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Zhou G, Jiang M, Liu X, Yin J, yang Z, Li S, Chen J. Effect of Prolonging the Duration of Stenting on Urethral Stricture in Proximal Hypospadias with Severe Curvature Repair: A Prospective Cohort Study. Eur J Pediatr Surg 2024; 34:363-367. [PMID: 37336243 PMCID: PMC11226329 DOI: 10.1055/s-0043-1769797] [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: 03/01/2023] [Accepted: 05/04/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate whether prolonged stenting reduces the risk of urethral stricture after proximal hypospadias (PH) with severe curvature (SC) repair. MATERIALS AND METHODS We prospectively studied a cohort of patients with PH with SC repair who underwent urethral plate transection and urethroplasty between January 2010 and December 2020. According to the duration of stenting, the patients were divided into 2-, 4-, and 6-week groups. Postoperative complications and time of urethral stricture occurrence were analyzed. RESULTS In total, 665 patients were included in the analysis. The overall incidence of complications was 26.6% (n = 177), including 42 cases of urethral strictures: 27 (64.3%) cases of urethral stricture occurred between 4 and 6 weeks after urethroplasty, 7 cases occurred between 7 weeks and 6 months after urethroplasty, 7 cases occurred more than 6 months after urethroplasty, and 1 case occurred at 3 weeks after urethroplasty. The incidence of urethral stricture in the 6-week group (1.8%) was significantly lower than that in the 4- (5.8%) and 2-week groups (10.9%) (p < 0.05). CONCLUSION Prolonged stenting reduces the risk of urethral stricture in PH with SC repair. Four to six weeks after PH with SC repair may be the key period for the formation of early urethral strictures.
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Affiliation(s)
- Guanglun Zhou
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Man Jiang
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, China
| | - Xiaodong Liu
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Jianchun Yin
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Zhilin yang
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Shouln Li
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Guangdong, Shenzhen, China
| | - Jinjun Chen
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Guangdong, Shenzhen, China
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Lavoie C, Do C, Baker Z, Trabold M, Han J, Thaker H, Chang A. Human umbilical cord allograft associated with higher pediatric urethrocutaneous fistula repair success rates. J Pediatr Urol 2024:S1477-5131(24)00312-7. [PMID: 38951046 DOI: 10.1016/j.jpurol.2024.06.013] [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: 12/06/2023] [Revised: 05/02/2024] [Accepted: 06/11/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Urethrocutaneous fistula (UCF) formation is a known complication following hypospadias repair, affecting between 5 and 70% of cases. Moreover, approximately 30% of patients experience refistulization after UCF repair. The use of extracellular matrices, such as AmnioCord, a dehydrated human umbilical cord allograft manufactured by MiMedx®, may mitigate high rates of refistulization. OBJECTIVE To determine whether the use of AmnioCord during UCF repair is associated with reduced incidence of subsequent UCFs among pediatric patients. DESIGN, SETTING, AND PARTICIPANTS Electronic medical records were retrospectively reviewed among 60 patients who underwent at least one UCF repair at a pediatric hospital in a large urban setting in the U.S. between January 2012-June 2018. Patients were followed through January 2024. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Adjusted generalized estimating equation regression models were used to assess the association between AmnioCord use and rates of refistulization, while controlling for confounding variables. RESULTS The number of fistula presentations per patient ranged from one to four; 53.3% had one fistula, 30.0% had two, and 16.6% had three or more. Overall fistula repair success rate was 56.8% but significantly differed by AmnioCord use in adjusted modelling; 69.4% of cases that received AmnioCord were successfully repaired, compared to 47.2% of cases that did not receive AmnioCord. In adjusted models, patients who received AmnioCord had 2.66 times greater odds of surgical success than patients who did not receive AmnioCord (95% CI:1.13-6.24; p = 0.02). CONCLUSIONS This study demonstrates a positive association between AmnioCord use and successful UCF closure among pediatric patients.
