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Abozamel A, Rammah A, Abdelwahed M, Mostafa A, AbdelAziz AY. Does local injection of long acting corticosteroid improve postoperative outcome of hypospadias repair? A randomized controlled trial. Int Urol Nephrol 2024; 56:9-15. [PMID: 37702895 PMCID: PMC10776459 DOI: 10.1007/s11255-023-03730-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/31/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE To assess the safety and efficacy of local corticosteroid injection during hypospadias repair. METHODS Between May 2021 and March 2023 children less than 10 years who were admitted for hypospadias repair were divided by random allocation into two groups. We injected local corticosteroid 2 ml proximal to coronal sulcus in group A while in group B we didn't. All types of hypospadias were included in the study. We excluded patients older than 10 years and those with pre-existing complicated hypospadias (multiple fistulae and multiple surgeries), or bleeding diatheses. Pre-operative, intraoperative and postoperative variables were compared between the two groups. RESULTS A total of 120 patients (60 in each group) were enrolled in the study. The mean ages and preoperative variables were not significantly different. The site of hypospadias and the type of surgery were comparable in both groups. (Table) There were no significant differences between both groups regarding average blood loss and operative time in each type of surgical repair. There was a significant higher incidence of intraoperative and postoperative penile oedema in group B (P-value < 0.001) while the incidence of skin discolouration was higher in group A. Postoperative complications, described as Clavian classification, were significantly higher in group B. The incidences of superficial skin infection, meatal stenosis, urethral fistula, and recurrence with the need for redo repair were significantly higher in group B (P-value: 0.002, 0.018, 0.032, and 0.001, respectively). CONCLUSION Local corticosteroid injection during hypospadias repair minimize the penile oedema and decrease the incidence of postoperative functional and cosmetic complications.
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Affiliation(s)
- Ahmed Abozamel
- Urology department, Faculty of Medicine, Cairo University, Giza, 11562, Egypt
| | - Ahmed Rammah
- Urology department, Faculty of Medicine, Cairo University, Giza, 11562, Egypt
| | - Mohammed Abdelwahed
- Urology department, Faculty of Medicine, Cairo University, Giza, 11562, Egypt
| | - Amr Mostafa
- Urology department, Faculty of Medicine, Cairo University, Giza, 11562, Egypt
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Kränkel N. Increased cardiovascular risk in boys born with hypospadias: intriguing observations and remaining questions. Eur Heart J 2022; 43:1846-1848. [PMID: 35567565 DOI: 10.1093/eurheartj/ehac152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nicolle Kränkel
- Charité-Universitätsmedizin Berlin, Department of Cardiology, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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Gamidov S, Shatylko T, Gasanov N, Popova A, Dusmukhamedov R, Safiullin R, Sukhikh G. Sexual dysfunction in patients with late complications of hypospadias surgery. Andrologia 2022; 54:e14413. [PMID: 35243664 DOI: 10.1111/and.14413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/08/2022] [Accepted: 02/25/2022] [Indexed: 11/29/2022] Open
Abstract
Most hypospadias cases are successfully treated in childhood. Still, patients with sequelae of failed hypospadias repair and sexual dysfunction may be encountered. We evaluated 112 patients with a history of failed hypospadias repair, defined as the presence of voiding symptoms or cosmetic problems remaining despite previous surgery or caused by it. Patients' median age was 29.5 years (range: 18-62). There were no intersex cases. Only 9.8% (11/112) underwent single attempt at surgical reconstruction, the median number of attempts was 3.5 (range: 1-9). Patients with IIEF-EF score ≤25 were considered to have erectile dysfunction; those with IIEF-EF ≤16 underwent penile doppler ultrasound, penile electromyography and endocrine assessment. About 64.2% of patients (72/112) were dissatisfied with penile appearance, 40.2% (45/112) had ED, 71.4% (80/112) had ejaculation disorders. Psychogenic ED was diagnosed in 21 patients with preserved non-coital erections and no evidence of organic ED. Median IIEF-EF in ED patients was 20 (range: 8-25). Asthenic ejaculation, delayed ejaculation and anejaculation were present in 63.4% (71/112), 7.1% (8/112) and 3.5% (4/112) patients respectively. Premature ejaculation was present in 28.6% (32/112) patients, but its association with hypospadias or previous surgery is unlikely.
