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Anttila A, Lahdes-Vasama T, Pakkasjärvi N, Taskinen S. Cumulative re-operation rates during follow-up after hypospadias repair. BJU Int 2024. [PMID: 39224939 DOI: 10.1111/bju.16519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To assess the cumulative rates of re-operations after hypospadias repair and evaluate long-term surgical outcomes at a tertiary paediatric urology centre. PATIENTS AND METHODS Retrospective analysis of 293 boys born between 1991 and 2003 undergoing hypospadias surgery was conducted. The study included 274 patients: 165 with distal, 34 with midshaft, and 75 with proximal hypospadias. Kaplan-Meier methods were used to evaluate the re-operation data. RESULTS The median age at primary surgery was 1.3 years, with a median follow-up of 14.4 years. The overall re-operation rate was 48.2%, with approximately half of the problems detected within the first 3 months after surgery. The risk of re-operation was correlated with hypospadias severity, with 5- and 15-year re-operation risks at 39.3% and 51.8%, respectively. Limitations of the study include its retrospective nature and variations in surgical techniques from current standards. CONCLUSION There is a significant risk of unplanned re-operations following hypospadias repair, increasing with the severity of the original condition. This underscores the need for extended follow-up and effective communication with patients and their families about the likelihood of requiring multiple surgeries for optimal outcomes.
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Affiliation(s)
- Annaleena Anttila
- Department of Pediatric Surgery, Section of Pediatric Urology, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
- Department of Pediatric Surgery, Tampere University Hospital, Tampere, Finland
| | - Tuija Lahdes-Vasama
- Department of Pediatric Surgery, Tampere University Hospital, Tampere, Finland
| | - Niklas Pakkasjärvi
- Department of Pediatric Surgery, Section of Pediatric Urology, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Seppo Taskinen
- Department of Pediatric Surgery, Section of Pediatric Urology, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
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Aboalazayem A, Ba'ath ME, Kaddah SN, El-Barbary MM, Marei MM. Teaching hypospadias repair by utilising a novel 3D-printed silicon model: An initial assessment using structured trainee and trainer feedback. J Pediatr Urol 2024; 20:607.e1-607.e11. [PMID: 38824107 DOI: 10.1016/j.jpurol.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/17/2023] [Accepted: 01/04/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Simulated paediatric surgical training is inherently advantageous and flourishing. Moreover, several working conditions resulted in reduced training hours, index and subspecialty cases encountered, and the COVID-19 pandemic affected elective surgery backlogs, hence training opportunities. Hypospadias repair is technically-demanding and requires a spectrum of dissective and reconstructive skills. We therefore aimed to test a 3D-printed silicon model for hypospadias repair, in the context of hands-on surgical training. MATERIAL AND METHODS Twenty-Seven trainees, under the supervision of 15 instructors, completed the activity. They were given a seminar to show the relevant anatomy, and 8 key steps of the exercise: (1)-degloving; (2)-urethral plate marking; (3)-incision; (4)-tubularisation; (5)-glansplasty/glanuloplasty; (6)-dartos layer preparation; (7)-preputioplasty and (8)-skin closure. Each trainee completed a structured feedback assessment. An on-site trainer supervised and evaluated each exercise. Trainees and trainers rated the model through the above steps from unsatisfactory-(1/5) to excellent-(5/5), presented herein via cross-sectional analysis. RESULTS Eleven-(40.7 %) trainees were in years:1-3 of specialist training, 10-(37 %) were in years:4-6, and 6-(22.2 %) were beyond year-6. Two-(7.4 %) trainees had nil-hypospadias experience, 16-(59.2 %) previously assisted in procedures or performed steps, 5-(18.5 %) performed whole procedures supervised and 4-(14.8 %) independently. Twenty-(74 %) trainees and 15-(100 %) instructors judged the model to resemble the anomaly. Seventeen-(63 %) trainees and 13-(86.6 %) instructors rated the material needle-penetrability ≥3/5, compared to human tissue. Sixteen-(59 %) trainees and 13-(86.6 %) instructors rated the material suture holding ≥3/5. Eleven-(73.3 %) trainees and 13-(86.6 %) instructors rated sutures' evenness and edge coaptability ≥3/5. DISCUSSION Hypospadias is an index operation, which requires precision skills. Simulated training in Paediatric Surgery and Urology is gaining importance. 3D-printed models are gaining a key role in simulated training. The study presents a novel 3D-printed high-fidelity silicon-based hypospadias model designed for hands-on training. A structured pathway to divide a standard hypospadias repair into key steps is displayed to ensure skill acquisition and stabilisation. CONCLUSION This 3D-printed silicon-based hypospadias model is proven useful for hands-on training. The fidelity can still improve, especially regarding suture holding of the material. LEVEL OF EVIDENCE LEVEL III.