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Affiliation(s)
- Callum Lavoie
- Division of Urology, Children's Hospital Los Angeles, USC Institute of Urology, Keck School of Medicine of USC, Los Angeles, CA, USA.
| | - Christine Do
- Division of Urology, Children's Hospital Los Angeles, USC Institute of Urology, Keck School of Medicine of USC, Los Angeles, CA, USA.
| | - Zoë Baker
- Division of Urology, Children's Hospital Los Angeles, USC Institute of Urology, Keck School of Medicine of USC, Los Angeles, CA, USA.
| | - Melissa Trabold
- Division of Urology, Children's Hospital Los Angeles, USC Institute of Urology, Keck School of Medicine of USC, Los Angeles, CA, USA.
| | - Jullet Han
- Division of Urology, Children's Hospital Los Angeles, USC Institute of Urology, Keck School of Medicine of USC, Los Angeles, CA, USA.
| | | | - Andy Chang
- Division of Urology, Children's Hospital Los Angeles, USC Institute of Urology, Keck School of Medicine of USC, Los Angeles, CA, USA.
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Abbas TO, Sennert M, Tiryaki S, Fernandez N, Fawzy M, Hadidi A. Hypospadias-associated penile curvature assessment and management: A global survey of current practice. J Pediatr Urol 2024; 20:440.e1-440.e10. [PMID: 38418260 DOI: 10.1016/j.jpurol.2024.02.006] [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: 12/30/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Our goal was to assess how surgical management of hypospadias-associated penile curvature (HAPC) varies across continents, focusing on factors that influence assessment and decision-making. METHODS Members of the European Society of Pediatric Urology (ESPU), Society of Pediatric Urology (SPU), and Hypospadias International Society (HIS) participated in an anonymous, 34-question online survey addressing pre-, intra-, and postoperative elements of HAPC evaluation and management. A selection of intraoperative photos were included in the survey to investigate the prevailing surgical approaches and identify management patterns. RESULTS Out of the 267 participants, 38.4% of them are located in Europe. Visual estimation was the predominant approach for evaluating HAPC, although being regarded as the least dependable compared to other techniques. Surgeons who performed more than 40 cases per year were more inclined to use goniometers and had varying degrees of HAPC that were considered acceptable without requiring any correction (P < .001). Out of 58% of respondents, a significant number reported regular utilization of artificial erection tests for all categories of hypospadias. Surgeons with fewer than 10 years of expertise commonly utilized erection test as part of their regular practice. A tourniquet was employed to maintain sufficient intra-corporeal pressure, by134 (50%). 116 participants (43%) inject Saline through the corpora cavernosa through the glans, while 150 (56%) administer saline from the lateral aspect. Moreover, the decision-making process differed based on the intraoperative picture scenarios of mild to moderate penile curvature during erection testing. Contrary to temperatures ranging from 25o to 35o, decision-making in cases with less severe degrees of HAPC was uncomplicated. CONCLUSION This survey reveals a wide range of surgical practice patterns in the assessment and management of HAPC. To our knowledge, this global survey of HAPC practice is the largest to date and could aid in developing new guidelines in pediatric urology. These findings may also provide a foundation for future prospective multinational studies.
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Affiliation(s)
- Tariq O Abbas
- Pediatric Urology Section, Sidra Medicine, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; Weill Cornell Medicine Qatar, Doha, Qatar.
| | - Michael Sennert
- Department of Pediatric Surgery, University Clinic, Hamburg, Germany
| | - Sibel Tiryaki
- Ege University, Faculty of Medicine, Department of Pediatric Surgery, Division of Pediatric Urology, Izmir, Turkey
| | - Nicolas Fernandez
- Division of Pediatric Urology Seattle Children's Hospital, Department of Urology University of Washington, United States
| | - Mohamed Fawzy
- Hypospadias Clinic, Department of Pediatric Surgery, Emma and Offenbach Hospitals, Offenbach, Germany
| | - Ahmed Hadidi
- Hypospadias Clinic, Department of Pediatric Surgery, Emma and Offenbach Hospitals, Offenbach, Germany
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Gaines T, Simhan J. Adult Hypospadias Outcomes for the Pediatric Urologist. Curr Urol Rep 2024; 25:63-70. [PMID: 38319558 DOI: 10.1007/s11934-024-01196-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE OF REVIEW This review article will examine the current literature on hypospadias-related complications in adult patients. RECENT FINDINGS In this article, we will review the most recent studies evaluating hypospadias-related stricture disease, erectile function, fertility, and psychosexual outcomes in adult men with history of hypospadias repair in childhood. Managing hypospadias-related complications in adult patients is challenging to reconstructive urologists due to the compounded complexity of innate tissue deficiency and history of prior surgical repairs. In this review, we explore overall functional outcomes of adults with history of hypospadias repair as well as repair strategies of hypospadias-related urethral stricture disease. We will review erectile function, fertility and psychosexual outcomes as well as potential complications, which often do not surface until late adolescence and adulthood. Although it is challenging to characterize and quantify hypospadias-related complications, further longitudinal study is needed to better care for this complex patient population.
