsch-Koch
- Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
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Genitourinary Tissue Engineering: Reconstruction and Research Models. Bioengineering (Basel) 2021; 8:bioengineering8070099. [PMID: 34356206 PMCID: PMC8301202 DOI: 10.3390/bioengineering8070099] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/28/2021] [Accepted: 07/06/2021] [Indexed: 01/15/2023] Open
Abstract
Tissue engineering is an emerging field of research that initially aimed to produce 3D tissues to bypass the lack of adequate tissues for the repair or replacement of deficient organs. The basis of tissue engineering protocols is to create scaffolds, which can have a synthetic or natural origin, seeded or not with cells. At the same time, more and more studies have indicated the low clinic translation rate of research realised using standard cell culture conditions, i.e., cells on plastic surfaces or using animal models that are too different from humans. New models are needed to mimic the 3D organisation of tissue and the cells themselves and the interaction between cells and the extracellular matrix. In this regard, urology and gynaecology fields are of particular interest. The urethra and vagina can be sites suffering from many pathologies without currently adequate treatment options. Due to the specific organisation of the human urethral/bladder and vaginal epithelium, current research models remain poorly representative. In this review, the anatomy, the current pathologies, and the treatments will be described before focusing on producing tissues and research models using tissue engineering. An emphasis is made on the self-assembly approach, which allows tissue production without the need for biomaterials.
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Ding Y, Gu S, Xia X, Yu Z. Comparison of Penile Appearance and Outcomes Between Prefabricated Urethra and Pre-implanted Urethral Plate for Treatment of Children With Severe Hypospadias: A Retrospective Study. Front Pediatr 2021; 9:719551. [PMID: 34595144 PMCID: PMC8476890 DOI: 10.3389/fped.2021.719551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To compare the effect of prefabricated urethra and pre-implanted urethral plate in the treatment of severe hypospadias in children. Methods: We retrospectively analyzed the clinical data of 53 patients who diagnosed as severe hypospadias underwent staging urethroplasty from January 2015 to January 2018 in the Department of Pediatric Surgery, First People's Hospital, Zunyi City. The patients were divided into two groups: group A (n = 25) were treated with prefabricated urethra and group B (n = 28) were treated with pre-implanted urethral plate. After the second stage surgery, the ratios of complications such as urethral fistula, urethral stenosis, urethrocele, and recurrence chordee were compared. The penis was scored from meatus, glans, shaft skin, general appearance by the parents, blinded urologists according to The Pediatric Penile Perception Score, and the scores were compared too. Results: All patients were followed up after two stage operations for an average of 28 months. Glans dehiscence occurred in two patients (8%), urethral orifice stenosis occurred in one (4%) and urethral fistula occurred in three (12%) in group A. No urethral stenosis, urethrocele and recurrence chordee was observed. One patient presented urethral plate inactivation (3.6%), two patients presented urethral fistula (7.1%) and one patient presented urethral stenosis (3.6%) in group B. No urethrocele, glans dehiscence and recurrence chordee was observed. The total complication rate in group A was 24 and 14.3% in group B, respectively, and the difference was not statistically significant (P = 0.582). The differences between two groups scored by parents in glans (P = 0.030) was statistically significant. The differences between two groups scored by operators in meatus (P = 0.041), shaft skin (P = 0.000), glans (P = 0.001), and general appearance (P = 0.007) were statistically significant. The differences between two groups scored by counterparts in meatus (P = 0.006), shaft skin (P = 0.003), glans (P = 0.010), and general appearance (P = 0.014) were statistically significant. Conclusion: Both prefabricated urethra and pre-implanted urethral plate methods are suitable for correction of severe hypospadias as staging surgery in children. In general, pre-implanted urethral plate is more worthy of spread because it is much more applied in patients with small glans and achieve good appearance of penis.