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Affiliation(s)
- Abeer Aboalazayem
- Cairo University, Faculty of Medicine (Kasr Alainy), Cairo University Hospitals, Paediatric Surgery Section/Units (Departments of General Surgery), Cairo University Specialized Paediatric Hospital [CUSPH] & Cairo University Children's Hospital [Abu El-Reesh El-Mounira], 11562, Cairo, Egypt.
| | - Muhammad Eyad Ba'ath
- American Hospital Dubai, Oud Maitha, Dubai & Gulf Medical University, Ajman, United Arab Emirates; King's College Hospital London, Dubai Branch, United Arab Emirates.
| | - Sherif Nabhan Kaddah
- Cairo University, Faculty of Medicine (Kasr Alainy), Cairo University Hospitals, Paediatric Surgery Section/Units (Departments of General Surgery), Cairo University Specialized Paediatric Hospital [CUSPH] & Cairo University Children's Hospital [Abu El-Reesh El-Mounira], 11562, Cairo, Egypt.
| | - Mohamed Magdy El-Barbary
- Cairo University, Faculty of Medicine (Kasr Alainy), Cairo University Hospitals, Paediatric Surgery Section/Units (Departments of General Surgery), Cairo University Specialized Paediatric Hospital [CUSPH] & Cairo University Children's Hospital [Abu El-Reesh El-Mounira], 11562, Cairo, Egypt.
| | - Mahmoud Marei Marei
- Cairo University, Faculty of Medicine (Kasr Alainy), Cairo University Hospitals, Paediatric Surgery Section/Units (Departments of General Surgery), Cairo University Specialized Paediatric Hospital [CUSPH] & Cairo University Children's Hospital [Abu El-Reesh El-Mounira], 11562, Cairo, Egypt.
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Gnech M, Bebi C, Berrettini A, Manzoni G. Response to commentary re "Commentary to surgical and functional outcomes of Dorsal Inlay Graft urethroplasty in revision vs primary hypospadias repair in the pediatric age". J Pediatr Urol 2024; 20:657-658. [PMID: 38734538 DOI: 10.1016/j.jpurol.2024.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 05/13/2024]
Affiliation(s)
- Michele Gnech
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Carolina Bebi
- Department of Pediatric Urology, Great Ormond Street Hospital for Children, London, WC1N 3JH, United Kingdom.
| | - Alfredo Berrettini
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianantonio Manzoni
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Wood D, Wilcox D. Hypospadias: lessons learned. An overview of incidence, epidemiology, surgery, research, complications, and outcomes. Int J Impot Res 2023; 35:61-66. [PMID: 35352016 DOI: 10.1038/s41443-022-00563-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022]
Abstract
Hypospadias is a common condition and familiar, though sometimes challenging territory for the pediatric urologist. This review is a summary of hypospadias incidence, epidemiology, surgery, research, and complications intended for the non-specialist. It outlines the history, the principles of surgery for hypospadias, and the long-term outcomes.
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Affiliation(s)
- Dan Wood
- University of Colorado, Aurora, CO, USA. .,Center for Childrens' Surgery Children's Hospital Colorado, Aurora, CO, USA.
