1
|
Alaoui O, Mahmoudi A, Khattala K, Bouabdallah Y. Retrospective Comparative Study between Duplay and Koff Methods in Repair of Distal Hypospadias. Afr J Paediatr Surg 2024; 21:160-165. [PMID: 38520234 PMCID: PMC11379338 DOI: 10.4103/ajps.ajps_157_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 04/15/2023] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Hypospadias repair is a complicated surgery even in the best of hands. To date, there is a lack of consensus on which surgical technique offers more favourable post-operative outcomes. The present work was undertaken to evaluate and compare the outcomes and complications rates of two single-stage techniques widely used to repair primary anterior hypospadias, namely Thiersch-Duplay Tubularized Plate Urethroplasty and Koff Urethral Mobilisation and Advancement. MATERIALS AND METHODS Data from the medical records of 120 patients operated on for primary anterior hypospadias were retrospectively analysed and compared. The patients were divided into two groups: 60 patients underwent Thiersch-Duplay procedure (Group A) and 60 patients underwent Koff procedure (Group B). They were compared using the Chi-squared or Fisher's exact test to assess the relationship between the adopted surgical technique and the complications' development with a P < 0.05. RESULTS Neither intraoperative complications nor acute post-operative complications occurred, whereas 28.3% ( n = 34/120) cases have exhibited at least one late post-operative surgical complication, including 38.3% ( n = 23/60) in Group A and 18.3% ( n = 11/60) in Group B, revealing a better outcome of the Koff procedure despite the statistical insignificance ( P = 0.102). We did not objectify any other complication besides meatal stenosis (MS), urethro-cutaneous fistula (UCF) and wound dehiscence. CONCLUSION Overall, our study could not demonstrate the superiority of one technique above another. At the same time, it established the versatility, satisfactory cosmetic and functional results, low MS and UCF rates of Koff urethral mobilization and advancement technique in primary anterior hypospadias repair.
Collapse
Affiliation(s)
- Othmane Alaoui
- Department of Pediatric Surgery, Hassan II University Hospital, Fez, Morocco
- Department of Pediatric Surgery, Faculty of Medicine and Pharmacy and Dental of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Abdelhalim Mahmoudi
- Department of Pediatric Surgery, Hassan II University Hospital, Fez, Morocco
- Department of Pediatric Surgery, Faculty of Medicine and Pharmacy and Dental of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Khalid Khattala
- Department of Pediatric Surgery, Hassan II University Hospital, Fez, Morocco
- Department of Pediatric Surgery, Faculty of Medicine and Pharmacy and Dental of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Youssef Bouabdallah
- Department of Pediatric Surgery, Hassan II University Hospital, Fez, Morocco
- Department of Pediatric Surgery, Faculty of Medicine and Pharmacy and Dental of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| |
Collapse
|
2
|
Spongioplasty with Buck's fascia covering dorsal inlay graft urethroplasty for primary hypospadias repair. J Pediatr Urol 2023:S1477-5131(23)00051-7. [PMID: 36801200 DOI: 10.1016/j.jpurol.2023.02.002] [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: 05/16/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Neourethral covering is an essential technique for preventing complications such as fistula and glans dehiscence in hypospadias repairs. The spongioplasty has been reported for neourethral coverage about 20 years ago. However, reports of the outcome are limited. OBJECTIVE This study aimed to retrospectively evaluate the short-term outcome of spongioplasty with Buck's fascia covering dorsal inlay graft urethroplasty (DIGU). METHODS From December 2019 to December 2020, 50 patients with primary hypospadias (median age at surgery, 37 months; range, 10 months-12 years) were treated by a single pediatric urologist. The patients underwent spongioplasty with Buck's fascia covering dorsal inlay graft urethroplasty in single stage. The penile length, glans width, urethral plate width and length, and the location of the meatus of the patients were recorded preoperatively. The patients were followed up,complications noted, and postoperative uroflowmetries at the one-year follow-up time were evaluated. RESULTS The average width of glans was 12.92 ± 1.86 mm. A minor penile curvature was observed in all patients (≤30°). The patients were followed up for 12-24 months, and 47 patients (94%) were free from complications. A neourethra formed with a slit-like meatus at the tip of the glans, and the urinary stream was straight. Three patients had coronal fistulae (3/50) and no glans dehiscence, and the mean ± SD Qmax of postoperative uroflowmetry was 8.13 ± 3.8 ml/s. DISCUSSION This study estimated the short-term outcome of the DIGU covered using spongioplasty with Buck's fascia as the second layer in patients diagnosed with primary hypospadias with a relatively small glans (average width <14 mm). However, only a few reports emphasize spongioplasty with Buck's fascia as the second layer and the DIGU procedure performed on a relatively small glans. The major limitations of this study were its short follow-up time and the retrospective data collection. CONCLUSIONS Dorsal inlay graft urethroplasty combined with spongioplasty with Buck's fascia as coverage is an effective procedure. In our study, this combination had good short-term outcomes for primary hypospadias repair.