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Affiliation(s)
- Yuan Ding
- Pediatric Surgery, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
| | - Shengli Gu
- Pediatric Surgery, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
| | - Xingrong Xia
- Pediatric Surgery, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
| | - Zhengbo Yu
- Pediatric Surgery, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
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Yilmaz Ö, Okçelik S, Soydan H, Ateş F, Yeşildal C, Aktaş Z, Şenkul T. Our urethrocutaneous fistula repair results in adults after hypospadias surgery. Rev Int Androl 2018; 16:143-146. [PMID: 30286868 DOI: 10.1016/j.androl.2017.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/11/2017] [Accepted: 07/24/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Our aim was to evaluate and share our urethrocutaneus fistula repair results in adult patients who had been operated for hypospadias in their childhood. MATERIAL AND METHODS The data of totally 48 patients who had been treated for urethrocutaneous fistula after hypospadias surgery in our department from May 2008 to January 2015 analyzed retrospectively. Patients' age at fistula repair, age at first hypospadias surgery, fistula size, localization and number, distal urethral obstruction status and surgical outcomes of fistula repairs were recorded. All patients were controlled three months after the repair for surgical outcomes. RESULTS Fistula repair performed in 45 patients. Mean age was 21.46 (20-26). Nineteen patients (42.2%) underwent first hypospadias surgery under the age of 7 years; 8 patients (17.7%) between 7 and 15 years, 18 patients between 15 and 20 years. Tubularized incised plate urethroplasty (TIPU) was performed in 40 patients (88.9%), extragenital tissue was used in 5 patients (11.1%). Twenty two patients (48.9%) had 1 or 2 operations, 17 patients (37.8%) had 3-5 operations and 6 patients (13.3%) had 6 or more operations. Thirteen (28.9%) coronal, 24 (53.3%) subcoronal, 6 (13.3%) penile and 2 (4.4%) penoscrotal fistulas were observed. While a single fistula was observed in 35 patients, multiple fistulas were seen in 10 patients. A fistula diameter les than 5mm was detected in 37 patients, and larger than 5mm in 8 patients. Fistula recurrence was observed in 3 patients at follow-up examinations carried out at 3 months postoperatively. The number of operations was more than 5, the fistula diameter was larger than 5mm and the fistulas were coronal in all three recurrent fistulas. CONCLUSION According to our results fistula size, previous surgery and well-vascularised, one or two layer tissue were the important factors in the success of fistula repair after hypospadias surgery.
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Affiliation(s)
- Ömer Yilmaz
- Haydarpasa Sultan Abdulhamid Teaching and Research Hospital, Department of Urology, İstanbul, Turkey
| | - Sezgin Okçelik
- VAN Teaching and Research Hospital, Department of Urology, Van, Turkey.
| | - Hasan Soydan
- Haydarpasa Sultan Abdulhamid Teaching and Research Hospital, Department of Urology, İstanbul, Turkey
| | - Ferhat Ateş
- Haydarpasa Sultan Abdulhamid Teaching and Research Hospital, Department of Urology, İstanbul, Turkey
| | - Cumhur Yeşildal
- Şişli Hamidiye Etfal Teaching and Research Hospital, Department of Urology, İstanbul, Turkey
| | - Zeki Aktaş
- Haydarpasa Sultan Abdulhamid Teaching and Research Hospital, Department of Urology, İstanbul, Turkey
| | - Temuçin Şenkul
- Haydarpasa Sultan Abdulhamid Teaching and Research Hospital, Department of Urology, İstanbul, Turkey
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Örtqvist L, Fossum M, Andersson M, Nordenström A, Frisén L, Holmdahl G, Nordenskjöld A. Sexuality and fertility in men with hypospadias; improved outcome. Andrology 2016; 5:286-293. [DOI: 10.1111/andr.12309] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 11/06/2016] [Accepted: 11/08/2016] [Indexed: 11/26/2022]
Affiliation(s)
- L. Örtqvist
- Department of Women's and Children's Health and Center for Molecular Medicine; Karolinska Institutet; Stockholm Sweden
- Unit of Pediatric Surgery; Astrid Lindgren Children's Hospital; Karolinska University Hospital; Stockholm Sweden
| | - M. Fossum
- Department of Women's and Children's Health and Center for Molecular Medicine; Karolinska Institutet; Stockholm Sweden
- Unit of Pediatric Surgery; Astrid Lindgren Children's Hospital; Karolinska University Hospital; Stockholm Sweden
| | - M. Andersson
- Sahlgrenska Academy; Women's and Children's Health; Gothenburg Sweden
- Department of Pediatric Surgery; Queen Silvia's Children's Hospital; Gothenburg Sweden
| | - A. Nordenström
- Department of Women's and Children's Health and Center for Molecular Medicine; Karolinska Institutet; Stockholm Sweden
- Department of Pediatric Endocrinology; Astrid Lindgren Children's Hospital; Karolinska University Hospital; Stockholm Sweden
| | - L. Frisén
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Child and Adolescent Psychiatry Research Center; Karolinska Institutet; Stockholm Sweden
| | - G. Holmdahl
- Sahlgrenska Academy; Women's and Children's Health; Gothenburg Sweden
- Department of Pediatric Surgery; Queen Silvia's Children's Hospital; Gothenburg Sweden
| | - A. Nordenskjöld
- Department of Women's and Children's Health and Center for Molecular Medicine; Karolinska Institutet; Stockholm Sweden