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Affiliation(s)
- Tyler Gaines
- Department of Urology, Fox Chase Cancer Center/Temple Health, Philadelphia, PA, USA
- Department of Urology, Einstein Healthcare Network, Philadelphia, PA, USA
| | - Jay Simhan
- Department of Urology, Fox Chase Cancer Center/Temple Health, Philadelphia, PA, USA.
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Bhatia V, Fernandez N, Long C, Sturm R, Farhat W, O’Kelly F. Advancements in Hypospadias Management: Trends, Techniques, Training, and Patient-Centric Outcomes. UROLOGY RESEARCH & PRACTICE 2024; 50:94-101. [PMID: 39115355 PMCID: PMC11232038 DOI: 10.5152/tud.2024.23219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/04/2024] [Indexed: 08/11/2024]
Abstract
Hypospadias has drawn increasing attention due to its prevalence, complex etiology, and significant impacts on psychological and sexual quality of life. This comprehensive review delves into the facets of hypospadias management, exploring pivotal themes that shape present understanding and practice. We demonstrate potential explanatory factors for its incidence through an analysis of geographic, genetic, and environmental influences. We then contextualize care by exploring historical and evolving surgical techniques, and highlight that advances in surgical approaches employ a spectrum of repair strategies. Innovation in surgical training, with a focus on simulation-based methodologies, offers a bridge between didactic learning and real-world application, which is particularly relevant due to the demonstrated effect of personal experience with hypospadias repair outcomes. Considering the importance of mentorship, case exposure, and hands-on practice, a holistic understanding of expertise cultivation at each training stage is essential. Lastly, patient-centric outcomes research must take center stage, particularly as the impact of our interventions on children with hypospadias will be judged by them as adults. Shifting from solely surgeon-reported outcomes to patient-reported outcomes is emphasized in the review, allowing for a more comprehensive assessment of the influence of surgical interventions across the lifespan. Integrating patients' perspectives refines surgical decision-making to align with expectations, ultimately enhancing overall satisfaction. Our multi-pronged exploration of advancements in hypospadias underscores the symbiotic relationship between evolving surgical techniques, training methodologies, personal experience, and patientreported outcomes. As the field progresses, these insights will collectively contribute to optimizing hypospadias care, advancing both medical practice and patient well-being.
