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Schwarztuch Gildor O, Shumaker A, Beberashvili I, Stav K, Neheman A. Reducing fistula rate in hypospadias repair: A comparative study between standard tubularized incised plate repair and incorporation of a layer of spongiosum tissue. J Pediatr Urol 2024:S1477-5131(24)00194-3. [PMID: 38670858 DOI: 10.1016/j.jpurol.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/18/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION The most prevalent complication in hypospadias repair is fistula formation. Adhering to the principle of providing urethroplasty coverage to mitigate fistula occurrence, we implemented a modification by integrating a spongiosum layer between the urethroplasty and the dartos flap. Our hypothesis posited that this approach would result in a reduced fistula formation rate. METHODS This study is a comparative analysis involving patients under 18 years of age who underwent primary hypospadias repair. The cases were allocated into two groups. In the study group, in addition to performing tubularized incised plate (TIP) repair, a spongiosum layer harvested from both sides of the urethra was used to cover the urethroplasty (modification of the Y-to-I urethroplasty). The control group underwent a standard TIP repair. The primary outcome was to assess urethrocutaneous fistula formation. Secondary outcomes included evaluating the development of meatal stenosis and glans dehiscence, along with assessing cosmetic results by the Hypospadias Objective Penile Evaluation (HOPE) score. RESULTS Overall, 154 hypospadias cases were included in the study. Eighty-seven patients (56%) were allocated to the study group, and 67 (44%) were allocated to the control group. Urethrocutaneous fistula developed in 3 (3.4%) and 11 (16.4%) patients in the study and control group, respectively (p = 0.006). Glans dehiscence occurred in 2 (2.3%) patients in the study group and 4 (6%) patients in the control group (p = 0.198). Meatal stenosis was observed in 4 (4.6%) patients in the study group and 5 (7.5%) patients in the control (p = 0.452). The mean HOPE score was 59 in both groups (p = 0.36). DISCUSSION This study details our encounters with the novel modification and compares the results with standard TIP. Our data suggest that adding a layer of spongiosum tissue over the urethroplasty reduces the complication of urethrocutaneous fistula without increasing the occurrence of dehiscence, significant meatal stenosis, or compromising cosmetic outcomes. CONCLUSION We advocate for implementing the described surgical modification as a viable option for hypospadias repair.
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Affiliation(s)
- Omri Schwarztuch Gildor
- Department of Urology, Meir Medical Center, Tchernichovsky St 59, Kfar Saba, 4428164, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Andrew Shumaker
- Department of Urology, Shamir Medical Center, Zerifin, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilia Beberashvili
- Department of Nephrology, Shamir Medical Center, Zerifin, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kobi Stav
- Department of Urology, Shamir Medical Center, Zerifin, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Neheman
- Department of Urology, Meir Medical Center, Tchernichovsky St 59, Kfar Saba, 4428164, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Neheman A, Schwarztuch Gildor O, Shumaker A, Beberashvili I, Bar-Yosef Y, Arnon S, Zisman A, Stav K. Use of Validated Questionnaires to Predict Cosmetic Outcomes of Hypospadias Repair. CHILDREN (BASEL, SWITZERLAND) 2024; 11:189. [PMID: 38397301 PMCID: PMC10887056 DOI: 10.3390/children11020189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Hypospadias is a syndrome of penile maldevelopment. The primary goal of hypospadias surgery is to create a penis with normal appearance and function. Historically, the outcome of hypospadias repair has been assessed based on the need for reoperation due to urethroplasty complications (UC), including fistula formation, dehiscence, meatal stenosis, or development of a urethral stricture. The Glans-Urethral Meatus-Shaft (GMS) score is a standardized tool to predict UC. Analysis of the cosmetic outcomes of hypospadias repair based on the appearance of the reconstructed penis has been validated, and standardized scores have been published. The Hypospadias Objective Penile Evaluation (HOPE) score is a validated questionnaire used to assess postoperative cosmetic outcomes. Although predictors of surgical outcomes and UC have been well documented, predictors of optimal cosmetic outcomes are lacking in the literature. Furthermore, reoperation due to cosmetic considerations has been poorly reported. OBJECTIVE To identify predictors of cosmetic outcomes after hypospadias repair and to assess the reoperation rate according to cosmetic considerations. MATERIALS AND METHODS This prospective cohort study included 126 boys who underwent primary hypospadias repair. The severity of hypospadias, degree of penile curvature, glans width, preoperative HOPE, and GMS scores were documented. The standard technique for single-stage repairs, the tubularized incised plate urethroplasty, was performed. The primary endpoint was cosmetic outcomes evaluated by the HOPE score questionnaire six months postoperatively. Optimal cosmetic