Collapse
|
3
|
Hisamatsu E, Sugita Y, Haruna A, Shibata R, Yoshino K. The learning curve in proximal hypospadias repair. J Pediatr Urol 2021; 17:330.e1-330.e6. [PMID: 33526367 DOI: 10.1016/j.jpurol.2021.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/06/2020] [Accepted: 01/07/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Although the learning curve in various surgical procedures is increasingly discussed, there have been only a few reports about the learning curve especially in proximal hypospadias repair. OBJECTIVES To evaluate the learning curve in one-stage hypospadias repair for proximal hypospadias. MATERIALS AND METHODS We retrospectively reviewed 73 cases of primary hypospadias repair by a single pediatric urologist using one-stage urethroplasty with a preputial skin graft between 2007 and 2018. The overall complication rate included fistula, glans dehiscence, and meatal stenosis. To analyze the impact of the surgeon's experience on the complication rate, we compared the complication rates among different groups of 20 consecutive cases each. In addition, we graphed the actual data of the operative time and cumulative complication rate to evaluate the learning curve. The cumulative complication rate was defined as the surgeon's complication rate (the number of complications accumulated at a time/number of cases at that time). RESULTS The median age at surgery was 18 months (range: 7-87). The median follow-up was 40 months (range: 3-114). In total, 13 (18%) children had complications: 9 fistulae, 3 glans dehiscence, and 2 metal stenoses. The analysis of each 20 cases revealed that the complication rate declined over time as the surgeon became more experienced. It was mainly attributed to a decline of the fistula rate. The diagram of the operative time showed a reduction with the increasing surgical experience. Additionally, the diagram of the cumulative complication rate demonstrated a plateau after 50 cases. CONCLUSION Our study showed the positive impact of surgeon experience on the outcome of one-stage repair for proximal hypospadias. In addition, the learning curve in proximal hypospadias repair stabilized after about 50 cases although the supervision of experienced surgeons is required during the early phase of learning curve.
Collapse
Affiliation(s)
- Eiji Hisamatsu
- Department of Urology, Aichi Children's Health and Medical Center, 7-426 Moriokacho, Obu Aichi 474-8710 Japan.
| | - Yoshifumi Sugita
- Department of Urology, Kobe Children's Hospital, 1-6-7 Minatojima Minamimachi Chuo-ku, Kobe Hyogo 650-0047 Japan.
| | - Akiko Haruna
- Department of Urology, Kobe Children's Hospital, 1-6-7 Minatojima Minamimachi Chuo-ku, Kobe Hyogo 650-0047 Japan.
| | - Ryohei Shibata
- Department of Urology, Aichi Children's Health and Medical Center, 7-426 Moriokacho, Obu Aichi 474-8710 Japan.
| | - Kaoru Yoshino
- Department of Urology, Aichi Children's Health and Medical Center, 7-426 Moriokacho, Obu Aichi 474-8710 Japan.
