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Sennert M, Perske C, Fawzy M, Wirmer J, Hadidi AT. The effect of preoperative hormonal stimulation on the urethral plate; A histologic and histochemical study. J Pediatr Urol 2024:S1477-5131(24)00349-8. [PMID: 39004546 DOI: 10.1016/j.jpurol.2024.06.040] [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: 02/01/2024] [Revised: 06/24/2024] [Accepted: 06/29/2024] [Indexed: 07/16/2024]
Abstract
AIM OF THE WORK Preoperative hormone stimulation (PHS) is used to increase the glans size and may improve the cosmetic appearance after hypospadias surgery. The exact effect of PHS on different penile tissues remains unclear and controversial. Previous studies showed that PHS increased vessel density in the foreskin. However, the effect of PHS on the urethral has never been studied before. In this study we examine the PHS effects on the urethral plate. MATERIALS AND METHODS Specimens of the urethral plate and the underlying tissue were excised to correct severe chordee in 16 children with proximal and perineal hypospadias with severe chordee in 2 groups. Group A consisted of 8 children received PHS prior to surgery. Group B included 8 children with proximal and perineal hypospadias with severe chordee who did not receive PHS and served as a control group. Specimens were examined blindly using hematoxylin-eosin and elastic van-Gieson stain as well as factor 8 and SMA antibodies. RESULTS The median age of Group A was 13 (range 10-20) months. The median age of Group B (without prior PHS) was 17 (range 14-29) months (p = 0,03). The median vessel-density in group A (82 vessels per mm2) was significantly higher than in Group B (65 per mm2), (p < 0.05). The median vessel diameter was also significantly higher in Group A (13 μm) than in Group B (11 μm), (p < 0.05). The median epithelial layer thickness in Group A was 110 μm and in Group B 98 μm, but showed no statistical significance (p = 0,16). There was no significant change in dartos fascia layer thickness or androgen receptor expression. There was no visual change in the organization of elastic fibers. CONCLUSION This study is the first study to document the effect of PHS on the urethral plate in hypospadias with severe chordee. PHS significantly increased the median vessel-density as well as median vessel diameter as compared to a matching control group. The findings of the study may justify PHS administration before the first operation to improve the vascularity and may reduce the severity of chordee.
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Affiliation(s)
- Michael Sennert
- Hypospadias Centre, Department of Pediatric Surgery, Emma and Sana Klinikum Offenbach Hospitals, Germany
| | - Christina Perske
- Institute for Pathology, University Medical Center Goettingen, Germany
| | - Mohammed Fawzy
- Hypospadias Centre, Department of Pediatric Surgery, Emma and Sana Klinikum Offenbach Hospitals, Germany
| | - Johannes Wirmer
- Hypospadias Centre, Department of Pediatric Surgery, Emma and Sana Klinikum Offenbach Hospitals, Germany
| | - Ahmed T Hadidi
- Hypospadias Centre, Department of Pediatric Surgery, Emma and Sana Klinikum Offenbach Hospitals, Germany.
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Ting CSY, Ting SW, Kuo G, Chang PY. Taping alone for persistent ventral curvature after urethral plate transection in hypospadias. J Pediatr Urol 2024; 20:409.e1-409.e8. [PMID: 38631939 DOI: 10.1016/j.jpurol.2023.10.035] [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: 06/23/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Ventral penile curvature is a key factor in determining the surgical approach to proximal hypospadias repair. However, there is limited evidence regarding the efficacy and long-term effects of the procedures used to address curvature. This study aimed to evaluate the effects of urethral plate transection alone with tissue traction therapy on penile curvature in two-stage repair of proximal hypospadias. MATERIAL AND METHODS This was a prospective study of primary hypospadias patients who underwent a two-stage repair with urethral plate transection as the sole straightening procedure. After stage 1, taping was applied as tissue traction therapy and continued until stage 2. Penile curvature was measured using a goniometer under artificial erection before and immediately after urethral plate transection and during the second stage of repair. The primary focus of this investigation is the angle of curvature after 6-month taping. RESULTS The study included 46 patients with a median age of 13 months at the start of treatment. The median angle of penile ventral curvature was 70° after degloving, 60° after urethral plate transection, and 0° during the second stage of repair. Full correction of ventral curvature was achieved in 42 patients (91 %). DISCUSSION This publication is the first of its kind to propose taping as a method for penile traction therapy in hypospadias. The study reveals that penile ventral lengthening can be achieved through tissue traction therapy following UP transection alone. These findings challenge the current consensus that complete straightening of the penis in the first stage is necessary to prevent recurrent curvature and that ventral lengthening is required to correct corporal disproportion. However, further validation and long-term data are needed to definitively confirm the effectiveness of tissue traction therapy after urethral plate transection. CONCLUSIONS This study demonstrated significant resolution rate of penile ventral curvature in proximal hypospadias following urethral plate transection alone with taping. Long-term follow-up studies are needed to confirm the sustainability of the results through puberty.