results were defined by HOPE scores ≥ 57. RESULTS The study population consisted of the following cases: 87 (69%) subcoronal, 32 (25%) shaft, and 7 (6%) proximal hypospadias. Among the study participants, 102 boys (81%) had optimal cosmetic results (HOPE ≥ 57), and 24 boys (19%) had surgeries with suboptimal cosmetic outcomes (HOPE < 57). Ancillary procedures were performed in 21 boys (16%), of which 14 (11%) were solely for cosmetic considerations, and 7 were secondary to UC. Using the Receiver Operating Characteristic analysis of potential predictors of optimal cosmetic outcomes, the preoperative HOPE score had the highest area under the curve (AUC = 0.79; 95% CI 0.69-0.89, p < 0.001). After multivariable analysis, the degree of penile chordee (p = 0.013), glans width (p = 0.003), GMS score (p = 0.007), and preoperative HOPE score (p = 0.002) were significant predictors of cosmetic outcomes. Although meatal location predicted suboptimal cosmetic results in univariate analysis, it was not a factor in multivariable analysis. CONCLUSIONS Over 80% of boys undergoing hypospadias repair achieved optimal cosmetic outcomes. More than 10% of cases underwent ancillary procedures, secondary solely to cosmetic considerations. Predictors of optimal cosmetic outcomes after hypospadias surgery included degree of chordee, glans width, and preoperative HOPE and GMS scores, which were the best predictors of satisfactory cosmetic results. Although meatal location is the main predictor of UC, it was not a predictor for cosmetic outcomes. Factors affecting cosmetic outcomes should be clearly explained to parents during the preoperative consultation.
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Affiliation(s)
- Amos Neheman
- Meir Medical Center, Department of Urology, Kfar Saba 44281, Israel; (A.N.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (A.S.); (I.B.); (Y.B.-Y.); (A.Z.); (K.S.)
| | - Omri Schwarztuch Gildor
- Meir Medical Center, Department of Urology, Kfar Saba 44281, Israel; (A.N.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (A.S.); (I.B.); (Y.B.-Y.); (A.Z.); (K.S.)
| | - Andrew Shumaker
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (A.S.); (I.B.); (Y.B.-Y.); (A.Z.); (K.S.)
- Shamir Medical Center, Department of Urology, Zerifin 703001, Israel
| | - Ilia Beberashvili
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (A.S.); (I.B.); (Y.B.-Y.); (A.Z.); (K.S.)
- Shamir Medical Center, Department of Nephrology, Zerifin 703001, Israel
| | - Yuval Bar-Yosef
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (A.S.); (I.B.); (Y.B.-Y.); (A.Z.); (K.S.)
- Department of Pediatric Urology, Dana-Dwek Children’s Hospital, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
| | - Shmuel Arnon
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (A.S.); (I.B.); (Y.B.-Y.); (A.Z.); (K.S.)
- Meir Medical Center, Department of Neonatology, Kfar Saba 4428164, Israel
| | - Amnon Zisman
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (A.S.); (I.B.); (Y.B.-Y.); (A.Z.); (K.S.)
- Shamir Medical Center, Department of Urology, Zerifin 703001, Israel
| | - Kobi Stav
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (A.S.); (I.B.); (Y.B.-Y.); (A.Z.); (K.S.)
- Shamir Medical Center, Department of Urology, Zerifin 703001, Israel
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Yuan Y, Wang YW, Liang YN, Wang YY, Ho JJ, Peng TY, Zhao Z, Deng N. A meta-analysis: single or double dartos flap layer in tubularized incised plate urethroplasty to prevent urethrocutaneous fistula? Front Pediatr 2023; 11:1091242. [PMID: 37360362 PMCID: PMC10286861 DOI: 10.3389/fped.2023.1091242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 04/17/2023] [Indexed: 06/28/2023] Open
Abstract
Backgrounds Urethrocutaneous fistula is one of the most common complications after urethroplasty. This meta-analysis aims to evaluate the superiority of double dartos flap to single dartos flap in preventing fistula during tubularized incised plate urethroplasty (TIPU), which is one of the most frequently used operations for hypospadias. Methods We extracted clinical trials under the following included criteria: (1) children with TIPU; (2) a comparison of single and double flap layer; and (3) record of complications with the following excluded criteria: (1) non-comparison and (2) lack of data. Finally, 13 studies from PubMed, Cochrane Library, Scopus, and Embase have been investigated, with a total of 1,185 patients from 2005 to 2022. The quality assessment was conducted according to the Cochrane handbook and the Newcastle-Ottawa scale. A mixed-effect model was utilized to weigh the risk of fistula, phallic rotation, meatal stenosis, and wound dehiscence by the Review Manager V.5.4 software. Results The double dartos flap layer group excels in descending the risk of postoperative fistula [odds ratio (OR) = 9.56; 95% confidence interval (CI) (4.76, 19.22); P < 0.00001] and phallic rotation [OR = 31.26; 95% CI (9.60, 101.84); P < 0.00001], while there are no differences in the rate of meatal stenosis [OR = 1.49; 95% CI (0.73, 2.70); P = 0.31] and wound dehiscence [OR = 2.30; 95% CI (0.80, 6.63); P = 0.12]. Conclusions The routine utility of a double dartos flap layer is recommended as a potential treatment during the tubularized incised plate urethroplasty. Systematic Review Registration identifier PROSPERO CRD42022366294.