| |
Collapse
|
4
|
Wang CX, Zhang WP, Song HC. Complications of proximal hypospadias repair with transverse preputial island flap urethroplasty: a 15-year experience with long-term follow-up. Asian J Androl 2020; 21:300-303. [PMID: 30880687 PMCID: PMC6498737 DOI: 10.4103/aja.aja_115_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
There is still debate regarding the optimal surgical approach for proximal hypospadias. This retrospective study aims to evaluate the long-term outcomes using transverse preputial island flap urethroplasty. A total of 320 patients were included, with a mean follow-up of 40.2 months (range: 1–156 months). Complications were encountered in 125 patients (39.1%), including fistulas in 53 (16.6%), urethral strictures in 31 (9.7%), and diverticula in 41 (12.8%). The mean timing of presentation with a complication was 15.8 months (median: 1.7, range: 1–145), of which 79.2% were early complications and 20.8% were late complications. In all, 20.8% of the patients with complications presented after ≥1 year, and 12.8% presented after ≥5 years. Univariate analysis revealed that age at the time of surgery, flap length, and location of the urethral meatus were not correlated with complications. A stricture was present in 31.7% (13/41) of those with diverticula (P < 0.001), while late urethral diverticula were accompanied by urethral strictures in 11.1% (1/9) of cases (P = 0.213). These results indicate that transverse preputial island flap urethroplasty still has a high incidence of complications, even when performed by highly experienced physicians. Most complications of hypospadias are diagnosed within 1 year postoperatively, while fistulas and urinary strictures generally occur within 2 months and diverticula tend to be present by 1 year.
Collapse
Affiliation(s)
- Chao-Xu Wang
- Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing 100045, China
| | - Wei-Ping Zhang
- Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing 100045, China
| | - Hong-Cheng Song
- Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing 100045, China
| |
Collapse
|
5
|
Bagnara V, Giammusso B, Castagnetti M, Esposito C, Bianchi A. Distal hypospadias repair using the needle point bipolar cutting-coagulation forceps. J Pediatr Urol 2020; 16:69.e1-69.e5. [PMID: 31740147 DOI: 10.1016/j.jpurol.2019.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To determine the outcome of distal hypospadias repairs performed using bipolar diathermy (BD) for all the dissection. METHODS Retrospective review of 310 patients undergoing distal hypospadias (264 subcoronal/distal penile and 46 coronal/glanular) over a 11-year period. Median age at surgery was 2.0 years (range 9 months-15 years). Caudal anesthesia was performed in all patients. All children underwent an in situ tubularization of the urethral plate, which was combined with midline incision of the plate in 30 (10%). Preputial reconstruction was performed in 303 (98%) patients. BD forceps was used for coagulation and for all the dissection including skin incision, elevation of glans wings, separation of the corpus spongiosum from the corpora cavernosa, and urethral plate incision, when deemed appropriate. The authors assessed surgical complications and cosmetic results. The latter using the hypospadias objective score (HOSE), with a score ≥ 14 considered as acceptable. RESULTS The average operative time was 70 min. There was no postoperative bleeding or hematomas that required surgical intervention. There were no wound infections or necrosis. Complications occurred in 37 patients (11.9%). Urethral fistula formation was the commonest (n = 18). Postoperative persistent preputial swelling occurred in 3.5% of cases. Two hundred twelve patients (90.6%) had a HOSE score ≥ 14, and no patient required revision surgery for skin problems after a median follow-up of 8.1 (range 1.2-13.1) years. DISCUSSION The study is limited by its retrospective nature and by the fact that a number of other pre-operative, intra-operative, and postoperative variables can affect outcome. CONCLUSIONS Bipolar diathermy can be safely used for distal hypospadias repairs. It allowed careful control of intra-operative bleeding and also clear visualization of tissue planes. Complication rate overall compares favorably with the literature, and cosmetic results were satisfactory.