- Unit of Pediatric Surgery; Astrid Lindgren Children's Hospital; Karolinska University Hospital; Stockholm Sweden
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Hoy NY, Rourke KF. Better Defining the Spectrum of Adult Hypospadias: Examining the Effect of Childhood Surgery on Adult Presentation. Urology 2016; 99:281-286. [PMID: 27693571 DOI: 10.1016/j.urology.2016.07.057] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/06/2016] [Accepted: 07/12/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe the spectrum of adult presentations with hypospadias-related complications and examine the effect of childhood surgical repair on these adult presentations. METHODS A retrospective chart review over a 10-year period, from August 2004 to December 2014, demonstrated 93 adult patients who presented to a reconstructive urologist with complications related to hypospadias. Patients were divided into 2 groups: those with no prior hypospadias surgery (Group 1, N = 19) and those who underwent surgical correction as a child (Group 2, N = 74). Charts were reviewed for age at presentation, initial complaints, history of repair, and surgical intervention required. RESULTS The mean age at presentation was 34.6 ± 0.6 years. Overall, lower urinary tract symptoms (LUTS) (49%) was the most common presenting complaint, followed by spraying (24%), urethrocutaneous fistula (18%), recurrent urinary tract infections (UTIs) (15%), and chordee (14%). Comparison demonstrated that Group 2 patients were more likely to present with LUTS (55% vs 26%; P = .038) and recurrent UTIs (19% vs 0%; P = .050). There was a trend toward Group 1 patients presenting more commonly with cosmetic dissatisfaction (16% vs 4%; P = .06). Urethral stricture was demonstrated more commonly in Group 2 (47% vs 11%; P = .0043). Of these, strictures were significantly longer in the previous surgery group (5.5 ± 0.6 cm vs 3.0 ± 0.6 cm, P = .019). CONCLUSION Correction of hypospadias as a child likely increases the future risk of urethral stricture, recurrent UTIs, and subsequent LUTS, with a trend toward improving patient satisfaction with cosmesis compared to nonsurgical management. Follow-up of hypospadias repair patients should extend into adulthood, as a significant portion of adult presentations ultimately require surgical intervention.
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Affiliation(s)
- Nathan Y Hoy
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Keith F Rourke
- Division of Urology, University of Alberta, Edmonton, AB, Canada.
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Multivariate Analysis of the Factors Associated With Sexual Intercourse, Marriage, and Paternity of Hypospadias Patients. J Sex Med 2016; 13:1488-95. [PMID: 27545860 DOI: 10.1016/j.jsxm.2016.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/25/2016] [Accepted: 07/25/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Patients with hypospadias are treated surgically during childhood, which has the intention of enabling a satisfactory sexual life in adulthood. However, it is unclear whether patients with corrected hypospadias can lead a satisfactory sexual life and sustain a marital relationship and produce offspring. AIM To evaluate factors associated with achievement of sexual intercourse, marriage, and paternity in patients with hypospadias who have reached adulthood. METHODS Self-completion questionnaires were mailed in April 2012 to patients with hypospadias at least 18 years old who had been treated at our institution during childhood from 1973 through 1998 by a single surgeon and the same surgical policy. Assessments included the International Prostate Symptom Score, the International Index for Erectile Function-5, and non-validated questions related to current social and physical status and sexual, marital, and paternity experiences. Candidate factors were extracted from patients' neonatal data, surgical findings and results, and current physical and social status obtained by the questionnaires. MAIN OUTCOME MEASURES Candidate factors associated with heterosexual intercourse, marriage, and paternity experiences were analyzed using univariate and multivariate proportional hazard models and log-rank test of Kaplan-Meier curves. RESULTS Of the 518 patients contacted, 108 (age = 18-50 years, median = 28 years) met the inclusion criteria. Two- and one-stage repairs were performed as the initial treatment in 79 and 12, respectively, and 17 of the analyzed cases were reoperations for patients initially treated elsewhere. Fifty-seven patients had the milder type (31 glandular, 26 penile), 36 had the proximal type (13 penoscrotal, 23 scrotal-perineal), and 15 had an unknown type. Multivariate analyses by Cox proportional hazard model and log-rank tests confirmed that experience of sexual intercourse was associated with the milder type of hypospadias (P = .025 and .0076 respectively), marriage was associated with stable employment (P = .020 and .026, respectively), and paternity was associated with the absence of additional surgery after completion of the initial repair (P = .013 by multivariate analysis). CONCLUSION There was scant overlap of factors associated with the three events. The present findings provide reference information for surgeons and parents regarding future sexual and marriage experiences of children treated for hypospadias.