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Affiliation(s)
- Yi Yuan
- Department of Urology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yu-wen Wang
- Department of Urology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yan-nei Liang
- Department of Urology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yu-ying Wang
- Department of Urology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jun-jie Ho
- Department of Urology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tong-yu Peng
- The First Clinical College, Chongqing Medical University, Chongqing, China
| | - Zhang Zhao
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou, China
| | - Nan Deng
- Department of Urology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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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: 0] [Impact Index Per Article: 0] [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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A cover flap reduces the rate of fistula after urethroplasty whatever the severity of hypospadias. World J Urol 2020; 39:2691-2695. [PMID: 33108479 DOI: 10.1007/s00345-020-03489-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To determine which patients should benefit from the interposition of a well-vascularized flap between the neourethra and the penile skin and if it should be performed even in mild hypospadias. PATIENTS AND METHODS A retrospective study on patients with a primary hypospadias repair was performed (2003-2017). Only patients undergoing urethroplasty based on the principle of a tubularization were selected to ensure comparable groups. Patients were assigned in two groups according to the use or not of a cover flap. Univariate analysis and adjusted logistic regression were used to evaluate the relation between postoperative complications, the severity of hypospadias, the use of flap and patients' characteristics. RESULTS Three-hundred and seventy-six patients were included with anterior (59.3%), midshaft (27.4%) and posterior hypospadias (13.3%). The median follow-up was 54 months (24 months-17 years). The overall rate of fistula was 11.7% (n = 44). Comparing the outcome in children with flap (n = 217) to controls (n = 159) showed that the use of a flap reduces the rate of fistula (6.5 vs 18.9%, p < 0.001). Stratification of the study according to the phenotype reveals that the more severe the hypospadias, the more protective was the flap (OR = 2.6 for anterior, 5.5 for midpenile, 7.1 for posterior hypospadias). The flap remains nevertheless significantly effective whatever the phenotype (p < 0.05 for anterior, p = 0.01 for midpenile, p = 0.02 for posterior hypospadias). CONCLUSIONS The more severe the hypospadias, the more effective is the cover flap to avoid fistula. It remains nevertheless suitable even in anterior hypospadias and the use of a cover flap should not be limited to the surgery of severe phenotypes.
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Razzaghi M, Rahavian A, Fallah Karkan M, Allameh F, Ghiasy S, Javanmard B. Use of human amniotic membrane repair of anterior urethral defect: First clinical report. Int J Urol 2020; 27:605-609. [PMID: 32430969 DOI: 10.1111/iju.14257] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/02/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the use of human amniotic membrane allograft to prevent urethrocutaneous fistula after tubularized incised plate repair for redo-hypospadias and anterior urethral defects. METHODS This pilot study included 28 patients (mean age 25.3 ± 11 years) with a history of previous failed hypospadia repair, who underwent tubularized incised plate urethroplasty in one session by the same surgical team from April 2016 to April 2019. After the reconstruction of a neourethra and proper hemostasis, a human amniotic membrane allograft - Grafting Scaffold - was used to cover the suture lines. RESULTS The mean follow-up time was 13.3 ± 4.5 months. Two urethrocutaneous fistulas occurred within the first 2 weeks after the surgery, one of which was caused by the infection of the surgical site. No penile torsion, urethral diverticula, meatal stenosis or glans dehiscence was reported. CONCLUSIONS Amniotic membrane graft provides an applicable, low-cost, feasible, biodegradable and safe second cover in redo-hypospadias repairs by tubularized incised plate technique. Its use is technically easy; it has satisfactory cosmetic outcomes and might decrease urethrocutaneous fistula formation.