| | - Duncan Wilcox
- Center for Childrens' Surgery Children's Hospital Colorado, Aurora, CO, USA
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Anand S, Kainth D. Fragility Index of Recently Published Meta-Analyses in Pediatric Urology: A Striking Observation. Cureus 2021; 13:e16225. [PMID: 34367825 PMCID: PMC8343562 DOI: 10.7759/cureus.16225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background and objective Fragility Index (FI) of meta-analyses determines their stability in terms of the level of confidence and strength behind the results depicted by them. The present study was conducted to estimate the FI of recently published meta-analyses in the Journal of Pediatric Urology (JPUrol). Method Twenty recently published articles on meta-analyses were screened to identify the eligible ones. The baseline data of each meta-analysis including the details of the author, number of included studies, total sample size, the total number of events, the status of the overall outcome (significant or non-significant), type of effect measure, type of method used for pooling the estimates, and type of effects model were recorded. FI was calculated by doing each single status modification. The 95% CI of the treatment effect was re-calculated until the statistical significance of the meta-analysis was reversed. Results A total of seven articles incorporating 22 meta-analyses were included. Seven (32%) of them had a statistically significant outcome prior to FI estimation. The risk ratio (17/22; 77%) was the most commonly used effect measure. The random-effects model (15/22; 68%) and the Mantel-Haenszel method (20/22; 91%) of pooling the estimates were utilized in the majority of meta-analyses. The median (Q1-Q3; range) FI of statistically significant, non-significant, and total meta-analyses were 5 (3-19.5; 2-39), 5 (3.5-6; 1-17), and 5 (3-13; 1-39) respectively. FI of ≤5 was noticed in four out of seven (57%), 9/15 (60%), and 13/22 (59%) of these meta-analyses respectively. Conclusion Based on our findings, the majority of the recently published meta-analyses in the field of pediatric urology are fragile and depend upon the event status of ≤5 participants.
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Affiliation(s)
- Sachit Anand
- Pediatric Surgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, IND.,Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, IND
| | - Deepika Kainth
- Pediatrics, All India Institute of Medical Sciences, New Delhi, IND
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Silay MS, 't Hoen L, Bhatt N, Quaedackers J, Bogaert G, Dogan HS, Nijman RJM, Rawashdeh Y, Stein R, Tekgul S, Radmayr C. Are there any benefits of using an inlay graft in the treatment of primary hypospadias in children? A systematic review and metanalysis. J Pediatr Urol 2021; 17:303-315. [PMID: 33691984 DOI: 10.1016/j.jpurol.2021.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/16/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Dorsal inlay graft urethroplasty (DIGU) has been described as an effective method for hypospadias repair with the proposed advantage of reducing the risk of complications. We aimed to systematically assess whether DIGU has any additional advantages over standard tubularized incised plate urethroplasty (TIPU) repair in children with primary hypospadias. MATERIALS AND METHODS This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The a priori protocol is available at the PROSPERO database (CRD42020168305). A literature search was conducted for relevant publications from 1946 until January 10, 2020 in seven different databases. Randomized controlled trials (RCTs), comparative studies (TIPU vs DIGU) and single arm case series (>20 cases) of DIGU were eligible for inclusion. Secondary hypospadias, two-stage repairs, disorders of sex development, significant curvature of >30°, and a mean or median follow-up of less than 12 months were excluded. DISCUSSION A total of 499 articles were screened and 14 studies (3 RCTs, 5 non-randomized studies (NRSs), and 6 case series) with a total of 1753 children (distal: 1334 (76%) and proximal: 419 (24%)) were found eligible. Mean follow-up of the studies was between 16 and 77 months. DIGU was found superior to TIPU in decreasing meatal/neourethral stenosis (p = 0.02, 95% CI 0.02-0.78). All other parameters were found comparable including overall complications, fistula and glans dehiscence rates. Success rates were similar among the groups ranging between 48% and 96% for DIGU and 43-96% in the TIPU group. The lack of standardization in the definition of complications and success was the major limitation of this study. CONCLUSIONS Using an inlay graft during primary hypospadias repair decreases the risk of meatal/neourethral stenosis. However, current evidence does not demonstrate superiority of DIGU over TIPU in terms of treatment success and overall complication rates.
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Affiliation(s)
- Mesrur Selcuk Silay
- Division of Pediatric Urology, Deparment of Urology, Biruni University, Istanbul, Turkey.
| | - Lisette 't Hoen
- Erasmus MC, Department of Urology, Rotterdam, the Netherlands
| | - Nikita Bhatt
- Urology Registrar, East of England Deanery, Cambridge, United Kingdom
| | - Josine Quaedackers
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, University of Groningen, the Netherlands
| | - Guy Bogaert
- Department of Urology, University of Leuven, Belgium
| | - Hasan Serkan Dogan
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Rien J M Nijman
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, University of Groningen, the Netherlands
| | | | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, University of Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
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