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Adams J, Bracka A. Reconstructive surgery for hypospadias: A systematic review of long-term patient satisfaction with cosmetic outcomes. Indian J Urol 2016; 32:93-102. [PMID: 27127350 PMCID: PMC4831515 DOI: 10.4103/0970-1591.179178] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Research on long-term results of hypospadias has focused on surgical techniques and functional outcomes, and it is only recently that patient satisfaction with appearance and psychosocial outcomes have been considered. The aim of this study was to provide an evidence-based systematic review of adolescent and adult patient perceptions of cosmetic outcomes following childhood surgery for hypospadias. METHODS A systematic review was performed in accordance with the PRISMA and PICO guidelines, and studies assessed using the Oxford Centre for Evidence-Based Medicine system. MEDLINE, PsycInfo, EMBASE, and CINAHL databases were searched from 1974 to 2014 for clinical studies containing patient perceptions of appearance, deformity, and social embarrassment following hypospadias surgery. RESULTS A total of 495 publications were retrieved, of which 28 met the inclusion criteria. Due to study design/outcome measure, heterogeneity data were synthesized narratively. Results indicate (i) patient perceptions of penile size do not differ greatly from the norm; (ii) perceptions of appearance findings are inconsistent, partially due to improving surgical techniques; (iii) patients who are approaching, or have reached, sexual maturity hold more negative perceptions and are more critical about the cosmetic outcomes of surgery than their prepubertal counterparts; (iv) patients report high levels of perceptions of deformity and social embarrassment; and (v) there is a lack of data using validated measurement tools assessing long-term patient perceptions of cosmetic outcomes, particularly with patients who have reached genital maturity. CONCLUSIONS Protocols for clinical postpuberty follow-up and methodologically sound studies, using validated assessment tools, are required for the accurate assessment of cosmetic and psychological outcomes of hypospadias surgery.
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Affiliation(s)
- Julie Adams
- Department of Applied Health, Faculty of Health, Edge Hill University, Ormskirk, Lancashire, UK
| | - Aivar Bracka
- Formerly at the Dudley Group of Hospitals, West Midlands, UK
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The use of dermal graft in severe chordee hypospadias repair: experience from Vietnam. Pediatr Surg Int 2015; 31:291-5. [PMID: 25573387 DOI: 10.1007/s00383-015-3656-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE Severe chordee with hypospadias may require repair by ventral corporoplasty with a free graft before urethroplasty. We report an 11 year experience with one-stage and two-stage hypospadias repair using dermal grafts. MATERIALS AND METHODS From 12/1997 to 12/2008, 47 hypospadias with severe chordee were repaired using a ventral dermal graft to correct the chordee. Forty cases were repaired in two stages; the remaining seven patients had adequate preputial skin and were repaired in one stage. In 28 cases the neourethra was covered with both tunica vaginalis and penile dartos flap while 12 were covered only with penile dartos flap. Patients ranged from 12 to 152 months of age. Follow-up ranged from 6 months to 4 years. RESULTS 28 patients with both tunica vaginalis and dartos flap had 7 urethral fistulas and 2 developed meatal stenosis. 12 patients with only penile dartos flap had 3 fistulas and 2 had meatal regression. The seven patients who underwent a one-stage repair had good results with a straight penis and no evidence of urethral fistula or urethral stenosis. CONCLUSIONS Dermal graft can be performed in one or two stage hypospadias repair. Complication rates are similar to other standard repairs for proximal hypospadias.
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Johnson EK, Kozinn SI, Johnson KL, Kim S, Diamond DA, Retik AB. Use of buccal mucosa grafts for urethral reconstruction in children: a retrospective cohort study. BMC Urol 2014; 14:46. [PMID: 24902693 PMCID: PMC4066324 DOI: 10.1186/1471-2490-14-46] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of buccal mucosa grafts (BMG) for urethral reconstruction has increased in popularity over the last several decades. Our aim was to describe our institutional experience with and outcomes after BMG urethroplasty. METHODS We conducted a retrospective cohort study of boys undergoing BMG urethral reconstruction. Preoperative and perioperative characteristics and postoperative outcomes were evaluated. RESULTS Twenty-nine patients (median age 8.2 years) underwent BMG urethroplasty from 1995-2012. Of the 10 patients undergoing 1-stage repairs, 6 had tubularized grafts, the last of which was performed in 2000 due to an unacceptably high revision rate (100%). A 2-stage approach was elected for 19 patients (median follow-up 21.3 months). Complications including stricture, fistula, or chordee were seen in 60% of patients completing both stages and 32% required ≥1 revision. However, 71% of 2-stage patients were free of significant problems at last follow-up. CONCLUSIONS We found BMG to be a reasonable option for use in complex pediatric urethral reconstruction. Tubularized grafts had poor results, and we no longer use them. We favor a 2-stage approach for all patients except those with "simple" non-hypospadiac strictures. Although revision procedures were not uncommon, the majority of patients were ultimately free of long-term problems.