Collapse
Affiliation(s)
- V Bagnara
- Paediatric Surgery Unit, Polyclinic G.B. Morgagni, Catania, Italy.
| | - B Giammusso
- Paediatric Surgery Unit, Polyclinic G.B. Morgagni, Catania, Italy
| | - M Castagnetti
- Section of Paediatric Urology, Department of Surgical, Oncological and Gastrointestinal Sciences, University Hospital of Padova, Padua, Italy
| | - C Esposito
- Paediatric Surgery Unit, University Hospital of Naples, Naples, Italy
| | - A Bianchi
- Specialist Paediatric Reconstructive Surgeon, Royal Manchester Children's Hospital, United Kingdom
| |
Collapse
|
6
|
Staged transverse preputial island flap urethroplasty for proximal hypospadias: a single-center experience. Pediatr Surg Int 2019; 35:823-827. [PMID: 31049665 DOI: 10.1007/s00383-019-04480-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the intermediate outcomes of our institution's experience with staged TPIF urethroplasty for proximal hypospadias repair. METHODS We retrospectively evaluated the medical records of patients who underwent repair of proximal hypospadias using staged TPIF urethroplasty at our hospital from 2011 to 2017. RESULTS One hundred and two patients were included in the present study. The mean follow-up was 52.4 months (range 13-74 months). The mean age at the time of the first surgery was 13.5 months (range 11-65 months). There were two main types of initial complications including meatal stenosis in four (3.9%) and urethrocutaneous fistula in three (2.9%) patients after the first stage. Surgical complications were seen in 15 patients after second stage, including urethrocutaneous fistulas in 8 (7.8%), urethral strictures in 5 (4.9%), urethral diverticula in 2 (1.9%). Overall complication rates after second stage were 14.7%. The incidence of fistulas was lower in patients who underwent repair with a tunica vaginalis flap (1/29, 3.4%) than with the dartos fascia (7/73, 9.6%; p = 0.435). CONCLUSIONS Our results show that staged TPIF urethroplasty is a viable and durable technique for primary severe proximal hypospadias. This procedure was associated with a 14.7% complication rate in the present study. Staged TPIF urethroplasty can reduce the incidence of urethral strictures and diverticula associated with the second stage.
Collapse
|
7
|
Distal Urethroplasty and Glanuloplasty Procedure Can be Suitable for All Types of Glanular/Subcoronal Hypospadias. Urology 2019; 124:248-253. [DOI: 10.1016/j.urology.2018.06.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/08/2018] [Accepted: 06/18/2018] [Indexed: 11/18/2022]
|
8
|
Kawai S, Hyuga T, Nakamura S, Nakai H. AUTHOR REPLY. Urology 2019; 124:252-253. [DOI: 10.1016/j.urology.2018.06.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/08/2018] [Accepted: 06/18/2018] [Indexed: 11/17/2022]
|
9
|
Surgery of Anomalies of Gonadal and Genital Development in the “Post-Truth Era”. Urol Clin North Am 2018; 45:659-669. [DOI: 10.1016/j.ucl.2018.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
10
|
Affiliation(s)
- Christopher J Long
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
11
|
Intermediate-Term Followup of Proximal Hypospadias Repair Reveals High Complication Rate. J Urol 2017; 197:852-858. [DOI: 10.1016/j.juro.2016.11.054] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 11/20/2022]
|
12
|
Abstract
Hypospadias surgery is a humbling art form. The evolution of surgical techniques has made distal hypospadias outcomes favorable, but recent publications suggest that our complication rates for proximal hypospadias are much higher than previously reported. To explain these shortcomings, we examine the literature and focus on the lack of standardized documentation, the subsequent inability to objectify the severity of the phenotype, and the underestimation of complications due to lack of long-term follow up. The variability in surgical technique and the fact that the literature abounds with small case series from single institutions also limits our ability to compare outcomes. We believe that the use of standardized and scored phenotype assessments from diagnosis through the extended postoperative period will allow for improved scientific assessment of outcomes. This will facilitate multi-institution collaboration and tabulation of outcomes, allowing rapid data accumulation and assessment for this rare disorder. As surgeons, we must follow boys through puberty into adulthood and must honestly report our results in order to advance our surgical approach to this complicated problem.