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Affiliation(s)
- Vinaya Bhatia
- Department of Urology, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA
| | - Nicolas Fernandez
- Department of Pediatric Urology, Seattle Children’s Hospital, Seattle, WA, USA
| | - Christopher Long
- Department of Pediatric Urology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Renea Sturm
- Division of Pediatric Urology, Mattel Children’s Hospital, University of California Los Angeles, Los Angeles, CA, USA
| | - Walid Farhat
- Department of Urology, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA
| | - Fardod O’Kelly
- Division of Pediatric Urology, Women and Children’s Hospital, University of Wisconsin School of Medicine and Public Health, Wisconsin, USA
- Division of Pediatric Urology, Beacon Hospital, University College Dublin, Dublin, Ireland
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AbouZeid AA. Letter to the Editor: Quantifying Severity in Hypospadias. J Pediatr Surg 2024; 59:345-346. [PMID: 37716843 DOI: 10.1016/j.jpedsurg.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/18/2023]
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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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Wen X, Fan LJ, Zhang WP, Ni X, Gong CX. Genotype-phenotype correlations, surgical selections, and postoperative complications of 5α-reductase 2 deficiency in 69 children with hypospadias. Asian J Androl 2023; 25:731-736. [PMID: 37313883 DOI: 10.4103/aja202313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/14/2023] [Indexed: 06/15/2023] Open
Abstract
5α-reductase 2 deficiency prevents testosterone from being converted to dihydrotestosterone, which causes abnormal urogenital sinus development. The aim of this study was to analyze the relationship between genotype-phenotype, surgical selections, and postoperative complications of 5α-reductase 2-deficient patients with hypospadias. We retrospectively evaluated the medical records of patients who were diagnosed with 5α-reductase 2 deficiency after genetic testing in the Department of Endocrinology and underwent initial hypospadias surgery in the Department of Urology in Beijing Children's Hospital, Capital Medical University (Beijing, China), from April 2007 to December 2021. A total of 69 patients were included in this study; the mean age at surgery was 34.1 months, and the average follow-up time was 54.1 months. Sixty children were treated with preoperative hormone stimulation (PHS) to promote penile growth. The average penis length and glans width were increased by 1.46 cm and 0.62 cm, respectively. The most frequent mutations were p.R227Q (39.1%, 54/138), p.Q6* (15.2%, 21/138), p.G203S (12.3%, 17/138), and p.R246Q (11.6%, 16/138). In 64 patients who were followed up, 43 had a one-stage operation and 21 had a staged operation, and there were significant differences in external masculinization score (EMS) ( P = 0.008) and the average number of operation required to cure ( P < 0.001) between one-stage and staged operations. PHS had a positive effect ( P < 0.001) on penile development. The p.R227Q mutation was associated with higher EMS and less severe hypospadias. One-stage surgery can be selected if conditions permit. The growth and development of children are acceptable in the long term, but penis growth remains unsatisfactory. Long-term complications of hypospadias should be considered during puberty.
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Affiliation(s)
- Xu Wen
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Li-Jun Fan
- Department of Endocrinology, Genetics, Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
- Beijing Key Laboratory for Genetics of Birth Defects, Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Wei-Ping Zhang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Xin Ni
- Department of Otolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Chun-Xiu Gong
- Department of Endocrinology, Genetics, Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
- Beijing Key Laboratory for Genetics of Birth Defects, Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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Scougall K, Bryce J, Baronio F, Boal RL, Castera JR, Castro S, Cheetham T, Costa EC, Darendeliler F, Davies JH, Dirlewanger M, Gazdagh G, Globa E, Guerra-Junior G, Guran T, Herrmann G, Holterhus PM, Akgül AK, Markosyan R, McElreavey K, Miranda ML, Nordenstrom A, O’Toole S, Poyrazoglu S, Russo G, Schwitzgebel V, Stancampiano M, Steigert M, Ahmed SF, Lucas-Herald AK. Predictors of surgical complications in boys with hypospadias: data from an internationa registry. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000599. [PMID: 37860275 PMCID: PMC10582860 DOI: 10.1136/wjps-2023-000599] [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: 03/24/2023] [Accepted: 08/25/2023] [Indexed: 10/21/2023] Open
Abstract
Background Complications are frequently reported after hypospadias repair and there is a need to understand the factors that influence their occurrence. Methods Data from boys with hypospadias born between 2000 and 2020 were obtained from the International Disorders of Sex Development (I-DSD) Registry. Logistic regressions, fisher's exact tests and spearman's correlation tests were performed on the data to assess associations between clinical factors and complication rates. Results Of the 551 eligible boys, data were available on 160 (29%). Within the cohort, the median (range) External Masculinization Score (EMS) was 6 (2, 9). All presented with one or more additional genital malformation and 61 (38%) presented with additional extragenital malformations. Disorders of androgen action, androgen synthesis and gonadal development were diagnosed in 28 (18%), 22 (14%) and 9 (6%) boys, respectively. The remaining 101 (62%) patients were diagnosed as having non-specific 46,XY Disorders of Sex Development. Eighty (50%) boys had evidence of abnormal biochemistry, and gene variants were identified in 42 (26%). Median age at first hypospadias surgery was 2 years (0, 9), and median length of follow-up was 5 years (0, 17). Postsurgical complications were noted in 102 (64%) boys. There were no significant associations with postsurgical complications. Conclusions Boys with proximal hypospadias in the I-DSD Registry have high rates of additional comorbidities and a high risk of postoperative complications. No clinical factors were significantly associated with complication rates. High complication rates with no observable cause suggest the involvement of other factors which need investigation.