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Affiliation(s)
- Safar Gamidov
- V.I. Kulakov National Medical Research Center of obstetrics, gynecology and perinatology, Moscow, Russian Federation.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Taras Shatylko
- V.I. Kulakov National Medical Research Center of obstetrics, gynecology and perinatology, Moscow, Russian Federation
| | - Natig Gasanov
- V.I. Kulakov National Medical Research Center of obstetrics, gynecology and perinatology, Moscow, Russian Federation
| | - Alina Popova
- V.I. Kulakov National Medical Research Center of obstetrics, gynecology and perinatology, Moscow, Russian Federation
| | - Runis Dusmukhamedov
- N.I. Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Ruslan Safiullin
- V.I. Kulakov National Medical Research Center of obstetrics, gynecology and perinatology, Moscow, Russian Federation
| | - Gennadiy Sukhikh
- V.I. Kulakov National Medical Research Center of obstetrics, gynecology and perinatology, Moscow, Russian Federation.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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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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Chang C, Reifsnyder JE, Fahmy AG, Hanna MK. The adolescent glans penis: Functional and aesthetic issues following childhood hypospadias repair. J Pediatr Urol 2021; 17:609.e1-609.e8. [PMID: 34538562 DOI: 10.1016/j.jpurol.2021.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/21/2021] [Accepted: 07/31/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION As children with childhood hypospadias repairs transition into adolescence, the function and appearance of the genitalia acquire greater importance. For some, the direction and shape of the urinary stream can be embarrassing if abnormal, and the appearance of the glans penis and meatus are a concern as they develop the capacity for self-awareness. OBJECTIVE Herein, we address the surgical correction and outcomes of urine spraying with or without fistulae, and cosmesis over 12 years. We also analyze if any specific prior repairs were more related to their complaints i.e. cosmesis, spraying, and/or fistulae. STUDY DESIGN We retrospectively reviewed hypospadias revisions by a single surgeon over 12 years. We included adolescents and young adults who complained of abnormal urinary stream and/or aesthetic complaints. Patients then evaluated the post op result as very good, good, acceptable, or unsatisfactory. RESULTS Of 542 patients who underwent revisionary procedures, 90 (16.6%) presented with complaints of urinary spraying, and appearance of the glans penis and/or meatus (see figure). Of these, 19 (21.1%) presented with aesthetic complaints alone, 37 (41.1%) presented with aesthetic complaints and spraying, and 34 (37.7%) presented with aesthetic concerns, spraying, and were noted to have urethral fistula either during preoperative examination or during surgery. 3/90 patients (3.3%) developed wound infection and dehiscence (one had a tubularized incised plate repair, another a Thiersch-Duplay repair, and the primary repair of the third patient was unknown). CONCLUSIONS Adolescents and young adults who underwent hypospadias repair during childhood can return with concerns regarding functional and aesthetic abnormalities of the glans penis. Glans sculpting and meatal contouring may be utilized to normalize the urinary stream and achieve a normal aesthetic appearance of the glans penis. Surgeons should follow these patients through adolescence and into adulthood, because complications from hypospadias repairs acquire greater significance later and young adults seek to normalize their phalluses.
