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Naumeri F, Munir MA, Ahmad HM, Sharif M, Awan NU, Butt G. Comparison of Urethrocutaneous Fistula Rate After Single Dartos and Double Dartos Tubularized Incised Plate Urethroplasty in Pediatric Hypospadias. Cureus 2021; 13:e13378. [PMID: 33754103 PMCID: PMC7971730 DOI: 10.7759/cureus.13378] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background and objective Tubularized incised plate (TIP) urethroplasty is an easy and popular technique for repairing hypospadias, however urethrocutaneous fistula (UCF) is a frequently reported complication. Different techniques are used to reduce this complication. We aimed to compare the rate of UCF after single dartos and double dartos TIP urethroplasty in children with distal and mid penile hypospadias. Methods A randomized controlled trial (NCT 04699318) was conducted in the Department of Pediatric Surgery, Mayo Hospital, Pakistan from August 2017 to February 2018, after ethical approval. After informed consent, a total of 60 patients with distal and mid penile hypospadias who were uncircumcised, had no chordee, and/or previous surgery, were randomly allocated in two groups using computer generated table numbers. Group A underwent single dartos TIP urethroplasty and Group B underwent double dartos TIP urethroplasty. Catheter was removed on day 10 post-operatively in both groups and primary outcome (UCF) was noted after a week of catheter removal. Rate of UCF was compared using chi square and p-value of <0.05 was taken as significant. Data was stratified to check for effect modifiers. Results Out of 60 children, eight (13.3%) developed UCF. In Group A, seven (23.3%) developed UCF and in Group B, one (3.3%) developed UCF (p-value 0.02). In both groups, no patient (0%) had urethral disruption, penile torsion, skin necrosis or meatal stenosis. Conclusion Additional covering of neo-urethra by a double dartos layer significantly reduces fistula rate after tubularized incised plate urethroplasty in both primary distal and mid penile hypospadias.
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Affiliation(s)
- Fatima Naumeri
- Pediatric Surgery, King Edward Medical University/Mayo Hospital, Lahore, PAK
| | - Malik Asad Munir
- Pediatric Surgery, King Edward Medical University/Mayo Hospital, Lahore, PAK
| | - Hafiz Mahmood Ahmad
- Pediatric Surgery, King Edward Medical University/Mayo Hospital, Lahore, PAK
| | - Muhammad Sharif
- Pediatric Surgery, King Edward Medical University/Mayo Hospital, Lahore, PAK
| | - Nukhbat U Awan
- Otolaryngology, King Edward Medical University/Mayo Hospital, Lahore, PAK
| | - Ghazala Butt
- Dermatology, King Edward Medical University/Mayo Hospital, Lahore, PAK
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Bandini M, Sekulovic S, Spiridonescu B, Dangi AD, Krishnappa P, Briganti A, Salonia A, Montorsi F, Djinovic R. Vacuum physiotherapy after first stage buccal mucosa graft (BMG) urethroplasty in children with proximal hypospadias. Int Braz J Urol 2020; 46:1029-1041. [PMID: 32822133 PMCID: PMC7527085 DOI: 10.1590/s1677-5538.ibju.2019.0845] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/20/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION To assess the feasibility of vacuum physiotherapy meant to decrease graft contraction and recurrent penile curvature (PC), hence successful tubularization and a straight penis in patients underwent two-stage buccal mucosa graft (BMG) urethroplasty, in proximal hypospadias repair. MATERIAL AND METHODS Between January 2014 and July 2018, 59 two-stage BMG urethroplasties performed at our referral center, were included in the study. The parents were counseled to use the vacuum device between the two stages. An internal, self-administered, semiquantitative, non-validated questionnaire was designed to record parent and patient adherence to the vacuum physiotherapy and parent satisfaction. Success rate of graft tubularization, curvature correction rates, and status of early (4 months) postoperative urinary stream were evaluated. RESULTS Of 45/59 (76.3%) who returned the questionnaire, 77.8% followed the recommended physiotherapy protocol using the vacuum device. 93.3% of parents replied that the use of the vacuum was easy or moderately easy. None of the parents interrupted the physiotherapy because of perceived difficulty or intolerability. 100% of parents would have repeated the physiotherapy, if they had to. Overall, success rate of tubularization was 98.3% (58/59), complete curvature correction was achieved in 88.2% (52/59) of patients, and 79.7% (47/59) of patients showed a straight and powerful early post-operative urinary stream. CONCLUSIONS Physiotherapy with the vacuum device is safe, easy and practically feasible. Our vacuum physiotherapy protocol had high compliance rate. Vacuum physiotherapy should be considered for further assessment in patients undergoing two stage hypospadias repair using buccal mucosa.
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Affiliation(s)
- Marco Bandini
- Sava Perovic Foundation, Center for Genito-Urinary Reconstructive Surgery, Belgrade, Serbia.,Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Sasha Sekulovic
- Sava Perovic Foundation, Center for Genito-Urinary Reconstructive Surgery, Belgrade, Serbia
| | - Bogdan Spiridonescu
- Sava Perovic Foundation, Center for Genito-Urinary Reconstructive Surgery, Belgrade, Serbia.,FundeniClinical Institute-Center for Uronephrology and Renal Transplantation, Bucharest, Romania
| | - Anuj Deep Dangi
- Sava Perovic Foundation, Center for Genito-Urinary Reconstructive Surgery, Belgrade, Serbia.,Department of Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Pramod Krishnappa
- Sava Perovic Foundation, Center for Genito-Urinary Reconstructive Surgery, Belgrade, Serbia.,Department of Urology, NU Hospitals, Bangalore, India
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Salonia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Rados Djinovic
- Sava Perovic Foundation, Center for Genito-Urinary Reconstructive Surgery, Belgrade, Serbia
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