Collapse
Affiliation(s)
- Christopher J Long
- Division of Urology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas A Canning
- Division of Urology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
13
|
Long CJ, Canning DA. Hypospadias: Are we as good as we think when we correct proximal hypospadias? J Pediatr Urol 2016; 12:196.e1-5. [PMID: 27296789 DOI: 10.1016/j.jpurol.2016.05.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Hypospadias surgery is a humbling art form. Although outcomes with distal hypospadias are favorable, recent publications have suggested that the complication rates are much higher than previously anticipated for proximal hypospadias. The present review examined the literature concerning proximal hypospadias, to explore some of the inadequacies and identify some of the reasons behind these shortfalls in the reported data. METHODS A systematic review of the published literature was conducted using keywords relevant to proximal hypospadias and long-term outcomes. RESULTS The literature for hypospadias was reviewed, and outcomes for distal vs proximal variants were compared. The quality of the literature for proximal hypospadias was examined, and the shortcomings that led to underreporting of the surgical outcomes were identified. Special focus was on the lack of standardized documentation, the subsequent inability to objectify the severity of the phenotype, and the underestimation of complications due to lack of long-term follow-up. There was also a great deal of variability in the utilized techniques, and the literature was filled with small case series from single institutions. To enable scientific assessment of outcomes, it is proposed that the following be implemented: acceptance and incorporation of standardized phenotype assessment scores in the pre-operative period, objective intraoperative hypospadias characterization, and postoperative score assessment. CONCLUSIONS Treatment of proximal hypospadias is much less successful than the distal variant. A specialty wide commitment to standardize the hypospadias language is required to make advancement in surgical outcomes. Boys need to be followed through puberty into adulthood, and honest reporting of outcomes must be discussed so that surgical techniques for this complicated disease process can be advanced.
Collapse
Affiliation(s)
- C J Long
- Division of Urology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3rd Floor Wood Center, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - D A Canning
- Division of Urology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3rd Floor Wood Center, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| |
Collapse
|
14
|
Mouriquand P. Commentary to "Biometry of the hypospadic penis after hormone therapy (testosterone and estrogen): A randomized double-blind controlled trial". J Pediatr Urol 2016; 12:201. [PMID: 27499278 DOI: 10.1016/j.jpurol.2016.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 04/29/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Pierre Mouriquand
- Hôpital Mère-Enfant - Hospices Civils de Lyon-Université Claude-Bernard, Bron Cedex, France.
| |
Collapse
|
15
|
Elbakry A, Hegazy M, Matar A, Zakaria A. Tubularised incised-plate versus tubularisation of an intact and laterally augmented plate for hypospadias repair: A prospective randomised study. Arab J Urol 2016; 14:163-70. [PMID: 27489745 PMCID: PMC4963157 DOI: 10.1016/j.aju.2016.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 03/21/2016] [Accepted: 03/30/2016] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To compare the outcome of hypospadias repair using tubularised incised-plate (TIP) urethroplasty and tubularisation of an intact and laterally augmented urethral plate. PATIENTS AND METHODS This prospective randomised study included 370 patients with primary distal hypospadias. All had urethral plate widths of 8-10 mm and a glans of ⩾15 mm. Exclusion criteria were previous repair, circumcision, a wide urethral plate of >10 mm or a narrow plate of <8 mm in diameter, a small glans of <15 mm in diameter, chordee of >30°, and hormonal stimulation. Patients were randomised into two groups: Group 1 (185 patients) underwent TIP urethroplasty and Group 2 (185 patients) underwent tubularisation of the intact plate with lateral augmentation of the urethral plate using penile skin. The follow-up period was 12-28 months. RESULTS There were 172 evaluable patients in Group 1 and 177 in Group 2. The urethroplasty was successful in 83.2% and 94.4% in Groups 1 and 2, respectively. Complications occurred in 16.8% in Group 1 and 5.6% in Group 2 (P = 0.001). Meatal stenosis occurred in 7% and 3.4% in Groups 1 and 2, respectively (P = 0.130). There were statistically significant differences in the wound dehiscence, fistula, and re-operation rates of Group 1 versus Group 2, at 6% versus 0%, 9.8% versus 2.8%, and 13.4% versus 5.6%, respectively. The presence of mild chordee did not affect the complication rate (P = 0.242). The mean (SD) operative time was 56.7 (8.9) min in Group 1 and 93.7 (8.3) min in Group 2 (P < 0.001). CONCLUSION The outcome of tubularised intact and laterally augmented plate is better than classical TIP urethroplasty of hypospadias. Further trials are mandatory to extend the indications of the technique.