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Affiliation(s)
- Cynthia Sze-Ya Ting
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Linkou Branch. No.5 Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan.
| | - Sze-Wen Ting
- Department of Dermatology, New Taipei City Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - George Kuo
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Pei-Yeh Chang
- Department of Pediatric Surgery, Chang Gung Children's Hospital, Chang Gung University, School of Medicine, No.5, Fuxing St., Guishan Dist., Taoyuan City 33305, Taiwan.
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Gabra A, Beyari BM, AlNuwaiser SJ, Allaf SM, Alghanmi R, Alrayiqi R, Mosaad F, Kurdi M. Outcomes of Hypospadias Repair Based on Surgical Techniques: A 4-Year Retrospective Study. Res Rep Urol 2024; 16:79-87. [PMID: 38558857 PMCID: PMC10981871 DOI: 10.2147/rru.s451552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose This study aimed to report the outcomes of hypospadias repair performed at a tertiary-level hospital during 2018 to 2021. Methods A retrospective chart review of 119 patients was performed. Results The most frequent coronal hypospadias cases were distal. However, the most common scrotal hypospadias cases were proximal. The average age at the time of the first surgery was 2.4 years (standard deviation, ±2.3 years). The tubularised incised plate technique was performed for 57 of these 119 patients. Urethral fistula was the most common complication associated with distal and proximal cases (23.96% and 30.43%, respectively). No significant correlation was observed between any complication and the surgical technique. Based on the logistic regression model, the duration of urethral stenting was statistically significant (p=0.025), indicating that a urinary catheter duration of more than 5 days resulted in a 2.9-times increased risk of postoperative urethral fistula. Conclusion Prolonged urethral stenting for more than 5 days may result in subsequent urethral fistula development. Neither the severity of hypospadias nor the surgical technique seems to affect postoperative complications.
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Affiliation(s)
- Aisha Gabra
- Division of Pediatric Surgery, Department of Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Badr Mohammed Beyari
- Faculty of Medicine and Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Sara Jamal AlNuwaiser
- Faculty of Medicine and Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Sarah Mamdouh Allaf
- Faculty of Medicine and Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Reem Alghanmi
- Faculty of Medicine and Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Rahaf Alrayiqi
- Faculty of Medicine and Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Faisal Mosaad
- Division of Pediatric Surgery, Department of Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Mazen Kurdi
- Division of Pediatric Surgery, Department of Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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Lyu Y, Chen F, Xie H, Huang Y, Wu M, Li X, Liang Y, Peng Z. One-stage repair of proximal hypospadias by in situ tubularization of the transverse preputial island flap. World J Urol 2023; 41:813-819. [PMID: 36745192 PMCID: PMC10082699 DOI: 10.1007/s00345-023-04296-0] [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: 10/01/2022] [Accepted: 01/13/2023] [Indexed: 02/07/2023] Open
Abstract
PURPOSE This study aimed to compare the efficacy of modified transverse preputial island flap (TPIF) repair with the traditional TPIF procedure and Byar's two-stage procedure in proximal hypospadias repair, especially in the postoperative urethral stricture incidence rates. MATERIALS AND METHODS Patients admitted for proximal hypospadias treated with modified TPIF repair, the traditional TPIF procedure, or Byar's two-stage procedure at our institution from 2017 to 2021 were identified, and the incidence of postoperative complications among them was compared. RESULTS In total, 142 patients were included (modified TPIF group, 43; traditional TPIF group, 37; and Byar's two-stage group, 62). The length of the neourethra was 4.21 ± 0.63 cm in the modified TPIF group, 4.18 ± 0.71 cm in the traditional