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Affiliation(s)
- Mohammadreza Razzaghi
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhossein Rahavian
- Clinical Research Development Unit, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Fallah Karkan
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Allameh
- Center of Excellence for Training Laser Applications in Medicine, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saleh Ghiasy
- Clinical Research Development Unit, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Javanmard
- Clinical Research Development Unit, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Karakan T, Ozcan S, Bagcioglu M, Aydın A, Doluoglu OG, Yucel MO, Adalı Y, Yagli OF. The effect of intraurethral dexpanthenol in hypospadias repair: experimental rabbit study. J Pediatr Urol 2019; 15:375.e1-375.e5. [PMID: 31040076 DOI: 10.1016/j.jpurol.2019.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 03/24/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION In this study, the authors aimed to research the histopathologic effects of intraurethral use of dexpanthenol for hypospadias repair. Dexpanthenol is a derivative of pantothenic acid, a B complex vitamin. Pantothenic acid is a molecule contributing in the structure of coenzyme A. It decreases the release of myeloperoxidase from granulocytes and inhibits the formation of free oxygen radicals, and it exhibits an anti-inflammatory effect by increasing mitotic activity. OBJECTIVE The objective of this study is to evaluate the use of dexpanthenol after a tubularized incised plate urethroplasty (TIP) on wound healing, inflammation, and fibrosis. STUDY DESIGN In this study, 18 healthy male New Zealand white rabbits weighing 2500-3000 g were used. The 18 rabbits were randomly divided into 3 groups. For the hypospadias model, rabbits had a urethral catheter inserted in the urethra and a ventral midline incision was made from the glans tip to the central line of the penis. Afterward, the incision was closed with Vicryl (7/0) using the continuous suture technique, and urethroplasty was completed. For fourteen days, group I had 0.9% saline solution administered intraurethrally twice per day with a 22G catheter sleeve (control group), group II had one dose of 500 mg/kg dexpanthenol (Bepanthene®; Bayer Turk Chemical Industry Limited Company, Turkey) ampoule and one dose of saline solution administered in the same way, and group III had two doses of 500 mg/kg dexpanthenol ampoule administered. On the fifteenth day, the penis was degloved and rabbits had penectomy performed with samples sent to the pathology department for histopathological assessment. RESULTS The degree of fibrosis and inflammation in group I (control group) was more severe than groups II and III. The differences between groups I and II were statistically significantly different for both fibrosis and inflammation (P = 0.018 and P = 0.041, respectively). The differences between groups I and III were also statistically significantly different for both fibrosis and inflammation (P = 0.019 and P = 0.011, respectively). Groups II and III were not different significantly for fibrosis and inflammation (P > 0.05). DISCUSSION This study shows that intraurethral dexpanthenol application has positive effects on fibrosis and inflammation. The main limitations of the study are that the hypospadias model was created surgically and long-term follow-up for fistula formation was not assessed. CONCLUSIONS Administration of intraurethral dexpanthenol after hypospadias repair has positive effects on fibrosis and inflammation.
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Affiliation(s)
- T Karakan
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey.
| | - S Ozcan
- Department of Urology, İzmir Katip Çelebi University, İzmir, Turkey
| | - M Bagcioglu
- Urology Department, Kafkas University Faculty of Medicine, Kars, Turkey
| | - A Aydın
- Department of Urology, Faculty of Medicine, Necmettin Erbakan University Meram, Konya, Turkey
| | - O G Doluoglu
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | - M O Yucel
- Department of Urology, Adiyaman University, Faculty of Medicine, Adiyaman, Turkey
| | - Y Adalı
- Department of Pathology, Kafkas University, Faculty of Medicine, Kars, Turkey
| | - O F Yagli
- Department of Urology, Kartal Yavuz Selim State Hospital, Istanbul, Turkey
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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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Saiad MO. The Modified Multilayer Coverage of Urethroplasty for Distal Hypospadias. J Indian Assoc Pediatr Surg 2018; 23:140-143. [PMID: 30050262 PMCID: PMC6042167 DOI: 10.4103/jiaps.jiaps_164_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: Our purpose is to present the modified multilayer coverage to prevent fistula and to present also the glans dissection respecting the continuity between glans and corpus spongiosum. We think an important factor for glans vascularization that prevents glans disruption for patients with distal hypospadias and report the follow-up. Introduction: Fistula and glans disruption are still the most frequent complications of hypospadias surgery. Neourethral coverage is a mandatory step in this challenging surgery; it reduces the rate of fistula. Materials and Methods: Between September 2013 and December 2015, the modified multilayer coverage using two or three intermediate layers was performed in 110 patients with distal and midshaft hypospadias. Follow-up based on local examination, visual assessment of urine stream, and parent satisfaction was recorded at 1, 3, 6 months, 1 year, and yearly thereafter. Patients lost for the follow-up and the circumcised patients with a bad quality remaining dorsal dartos are excluded from the study. Results: Intraoperatively, the decision whether two or three intermediate layers should be performed depending on the type of the hypospadias and the presence of hypoplastic urethra. Among the 88 patients retained for the study, 86 patients presented satisfactory results, but one patient had a fistula that healed spontaneously and the second patient had a glans disruption. Conclusions: The modified multilayer coverage with a wings glans dissection respecting the continuity of spongiosum and glans is a reliable procedure to reduce the rate of fistula and glans disruption in anterior and midshaft hypospadias.