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Affiliation(s)
- Emilie K Johnson
- Department of Urology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
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Fraumann SA, Stephany HA, Clayton DB, Thomas JC, Pope JC, Adams MC, Brock JW, Tanaka ST. Long-term follow-up of children who underwent severe hypospadias repair using an online survey with validated questionnaires. J Pediatr Urol 2014; 10:446-50. [PMID: 24582083 DOI: 10.1016/j.jpurol.2014.01.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 01/21/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Few studies of hypospadias repair in childhood have used validated questionnaires to investigate outcomes of cosmesis, urinary function, and sexual function in adulthood. We sought to investigate long-term outcomes in adult patients who had undergone severe hypospadias repair as children using an existing web-based application available to multiple institutions in order to develop an online patient survey of previously validated questionnaires. MATERIALS AND METHODS Patients aged 18 years or older who underwent severe hypospadias repair between 1992 and 1997 at our institution were contacted to complete an online survey. Through medical chart reviews, we analyzed the location of meatus, type of repair, and complications. The online survey included questions about penile appearance, and validated questionnaires to assess urinary and sexual function. RESULTS Of 58 patients who met the inclusion criteria, we contacted 19, and 13 completed the survey. Fifty-nine percent had complications, with an average of 2.2 procedures per patient. Most (85.0%) were satisfied with penile appearance, although 38.0% had residual penile curvature. Hypospadias patients had mean lower orgasmic function than normal controls. Mean scores for urinary function and other domains of sexual function were similar to normal controls. CONCLUSIONS Although the majority of adult patients were satisfied with the outcomes of penile appearance, urinary function, and sexual function, our online survey suggests decreased lower orgasmic function as measured by validated questionnaire. An online survey accessible to multiple institutions with validated questionnaires may facilitate assessment of long-term hypospadias results.
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Affiliation(s)
- Sarah A Fraumann
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 4012 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232-9820, USA
| | - Heidi A Stephany
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 4012 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232-9820, USA
| | - Douglass B Clayton
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 4012 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232-9820, USA
| | - John C Thomas
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 4012 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232-9820, USA
| | - John C Pope
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 4012 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232-9820, USA
| | - Mark C Adams
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 4012 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232-9820, USA
| | - John W Brock
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 4012 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232-9820, USA
| | - Stacy T Tanaka
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 4012 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232-9820, USA.
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Abstract
Hypospadias, epispadias with or without exstrophy, and disorders of sex development are among the most common anomalies of genitalia that occur during childhood. Considering the tremendous effect of genitourinary reconstruction on adult life, the evaluation of the long-term results of different techniques of genitoplasty in pediatrics is of the utmost importance. After reviewing the literature, the authors summarize the available long-term outcomes of genitoplasty in childhood, specifically focusing on the cosmetic, psychosocial, psychosexual and functional results, and emphasize that, contrary to the widely available data on early outcomes of genital reconstruction in the pediatric population, very few well described controlled studies have evaluated the long-term effect of genitoplasty in puberty and adulthood, in the sense that the surgeon should describe the peroperative findings in more detail and also be more structured in evaluating the postoperative result at follow-up visits. Finally, the authors conclude that more attention should be paid to the impact of these techniques on cosmetic aspects and psychosexual development in these patients after puberty, as they play a crucial role in their adult quality of life.
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Boillot B, Teklali Y, Moog R, Droupy S. Les malformations congénitales du pénis. Prog Urol 2013; 23:664-73. [DOI: 10.1016/j.purol.2013.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 01/29/2013] [Indexed: 11/29/2022]
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Functional, cosmetic and psychosexual results in adult men who underwent hypospadias correction in childhood. J Pediatr Urol 2011; 7:504-15. [PMID: 21429804 DOI: 10.1016/j.jpurol.2011.02.008] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 02/12/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Long-term results of hypospadias repair are scarce. Previous reviews mostly described mid-term results making extrapolation to long-term results difficult. This systematic review on long-term results in postpubertal men after hypospadias repair in childhood, aims to inform urologists and parents of a newborn boy with hypospadias about future expectations. METHODS AND MATERIALS The Pubmed/Medline and Embase databases were searched until February 2010. Inclusion criteria stated that patients with hypospadias were operated before the age of 6 years and were older than 14 years at follow up. Results were pooled and analyzed using SPSS 16.0. Data on proximal hypospadias patients and controls are described separately. RESULTS Twenty eligible studies investigating micturition, cosmesis and psychosexual functioning were found. Hypospadias patients report more urinary symptoms and have a lower Qmax than controls. Patients are less satisfied with penile appearance compared to controls. Objectively assessed cosmetic results are good. Sexually, patients are as active as controls, but are less satisfied. Patients less often have an intimate relationships compared to controls. CONCLUSION Study outcomes were heterogeneous due to operation techniques and a lack of validated questionnaires and control groups. Long-term results of hypospadias patients should be measured in a prospective design using validated measurement tools.