TPIF group, and 4.20 ± 0.68 cm in the Byar's two-stage group. The rate of urethral stricture in the modified TPIF group (two cases, 4.65%) was significantly lower than that in the traditional TPIF group (four cases, 10.81%) (P = 0.008). Seven (16.28%) cases of urethrocutaneous fistula occurred in the modified TPIF group, six (16.22%) in the traditional TPIF group, and eight (12.90%) in the two-stage group. Additionally, one case (2.33%) of urethral diverticulum occurred in the modified TPIF group, one (2.70%) in the traditional TPIF group, and three (4.84%) in Byar's two-stage group. CONCLUSIONS Modified TPIF repair can ensure a wedge anastomosis between the proximal urethral meatus and the neourethra, provide support and blood supply for the neourethra. Furthermore, it extended the urethral plate width at the anastomosis and urethral meatus, effectively reducing the incidence of urethral strictures.
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Affiliation(s)
- Yiqing Lyu
- Department of Urology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200040, China
| | - Fang Chen
- Department of Urology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200040, China.
| | - Hua Xie
- Department of Urology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200040, China
| | - Yichen Huang
- Department of Urology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200040, China
| | - Min Wu
- Department of Urology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200040, China
| | - Xiaoxi Li
- Department of Urology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200040, China
| | - Yan Liang
- Department of Urology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200040, China
| | - Zhiwei Peng
- Department of Urology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200040, China
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Nnabugwu II, Onoh WC, Ukekwe FI, Nwosu EO, Iwenofu CA, Anakebe IN, Nnabugwu CA, Onuh AC. Urethral duplication associated with complex chordee: a narrative review of literature and report of a case. AFRICAN JOURNAL OF UROLOGY 2022. [DOI: 10.1186/s12301-022-00311-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Urethral duplication (UD) is reportedly rare. It is rarer in females. Knowledge on this anomaly comes from isolated report of cases. The aim of this review is to summarize information available on this anomaly thereby revealing gaps in knowledge, and to appropriately situate a recently managed case.
Methods
Publications on UD in English language from 2001 to 2021 were searched for in the literature. Of importance were age at presentation, class of UD, nature of associated penile deformity and other structural anomalies. Available information was used to synthesize opinions after descriptive analyses using SPSS® version 21 (IBM Co., Armonk, NY, USA). In addition, a recently managed case of UD was reported and appropriately situated in the discourse.
Result
In all, 115 articles met the inclusion criteria. Majority (75.7%) were individual case reports, while the rest were retrospective review of case series. These provided a total of 269 reported cases. Of this lot, 38 cases were excluded because they either had no Effmann’s class or were not described well enough for an Effmann’s class to be assigned. Ultimately, 231 cases formed the basis for this review. Male to female ratio was 12:1. Types III and IIB had more females. Types IIA 2 (26.0%), IIA 2 “Y” (26.4%) and IA (22.5%) were frequently reported. About 61.8% males and 68.4% females had no associated defects. Isolated dorsal chordee was prevalent (7.1%), especially among type IA (16.7%) UD. Reported in 10.4%, vesicoureteric reflux may not be attributable always to high pressure voiding.
A boy who presented at the age of 18 years with Effmann type IA UD and an associated complex chordee of the penile shaft was reported. The complex nature of the chordee adds to the challenge of explaining associated penile defects in UD.
Conclusion
UD is rare, but reported from all parts of the globe. There are a number of associated defects involving the external genitalia and other organs reported in UD in the male. The mechanisms of these defects are yet to be fully understood.
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