Collapse
Affiliation(s)
- Adel Elbakry
- Department of Urology, Suez Canal University Hospital, Ismailia, Egypt
| | - Mahmoud Hegazy
- Department of Urology, Suez Canal University Hospital, Ismailia, Egypt
| | - Adel Matar
- Department of Urology, Suez Canal University Hospital, Ismailia, Egypt
| | - Ahmed Zakaria
- Department of Urology, Suez Canal University Hospital, Ismailia, Egypt
| |
Collapse
|
16
|
Arnaud A, Ferdynus C, Harper L. Can separation of the scrotal sac in proximal hypospadias reliably predict the need for urethral plate transection? J Pediatr Urol 2016; 12:121.e1-5. [PMID: 26747011 DOI: 10.1016/j.jpurol.2015.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/31/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION One of the main challenges in proximal hypospadias repair is correcting curvature. The best technique to achieve this remains the object of debate. Indeed, some authors believe the urethral plate should be kept and used as often as possible. In some cases, however, even after extensive mobilization and dorsal plication, significant curvature remains and it is necessary to transect the urethral plate. Having a reliable pre-dissection marker of the need for urethral transection would be useful in choosing a technique.We wanted to determine if presence of marked separation of the scrotal sac (SSS), also referred to as bifid scrotum, could reliably predict the need for urethral plate transection. STUDY DESIGN We prospectively enrolled a series of boys with proximal hypospadias. We noted age, degree of hypospadias, meatal position, presence of cryptorchidism, and presence or absence of SSS. During surgery we fully degloved the penile shaft, freeing all ventral tissues, and radically dissected the more proximal bulbar urethra. We then performed an erection test. If there was residual curvature <30° we performed a dorsal plication, if it was >30° we transected the urethral plate. RESULTS Twenty-nine patients were included, of whom 18 presented SSS. The average age was comparable in both groups, as was type of hypospadias and meatal position. We estimated transection of the urethral plate to be necessary in 15 out of the 18 children with SSS, and 2 out of the 11 children without SSS. The relative risk for requiring urethral plate transection in case of SSS in this series was 4.58. CONCLUSION Techniques that commit to urethral plate transection are criticized because they preclude using the urethral plate. In our study presence of SSS was predictive for the need to transect the plate. Obviously one can decide to keep the urethral plate at all cost, and mobilize it more than we did, or accept more residual curvature, but in reality our aim was to determine a preoperative marker allowing us to define a patient category. We believe presence of SSS is a marker of severity, and that this "severity" translates into "a less usable urethra". As recent studies caution us about the evolution of the reconstructed native urethra and the possibility that it may not grow as well as the other penile tissues, we believe this extra information could influence the surgeon's decision as to the most appropriate technique for each patient.
Collapse
Affiliation(s)
- Alexis Arnaud
- Department of Pediatric Surgery, CHU F Guyon, Bellepierre, Réunion Island, France
| | - Cyril Ferdynus
- Methodology Unit (USM), CHU F Guyon, Bellepierre, Réunion Island, France
| | - Luke Harper
- Department of Pediatric Surgery, CHU F Guyon, Bellepierre, Réunion Island, France.
| |
Collapse
|
17
|
|