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Affiliation(s)
- Chrystal Chang
- Department of Surgery, Division of Urology, Rutgers - New Jersey Medical School, 140 Bergen Street, G1680, Newark, NJ, 07103, USA.
| | - Jennifer E Reifsnyder
- Division of Pediatric Urology, Cohen Children's Medical Center, Northwell Health, 26901 76th Ave, New Hyde Park, NY, 11040, USA
| | - Ashraf G Fahmy
- Department of Urology, Masr El-Gedida Military Family Hospital, Cairo, Egypt
| | - Moneer K Hanna
- Department of Surgery, Division of Urology, Rutgers - New Jersey Medical School, 140 Bergen Street, G1680, Newark, NJ, 07103, USA; Division of Pediatric Urology, Cohen Children's Medical Center, Northwell Health, 26901 76th Ave, New Hyde Park, NY, 11040, USA; Department of Urology, Masr El-Gedida Military Family Hospital, Cairo, Egypt; New York Presbyterian Weill-Cornell Medical Center, 525 E 68th St, New York, NY, 10065, USA
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Herrera O, Mostafa S, Da Lomba T, Judge C, Andolfi C, Stahoviak K, Gundeti MS. A 10-step procedure for distal hypospadias repair with 50% resident involvement is safe and effective. UROLOGY VIDEO JOURNAL 2021. [DOI: 10.1016/j.urolvj.2021.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sexual functions and fertility outcomes after hypospadias repair. Int J Impot Res 2020; 33:149-163. [PMID: 33262531 DOI: 10.1038/s41443-020-00377-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 01/13/2023]
Abstract
Hypospadias is a common abnormality of the urogenital tract with a wide range of variety in its presentation and severity. The primary aim to correct hypospadias is to restore normal penile function and appearance. Although it can be corrected at any age, early correction between the 6 and 18 months of life is recommended. The functional and cosmetic outcomes have been very-well presented in the literature, although the aspects of sexuality and fertility of hypospadias repair in the long term are vague. In this narrative review, we aimed to gather the data around the sexuality and fertility outcomes of hypospadias repair and acknowledge urologists and parents of boys with hypospadias who will have a correction surgery about future sexual and fertility concerns.
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Accessory penis: A rare method of peno-urethral separation of sexual function and voiding following successful complex hypospadias reconstruction with a free ileum flap. Arch Plast Surg 2019; 46:381-385. [PMID: 31336427 PMCID: PMC6657190 DOI: 10.5999/aps.2018.00689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 04/23/2019] [Indexed: 12/29/2022] Open
Abstract
Hypospadias is a congenital malformation of the male genitalia. The reconstructive objectives are to obtain voiding with laminar flow and satisfactory sexual function. Several urethroplasty techniques have been described, but for perineal or revisional cases no single technique has shown robust success. In this study, we describe the expanded use of intestinal flaps for urethral reconstruction and report a peculiar request from a patient to undergo peno-urethral separation after successful hypospadias repair with a free ileum flap. A 51-year-old male patient with perineal hypospadias underwent several urethral reconstructive procedures with poor outcomes. A free ileum flap was attempted as a substitute for the urethra. Following successful reconstruction, separation of the neo-urethra (ileum) from the penile body was performed to address the patient's sexual expectations. A free ileum flap proved to be a reliable urethral substitute in perineal hypospadias reconstruction, with a successful outcome. The peno-urethral separation with the creation of an "accessory penis," however peculiar, optimized the results in terms of both sexual and urinary function. Anatomical restoration of the urethra and patient-reported expectations are the key to successful hypospadias reconstructive procedures. Sexual function outcomes and the patient's perception of success should not be underestimated, even when urinary function has been restored.