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Kiss A, Sulya B, Szász AM, Romics I, Kelemen Z, Tóth J, Merksz M, Kemény S, Nyírády P. Long-Term Psychological and Sexual Outcomes of Severe Penile Hypospadias Repair. J Sex Med 2011; 8:1529-39. [DOI: 10.1111/j.1743-6109.2010.02120.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Wang WW, Deng CH, Chen LW, Zhao LY, Mo JC, Tu XA. Psychosexual adjustment and age factors in 130 men undergone hypospadias surgery in a Chinese hospital. Andrologia 2011; 42:384-8. [PMID: 21105889 DOI: 10.1111/j.1439-0272.2010.01061.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The study investigated the psychosexual status and sexual function in adults who had hypospadias surgery at different ages. A detailed questionnaire was mailed to 130 patients who underwent hypospadias surgery between January 1988 and December 2007, and 50 healthy males who served as the control group. The patients were divided into three groups based on their age at which surgery was completed: group A (n=32; <10 years); group B (n=45; 10-18 years); and group C (n=53; >18 years). The Zung Self-Rating Anxiety Scale and The Zung Self-Rating Depression Scale were used to assess psychosexual status; a designed questionnaire and the International Index of Erectile Function-5 were used to assess sexual function. The incidence of anxiety and depression was significantly higher in patients than that in controls (P < 0.001), and was correlated with the age at which surgery was completed. The length and circumference of penises in patients were shorter than those of control groups with statistically significant differences (P < 0.01). There were no significant differences between patients and controls regarding libido strength, overall sexual satisfaction and erectile function (P > 0.05). In conclusion, difference existed in certain aspects of psychosexual and penile development between patients and controls. Hypospadias surgery should be performed early.
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Affiliation(s)
- W-W Wang
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, GuangZhou, China
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20
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Seibold J, Werther M, Alloussi S, Gakis G, Schilling D, Colleselli D, Stenzl A, Schwentner C. Objective long-term evaluation after distal hypospadias repair using the meatal mobilization technique. ACTA ACUST UNITED AC 2010; 44:298-303. [PMID: 20450394 DOI: 10.3109/00365599.2010.482944] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Meatal mobilization (MEMO) by distal urethral preparation has been demonstrated to be an efficient surgical technique for the correction of distal hypospadias offering excellent short-term success rates. This study objectively evaluates individual patient satisfaction using a validated score in the long term. MATERIAL AND METHODS A total of 218 patients who underwent hypospadias repair using the MEMO technique was identified. Of these, 104 (mean age at time of surgery 4.9 years, range 2-28 years) had a minimum follow-up of 5 years and were eligible for the study. They were investigated by physical examination and self-assessment. An objective evaluation using the validated Hypospadias Objective Scoring Evaluation (HOSE) was done in all patients. RESULTS Mean follow-up was 6.3 (range 5-8) years. Ninety-nine patients participated in the investigation, an overall survey response rate of 95.2%. One urethrocutaneous fistula occurred, but no cases of stenosis were noted. One patient developed a mild penile deviation during the postoperative follow-up. Ninety-three out of 99 patients reached the maximum of 16 points (median 15, range 12-16) on the HOSE symptom score. CONCLUSION The MEMO technique demonstrates a surgical success rate of 97% after 2 years. Even in the long-term follow-up of a mean 6.3 years objective outcome data and individual patient satisfaction were excellent. MEMO is a reliable and versatile method for distal hypospadias repair, as reflected by high patient satisfaction.
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Affiliation(s)
- Joerg Seibold
- Department of Urology, Eberhard-Karls University, Tuebingen, Germany
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21
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High odds for freedom from early complications after tubularized incised-plate urethroplasty in 1-year-old versus 5-year-old boys. J Pediatr Urol 2008; 4:452-6. [PMID: 18753012 DOI: 10.1016/j.jpurol.2008.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Accepted: 07/02/2008] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We present two parallel case series on outcome after tubularized incised-plate urethroplasty (TIP repair) for hypospadias in 1-year-old versus 5-year-old boys. PATIENTS AND METHODS Over a 2-year period two groups (1 year old, n=57 and 5 years old, n=65) of boys were operated in parallel using the TIP repair. Main endpoints were set as incidence of fistula, meatal stenosis and foreskin dehiscence/phimosis. A logistic regression model was used to predict the odds for freedom from either 'any complication' or fistula in 1-year-old boys versus 5-year-old boys. RESULTS Five-year-old boys had a significantly higher incidence of fistula (26% vs. 7%, P<0.01) and 'any complication' (50% vs. 18%, P<0.001) than the 1-year-old boys. The odds ratio for freedom from 'any complication' and fistula was 4.8:1 (P<0.001) and 4.7:1 (P=0.009), respectively, in favor of the 1-year-old group. Avoiding foreskin reconstruction gave increased odds for freedom of "any complication" (4.2:1, P=0.034), but was an insignificant factor concerning freedom from fistula. CONCLUSION These data substantiate why boys with hypospadias should be corrected early. Foreskin reconstruction increases postoperative problems but does not increase the rate of postoperative fistulae.