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Affiliation(s)
- Mohamed Oulad Saiad
- Division of General Pediatric Surgery, Mother and Child Unit, School of Medicine, Mohamed VI University Teaching Hospital, Cadi Ayyad University, Marrakesh, Morocco
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Zheng D, Fu S, Li W, Xie M, Guo J, Yao H, Wang Z. The hypospadias classification affected the surgical outcomes of staged oral mucosa graft urethroplasty in hypospadias reoperation: An observational study. Medicine (Baltimore) 2017; 96:e8238. [PMID: 29381913 PMCID: PMC5708912 DOI: 10.1097/md.0000000000008238] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The staged graft urethroplasty is a recommended technique for repairing complex hypospadias. This retrospective study aimed to investigate the outcomes of this technique in hypospadias patients undergoing reoperation and to analyze the underlying contributing factors including age, meatus location, and graft and suture type.We retrospectively analyzed 40 hypospadias patients undergoing reoperation who received a staged oral graft urethroplasty, including 15 buccal mucosal grafts and 25 lingual mucosal grafts. Median age at presentation was 18.5 years, and median follow-up was 17.5 months (range 8-30 months). The patients were classified according to their original meatus location.Twenty-five complications developed in 12 of 40 (30%) cases, including 6 fistulas (15%), 7 infections (17.5%), 9 cases of glans dehiscence (22.5%), and 3 cases of stenosis (7.5%). There was no significant difference in the overall complication rates between prepuberty and postpuberty groups. In addition, no significant difference in complications was found between the 2 graft techniques. The complications were significantly higher in the original perineal type compared with the original penoscrotal type (7/10 vs 5/30, P = .0031). Seven patients who originally had perineal hypospadias developed multiple complications.Based on this study, the staged graft urethroplasty is an effective technique in reoperative hypospadias repairs with reasonable complication risk. The hypospadias classification affects the surgical outcomes.
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Okçelik S, Soydan H, Ateş F, Yılmaz Ö, Malkoç E, Adayener C, Şenkul T, Karademir K. Comparison of factors affecting the short-term presentation of results in the surgery of distal hypospadias in adults. Rev Int Androl 2017. [DOI: 10.1016/j.androl.2017.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Springer A, Tekgul S, Subramaniam R. An Update of Current Practice in Hypospadias Surgery. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.eursup.2016.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Shirazi M, Rahimi M, Noorafshan A. Single vs. double layer suturing method repair of the urethral plate in the rabbit model of hypospadias. Cent European J Urol 2016; 69:425-430. [PMID: 28127462 PMCID: PMC5260454 DOI: 10.5173/ceju.2016.875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 07/25/2016] [Accepted: 09/26/2016] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION There are different methods of urethroplasty in hypospadias. The present study aimed to compare the repair of the urethral plate by single vs. double layer suturing. MATERIAL AND METHODS Fifteen male rabbits were assigned to the control, single layer, and double layer urethral plate suturing groups (n = 5). Experimental hypospadias was induced in the second and third groups and the urethral plates were sutured. After two weeks, the penis was dissected out and underwent histopathological processing. Stereological studies were applied to obtain quantitative histological data regarding the structure of the urethra and the related part of the corpus spongiosum. RESULTS Volume density of the urethral epithelium (the fraction of unit volume of the urethra occupied by its epithelium) was higher in the single layer suturing group when compared to the double layer or control groups (p <0.01). Additionally, the volume density of the urethral lumen (the fraction of the corpus spongiosum that is occupied by the urethral lumen) in the single versus the double layer suturing groups was respectively 2.4 and 2 folds higher than that in the control group (p <0.01). Besides, the volume density of the lumen was significantly higher in the single layer suturing when compared to the double layer suturing group (p <0.01). However, no significant difference was observed among the study groups regarding the volume density of the collagen and vessels in the incised site of the penis which implied that the fraction of the urethra and surrounding corpus spongiosum was occupied by collagen and vessels. CONCLUSIONS Urethral plate repair by the single layer suturing method could be accompanied by higher epithelialization and wider lumen in the rabbit model of hypospadias.