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Abstract
Hypospadias is one of the most common congenital anomalies in men. The condition is typically characterized by proximal displacement of the urethral opening, penile curvature, and a ventrally deficient hooded foreskin. In about 70%, the urethral meatus is located distally on the penile shaft; this is considered a mild form that is not associated with other urogenital deformities. The remaining 30% are proximal and often more complex. In these cases, endocrinological evaluation is advised to exclude disorders of sexual differentiation, especially in case of concomitant unilateral or bilateral undescended testis. Although the etiology of hypospadias is largely unknown, many hypotheses exist about genetic predisposition and hormonal influences. The goal of hypospadias repair is to achieve cosmetic and functional normality, and currently, surgery is recommended between 6 and 18 months of age. Hypospadias can be corrected at any age with comparable complication risk, functional, and cosmetic outcome; however, the optimal age of repair remains conclusive. Although long-term overall outcome concerning cosmetic appearance and sexual function is fairly good, after correction, men may more often be inhibited in seeking sexual contact. Moreover, lower urinary tract symptoms occur twice as often in patients undergoing hypospadias repair and can still occur many years after the initial repair. CONCLUSION This study explores the most recent insights into the management of hypospadias. What is Known: • Guidelines advise referral for treatment between 6 and 18 months of age. • Cosmetic outcome is considered satisfactory in over 70% of all patients. What is New: • Long-term complications include urinary tract symptoms and sexual and cosmetic issues. • New developments allow a more individualized approach, hopefully leading to less complications and more patient satisfaction.
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Affiliation(s)
- H. J. R. van der Horst
- Department of Urology, VUmc, De Boelelaan 1117, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - L. L. de Wall
- Department of Urology, Radboudumc, Geert Grooteplein 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Liu MMY, Holland AJA, Cass DT. Assessment of postoperative outcomes of hypospadias repair with validated questionnaires. J Pediatr Surg 2015; 50:2071-4. [PMID: 26455467 DOI: 10.1016/j.jpedsurg.2015.08.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 08/24/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE A standardized assessment for the optimal repair of hypospadias remains elusive. This study utilized validated questionnaires to assess the postoperative functional, cosmetic, and psychosocial outcomes of hypospadias repair. MATERIALS AND METHODS 172 patients who underwent hypospadias repair under the care of a single surgeon were identified. 25 agreed for follow-up using the validated questionnaires of Hypospadias Objective Scoring Evaluation (HOSE), Pediatric Penile Perception Scale (PPPS), and Pediatric Quality of Life Inventory (PedsQL™4.0). RESULTS Mean follow-up was 59months postoperatively (range 7-113months). Techniques used included tubularized incised plate urethroplasty, meatal advancement and glanuloplasty, and a 2-stage repair. 23 of 25 patients achieved a HOSE score of 14 or more (maximum of 16). The PPPS scores correlated with severity of the hypospadias. Those with glanular hypospadias (mean score=10) scored higher than those with coronal (mean score=9) and penile/penoscrotal hypospadias (mean score=7). There was no correlation between PedsQL™4.0 scores and the severity of hypospadias or procedure used. CONCLUSION Validated questionnaires revealed generally good functional, cosmetic, and early psychosocial outcomes after hypospadias repair. The use of validated questionnaires in routine follow-up sessions may facilitate objective assessment of both functional outcomes and patient satisfaction.
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Affiliation(s)
- Mona M Y Liu
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Westmead, Australia.
| | - Andrew J A Holland
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Westmead, Australia
| | - Danny T Cass
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Westmead, Australia
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Katib AA. Asymptomatic hypospadias with tight meatal stricture in the father of twelve children. Cent European J Urol 2013; 66:221-2. [PMID: 24579034 PMCID: PMC3936148 DOI: 10.5173/ceju.2013.02.art28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 02/22/2013] [Accepted: 03/21/2013] [Indexed: 11/24/2022] Open
Abstract
Hypospadias is a highly prevalent congenital anomaly. English articles, indexed in PubMed, published the long-term sexual and reproductive outcome following hypospadias repair. Almost all repairable cases of hypospadias are operated in childhood. Although distal hypospadias does not interfere with fertility, it is worthy reporting a case of an elderly man, who fathers 12 children and has no urologic complaint, presented with unrepaired coronal hypospadias and severely tight external urethral meatus.
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Affiliation(s)
- Atif A Katib
- Department of Urology, King Abdul-Aziz Hospital, Makkah, Saudi Arabia
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