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22
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Braga LHP, Lorenzo AJ, Salle JLP. Tubularized incised plate urethroplasty for distal hypospadias: A literature review. Indian J Urol 2008; 24:219-25. [PMID: 19468401 PMCID: PMC2684277 DOI: 10.4103/0970-1591.40619] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The tubularized incised plate (TIP) urethroplasty or Snodgrass procedure has gained worldwide acceptance for distal hypospadias repair due to its low complication rate, good cosmetic result, and technical simplicity. As a result, several articles have been published concerning various aspects and subtle variations of this procedure. The aim of this review is to critically and systematically analyze the published complication rates of TIP repair for distal hypospadias in children. We also reviewed the surgical modifications that have been introduced to the original technique and discussed the potential impact on the final outcome of the Snodgrass procedure.
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Affiliation(s)
- Luis Henrique P. Braga
- Division of Urology and University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Armando J. Lorenzo
- Division of Urology and University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joao L. Pippi Salle
- Division of Urology and University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
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Dodds PR, Batter SJ, Shield DE, Serels SR, Garafalo FA, Maloney PK. Adaptation of adults to uncorrected hypospadias. Urology 2008; 71:682-5; discussion 685. [PMID: 18279924 DOI: 10.1016/j.urology.2007.07.078] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Revised: 04/04/2007] [Accepted: 07/02/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Surgery has been advocated for children with hypospadias to improve the appearance of the penis, allow voiding in the standing position, and improve the chance of fertility. We undertook a survey of adults with hypospadias to determine their adaptation to this congenital anomaly without surgical correction. METHODS In a 2-year prospective study, six urologists in the general practice of urology identified 56 adult patients from their practices with hypospadias. The urethral meatus was glanular in 21 patients, subcoronal in 23, distal penile in 7, mid-penile in 4, and proximal penile in 1. Nine patients had undergone failed or incomplete hypospadias repairs as children. Seven patients had mild to moderate chordee. RESULTS Only 1 patient presented with a complaint referable to the hypospadias, and only 3 (5%) of the 56 patients expressed dissatisfaction with the appearance of their penis. Of the 56 patients, 18 (32%) stated that they were unaware that they had a congenital anomaly. The 2 patients who were known to be infertile were believed to be infertile on the basis of oligospermia. Although 20 (36%) of the 56 patients described angulation or spraying of the urinary stream, only 3 (5%) stated that they preferentially sat to void. No patient pursued an interest in corrective surgery. CONCLUSIONS Of the adults we surveyed with hypospadias, most stated that they were satisfied with the appearance of the penis, voided in the standing position, and did not have infertility associated with the abnormal position of the urethral meatus.
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Affiliation(s)
- Peter R Dodds
- Department of Surgery, Norwalk Hospital, Norwalk, Connecticut 06856, USA.
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Halachmi S, Pillar G. Congenital urological anomalies diagnosed in adulthood - management considerations. J Pediatr Urol 2008; 4:2-7. [PMID: 18631884 DOI: 10.1016/j.jpurol.2007.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Accepted: 03/01/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Despite worldwide availability of prenatal ultrasound, many patients are diagnosed in adult life with congenital anomalies such as ureteropelvic junction obstruction (UPJO), undescended testicle (UDT), ureterocele, hypospadias, vesicoureteral reflux (VUR) and primary obstructing megaureter (POM). The aim of this review was to describe these clinical conditions and their suggested management based on the available medical literature. REVIEW Adult UPJO is not a rare condition; symptomatic patients should be treated rather than observed. Treatment options are nephrectomy for non-functioning kidneys and reconstructive surgery for functioning renal units. The adult UDT has low fertility potential and increased cancer risk; hence most of the data in the literature indicate performing an orchiectomy. Adult ureteroceles are usually related to single systems and they are intravesical and less obstructive. For symptomatic patients endoscopic incision showed high efficacy for symptom elimination with minimal side effects. Primary hypospadias correction in the adult patient is feasible, but success rates are low compared to the pediatric age group. Secondary correction, whether primary correction was performed in childhood or adulthood, is a challenging task with a high complication rate. Treatment decisions regarding adult patients with VUR are difficult to make as the available data are inconsistent; there is no strict evidence that reflux in an adult is directly related to renal growth impairment, ascending pyelonephritis, and/or embryo loss in a pregnant woman. In contrast to the pediatric age group, adult POM is usually a symptomatic condition and related to a high complication rate including infections, stone formation and renal failure. Spontaneous resolution is rare and hence active surgical management is advocated. CONCLUSION Congenital urological anomalies identified in adulthood are not rare and pose a management challenge to the urologist. For most of the reviewed diseases, evidence-based management direction is difficult due to a lack of randomized trials and long-term follow up.