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Affiliation(s)
- Mehdi Shirazi
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
- Histomorphometry and Stereology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Rahimi
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Noorafshan
- Histomorphometry and Stereology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Anatomy, Shiraz University of Medical Sciences, Shiraz, Iran
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Hardwicke J, Bechar J, Hodson J, Osmani O, Park A. Fistula after single-stage primary hypospadias repair – A systematic review of the literature. J Plast Reconstr Aesthet Surg 2015; 68:1647-55. [DOI: 10.1016/j.bjps.2015.07.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/09/2015] [Accepted: 07/21/2015] [Indexed: 01/17/2023]
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Thomas DT, Karadeniz Cerit K, Yener S, Kandirici A, Dagli TE, Tugtepe H. The effect of dorsal dartos flaps on complication rates in hypospadias repair: a randomised prospective study. J Pediatr Urol 2015; 11:23.e1-4. [PMID: 25218352 DOI: 10.1016/j.jpurol.2014.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 07/01/2014] [Indexed: 10/24/2022]
Abstract
AIM This study prospectively analysed the effect of using a dartos flap on the complication rates of TIPU (tubularised incised plate urethroplasty) in hypospadias repair. MATERIAL AND METHODS Patients having TIPU repair for hypospadias at our university hospital between January 2010 and August 2013 were prospectively divided into two groups. Group 1 had TIPU repair with dorsal dartos flap, whereas group 2 had flapless repair. At the end of the follow-up period (mean 23.3 m, median 20.2), complication rates were compared between two groups. RESULTS There were 107 patients in each group. The overall complication rate was 9.3%. The complication rates were 12.1% in group 1 (6 glans dehiscence and 7 fistula) and 6.5% in group 2 (2 glans dehiscence and 5 fistula). The differences between complication rates and fistula were statistically insignificant (p = 0.2511 and p = 0.7710, respectively). CONCLUSION Our prospective and randomised study found that the use of dartos flaps in hypospadias offers no statistically significant advantage over flapless repair for complication rates.
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Affiliation(s)
- David Terence Thomas
- Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Sevim Yener
- Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Aliye Kandirici
- Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Tolga E Dagli
- Division of Pediatric Urology, Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Halil Tugtepe
- Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey.
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Gardikis S, Kambouri K, Giatromanolaki A, Agelidou M, Kalaitzis C, Giannakopoulos S, Touloupidis S, Vaos G. The use of a perimeatal-based penile skin flap to cover the repair of a tubularized incised plate urethroplasty: from experimental surgery to clinical practice. J Pediatr Urol 2014; 10:469-73. [PMID: 24444860 DOI: 10.1016/j.jpurol.2013.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 12/07/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To prospectively evaluate the efficacy and safety of a perimeatal-based penile skin flap for neourethral coverage after repair of distal hypospadias with tubularized incised plate urethroplasty (TIPU). METHODS In 12 New Zealand white rabbits a ventral urethral defect was created and reconstruction was accomplished with continuous suture. An epithelialized defect-based flap was harvested from the penile skin to cover the repaired defect. The animals were euthanized on the 28th postoperative day and their penises were processed for microscopic examination. In 32 children with distal hypospadias a TIPU was performed. A penile skin flap was created immediately below the distal end of the neourethra and used to cover the urethroplasty. RESULTS Histological examinations revealed complete restoration of continuity of the stratified squamous epithelium without evidence of inflammation or fistula formation with full consistency with the underlying papillary reticular and corium. There were no cases of fistula formation. One patient developed meatal stenosis. All patients had a satisfactory cosmetic appearance and excellent functional results. CONCLUSION The formation of a perimeatal-based skin flap is a simple and safe method of providing additional cover for the constructed neourethra after TIPU, minimizing the fistula rate.
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Affiliation(s)
- Stefanos Gardikis
- Department of Pediatric Surgery, Alexandroupolis University Hospital, Democritus University of Thrace School of Medicine, 68100 Alexandroupolis, Greece.
| | - Katerina Kambouri
- Department of Pediatric Surgery, Alexandroupolis University Hospital, Democritus University of Thrace School of Medicine, 68100 Alexandroupolis, Greece
| | - Alexandra Giatromanolaki
- Department of Pathology, Alexandroupolis University Hospital, Democritus University of Thrace School of Medicine, 68100 Alexandroupolis, Greece
| | - Maria Agelidou
- Department of Pediatric Surgery, Alexandroupolis University Hospital, Democritus University of Thrace School of Medicine, 68100 Alexandroupolis, Greece
| | - Christos Kalaitzis
- Department of Urology, Alexandroupolis University Hospital, Democritus University of Thrace School of Medicine, 68100 Alexandroupolis, Greece
| | - Stilianos Giannakopoulos
- Department of Urology, Alexandroupolis University Hospital, Democritus University of Thrace School of Medicine, 68100 Alexandroupolis, Greece
| | - Stavros Touloupidis
- Department of Urology, Alexandroupolis University Hospital, Democritus University of Thrace School of Medicine, 68100 Alexandroupolis, Greece
| | - George Vaos
- Department of Pediatric Surgery, Alexandroupolis University Hospital, Democritus University of Thrace School of Medicine, 68100 Alexandroupolis, Greece
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Inclusion and Exclusion Criteria to Overcome Bias and Reach a Valid Conclusion for Interpositional Flap Coverage in Primary Hypospadias Repair With Tubularized Incised Plate Urethroplasty. Ann Plast Surg 2013; 71:581-5. [DOI: 10.1097/sap.0b013e31825516a0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cimador M, Pensabene M, Sergio M, Catalano P, de Grazia E. Coverage of urethroplasty in pediatric hypospadias: randomized comparison between different flaps. Int J Urol 2013; 20:1000-5. [PMID: 23421595 DOI: 10.1111/iju.12092] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 12/26/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The use of covering urethroplasty with flaps in hypospadias surgery has been well recommended. Various techniques have been described for flap harvesting. The aim of the present study was to compare the outcome and complication rate of dorsal preputial flaps and ventral dartos flaps. METHODS A total of 130 patients were prospectively evaluated from January 2008 to December 2011. Using the tubularized incised plate urethroplasty procedure, urethroplasty was carried out by a single surgeon. Patients were randomly divided in two groups: group A (57 patients), in which a preputial flap was carried out using three different techniques; and group B (73 patients), in which a single or a double ventral dartos flap was used. RESULTS A total of 41 complications occurred in 24 patients. Urethrocutaneous fistulas were observed in 14.9%, quite equally distributed between groups A and B. There was only one urethrocutaneous fistula in a patient treated with the double ventral dartos flaps. Five cases (3.8%) of glans dehiscence were observed: four after single ventral dartos flap and one after dorsal preputial flap. Six patients in group A and seven in group B experienced meatal stenosis. In three cases of iatrogenic torsion of the penis, a dorsal preputial flap was laterally transposed. Finally, a lower complication rate was observed for double ventral dartos flap versus the other techniques. CONCLUSIONS The use of a double ventral dartos flap should represent the first-line technique for coverage of distal urethroplasty.
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Affiliation(s)
- Marcello Cimador
- Section of Pediatric Urology, Pediatric Surgical Unit, Department of Mother and Child Care, University of Palermo, Palermo, Italy
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Zheng DC, Wang H, Lu MJ, Chen Q, Chen YB, Ren XM, Yao HJ, Xu MX, Zhang K, Cai ZK, Wang Z. A comparative study of the use of a transverse preputial island flap (the Duckett technique) to treat primary and secondary hypospadias in older Chinese patients with severe chordee. World J Urol 2012. [DOI: 10.1007/s00345-012-0990-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Maarouf AM, Shalaby EA, Khalil SA, Shahin AM. Single vs. double dartos layers for preventing fistula in a tubularised incised-plate repair of distal hypospadias. Arab J Urol 2012; 10:408-13. [PMID: 26558059 PMCID: PMC4442928 DOI: 10.1016/j.aju.2012.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 09/23/2012] [Accepted: 09/26/2012] [Indexed: 11/24/2022] Open
Abstract
Objective To compare the outcome of a single vs. a double-layer dartos interposition for preventing a fistula after tubularised incised-plate (TIP) distal hypospadias repair. Patients and methods We retrospectively reviewed the records of patients with primary distal hypospadias who had the hypospadias repaired between February 2009 and June 2011, operated by one surgeon (S.A.K.). In all of the children a standard TIP urethroplasty was performed, which was covered by a dartos fascial flap fashioned using one of two techniques, i.e. in Group I (48 patients) double dartos preputial flaps were used, and in Group II (52 patients) a single dorsal dartos flap was used and transposed ventrally via a ‘buttonhole’. The fistula rate and other complications related to each group were recorded. Results The mean (range) follow-up was 12 (6–22) months for Group I and 14 (6–24) months for Group II. The result was considered a success in 96% of Group I and 92% of Group II. In Group I there were no fistulae, while in Group II there were four fistulae (8%) detected; this difference was statistically insignificant (P = 0.1). Meatal stenosis was associated with a fistula in one patient in Group II but not in the other three. In Group I a meatal stenosis developed late after complete healing of the urethroplasty, with no associated fistula. The repair broke down in one patient in Group I (2%). Conclusion A double-dartos neourethral cover in TIP hypospadias repair seems to be more effective than a single layer for preventing a fistula, despite there being no statistically significant difference between the groups. However, the protective effect of double-dartos flaps must be appropriately evaluated in a prospective, randomised and controlled study in more patients.