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Affiliation(s)
- Sarel Halachmi
- Pediatric Urology Service, The Department of Urology and Pediatrics, Rambam Medical Center and The Faculty of Medicine, Technion - Israeli Institute of Technology, Haifa, Israel.
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Kajbafzadeh AM, Arshadi H, Payabvash S, Salmasi AH, Najjaran-Tousi V, Sahebpor ARA. Proximal Hypospadias With Severe Chordee: Single Stage Repair Using Corporeal Tunica Vaginalis Free Graft. J Urol 2007; 178:1036-42; discussion 1042. [PMID: 17632178 DOI: 10.1016/j.juro.2007.05.062] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE We report the results of corporeal tunica vaginalis free graft for single stage correction of severe chordee in children with proximal hypospadias. MATERIALS AND METHODS A total of 18 children with proximal hypospadias and severe chordee underwent tunica vaginalis free graft for correction of chordee and urethroplasty. The graft was anastomosed to the ventral surface of the corpus cavernosum to correct severe penile curvature without dorsal plication of the corpus cavernosum. Single stage urethroplasty was then performed. In cases where the urethral plate was too short for urethral reconstruction a transverse preputial island flap was used for single stage urethroplasty. If the incised urethral plate did not have a well vascularized and supple appearance or the prepuce was not sufficient for phallic coverage, we transected the urethral plate and staged urethroplasty was done. RESULTS Mean followup was 27.5 months. In 13 patients ventral chordee was corrected using tunica vaginalis free graft without transecting the urethral plate, and urethroplasty was performed in 1 stage. In 3 patients the urethral plate was transected and a transverse preputial island flap was used for single stage urethroplasty. In 2 patients the urethral plate was transected and interposed with dermal graft and tunica vaginalis free graft, followed by staged urethroplasty. There was mild residual chordee in 2 cases. One child had a urethrocutaneous fistula at 2 weeks postoperatively, and 1 presented with obstructive pattern uroflowmetry due to meatal stenosis. CONCLUSIONS In this preliminary report the majority of patients with proximal hypospadias and severe chordee were successfully treated with single stage repair using tunica vaginalis free graft for correction of severe chordee.
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Affiliation(s)
- Abdol-Mohammad Kajbafzadeh
- Department of Urology, Pediatric Urology Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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Chrzan R, Dik P, Klijn AJ, de Jong TPVM. Quality assessment of hypospadias repair with emphasis on techniques used and experience of pediatric urologic surgeons. Urology 2007; 70:148-52. [PMID: 17656226 DOI: 10.1016/j.urology.2007.01.103] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Revised: 12/01/2006] [Accepted: 01/30/2007] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess outcomes in hypospadias repair at our institution, as compared with the literature, with repair technique and surgeon considered as risk factors. METHODS The results of 299 primary hypospadias corrections were analyzed. All procedures were performed by three experienced pediatric urologists. Mean patient age at operation was 16.3 months. Follow-up was between 6 months and 5.5 years. Distal hypospadias repair was carried out in 242 patients, with tubularized incised plate reconstruction in 100 patients, advancement in 128, and the Mathieu technique in 14. RESULTS During follow-up, complications occurred overall in 93 patients (31%). For distal hypospadias complications occurred in 59 patients (24%). The most common findings for distal hypospadias were urethral fistulas (14.4%). The complication rate depended on the severity of the anomaly (0 glanular, 28% pericoronal, and 63% proximal) and the chosen technique (16% advancement technique versus 60% tubular techniques). We found statistically significant differences in complication rates between operating surgeons. CONCLUSIONS Complications after hypospadias surgery are frequent. They are multifactorial and depend mainly on the type of the anomaly, the chosen technique, and the experience of the surgeon. More studies are needed to obtain an internationally accepted quality indicator for the outcome of hypospadias repair.
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Affiliation(s)
- Rafal Chrzan
- Department of Pediatric Urology, University Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
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Bibliography. Current world literature. Female urology. Curr Opin Urol 2007; 17:287-90. [PMID: 17558274 DOI: 10.1097/mou.0b013e3281fbd54d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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