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Bertozzi M, Yıldız A, Kamal B, Mustafa M, Prestipino M, Yiğiter M, Al-Darawany H, Oral A, Nardi N, Appignani A. Multicentric experience on double dartos flap protection in tubularized incised plate urethroplasty for distal and midpenile hypospadias. Pediatr Surg Int 2011; 27:1331-6. [PMID: 21935592 DOI: 10.1007/s00383-011-2978-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE We report a multicenter experience using double dartos flap to protect the neourethra in TIP urethroplasty for distal and midpenile hypospadias. METHODS A total of 394 patients underwent tubularized incised plate urethroplasty for primary distal and midpenile hypospadias using double dartos flap protection by ten pediatric surgeons and urologists at five different institutions. RESULTS Tubularized incised plate urethroplasty protected by a double dartos flap was simple to perform and flaps were easy to obtain. Complications occurred in 23 patients (5.83%): fistulas 1.01% (4 cases), stenosis 0.25% (1 case), mild stenosis 2.53% (10 cases), dehiscence of ventral cutis 0.50% (2 cases) and penile torsion 1.26% (5 cases). All fistulae had a spontaneous resolution. CONCLUSION Double dartos flap to protect tubularized incised plate urethroplasty is safe with a low complication rate. The neourethra is covered entirely with a double layer of vascularized tissue and the double coverage appears a good choice for preventing urethrocutaneous fistula formation.
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Affiliation(s)
- M Bertozzi
- S. C. di Clinica Chirurgica Pediatrica, Ospedale S. Maria della Misericordia, Università degli Studi di Perugia, 06100 S. Andrea delle Fratte, Perugia, Italy.
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Current world literature. Curr Opin Urol 2011; 21:535-40. [PMID: 21975510 DOI: 10.1097/mou.0b013e32834c87d0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Adel Elbakry
- Department of Urology, Suez Canal University, Ismailia, Egypt
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Interposition of dartos flaps to prevent fistula after tubularized incised-plate repair of hypospadias. Arab J Urol 2011; 9:123-6. [PMID: 26579282 PMCID: PMC4150563 DOI: 10.1016/j.aju.2011.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 06/12/2011] [Accepted: 06/27/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the effect of urethral coverage by a single- or double-layered dorsal dartos flap after tubularized incised-plate (TIP) repair of hypospadias on fistula formation. PATIENTS AND METHODS In this retrospective study we evaluated sequential patients with hypospadias who underwent TIP urethroplasty with a dorsal dartos interpositional flap between April 2008 and December 2009. We reviewed their medical records for the site of hypospadias, previous hypospadias repair, single- or double-layered dartos flap and postoperative complications. The patients were divided into two groups; in group A the urethra was covered by a single layer of dartos fascia, and in group B the urethra was covered by double layers of dartos flap. RESULTS Of 91 patients who opted for hypospadias repair during the time of the study, 62 had a TIP urethroplasty with a dorsal dartos flap; of these 62, three did not fulfil the requirement of the minimum follow-up, so 59 were eligible for the study (32 in group A and 27 in group B). Preoperative clinical data were comparable in both groups. At a mean of 12.2 months of follow-up, there was no reported fistula in group B, while two patients in group A developed a urethrocutaneous fistula (P = 0.19). Meatal stenosis occurred in two patients in group A and one in group B (P = 0.66). CONCLUSION There was no significant difference in subsequent urethrocutaneous fistula between a double-layered dorsal dartos flap and single layer for covering the urethra as a part of TIP urethroplasty for repairing hypospadias.
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