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Affiliation(s)
| | | | - Federico Baronio
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola, Bologna, Italy
| | - Rachel L Boal
- Great North Children's Hospital, Newcastle Upon Tyne, UK
| | | | | | - Tim Cheetham
- Great North Children's Hospital, Newcastle Upon Tyne, UK
| | | | | | | | | | | | - Evgenia Globa
- Ukrainian Research Center of Endocrine Surgery Endocrine Organs and Tissue Transplantation, Kyiv, Ukraine
| | | | | | | | - Paul-Martin Holterhus
- University Hospital of Schleswig-Holstein Campus Kiel/Christian-Albrechts-University of Kiel, Kiel, Germany
| | | | - Renata Markosyan
- Yerevan State Medical University Endocrinology Clinic, Yerevan, Armenia
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AbouZeid AA, Habak RA, Hamad MM, Shahin AEM. De-epithelialized overlap flap to secure urethroplasty in second stage hypospadias repair: revisiting the Smith technique. BMC Urol 2023; 23:143. [PMID: 37648994 PMCID: PMC10469420 DOI: 10.1186/s12894-023-01312-8] [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: 09/19/2022] [Accepted: 08/23/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The application of a second layer between the neourethra and skin was a major contribution, which has improved the outcome of hypospadias repair. Here, we report our experience of revisiting the original Smith technique using a de-epithelialized overlap flap to support the urethroplasty in staged hypospadias repair. METHODS The study included primary cases of proximal hypospadias with significant chordee who underwent two-stage repair during the period 2016 through 2021. The ventral curvature was corrected at first stage by excision of the urethral plate, followed by covering the ventral shaft by skin flaps or inner preputial graft. The second stage (Thiersch -Duplay urethroplasty) was performed six months later. The de-epithelialized overlap flap (double breasting) technique was used to cover the neo-urethra in all cases, which was combined with a dartos scrotal flap to cover the proximal neourethra when indicated. RESULTS The study included 17 boys with proximal hypospadias who underwent two-stage repair. Follow up period after the second stage ranged between 6 and 30 months (mean 19.7; median 18.5). Post-operative complications were detected in 7 cases (41%). Most complications were related to distal/glanular disruptions whether partial or complete (5 cases). One case developed a penoscrotal fistula that was closed surgically. Another case (belonging to the group which used preputial graft in the 1st stage) presented 21 months after the second stage with urethral stricture (penoscrotal). CONCLUSION Applying the de-epithelialized double-breasting skin closure can offer alternative second layer coverage for the neourethra along the penile shaft in staged repair of proximal hypospadias.
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Fischer KM, Van Batavia J, Hyacinthe N, Weiss DA, Tan C, Zderic SA, Mittal S, Shukla AR, Kolon TF, Srinivasan AK, Canning DA, Zaontz MR, Long CJ. Caudal anesthesia is not associated with post-operative complications following distal hypospadias repair. J Pediatr Urol 2023; 19:374-379. [PMID: 37002025 DOI: 10.1016/j.jpurol.2023.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/27/2022] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION The use of caudal anesthesia at the time of hypospadias repair remains controversial as some prior studies have reported increased postoperative complication rates associated with caudal nerve block. However, these results have been called into question due to confounding factors and heterogeneous study groups. OBJECTIVE Given the importance of identifying true risk factors associated with increased hypospadias complication rate, we examined our experience with caudal anesthesia limiting our analysis to distal repairs. We hypothesized that caudal anesthesia would not be associated with increased postoperative complications. STUDY DESIGN We retrospectively reviewed our institutional hypospadias database from June 2007 to January 2021. All boys who underwent single-stage distal hypospadias repair with either caudal or penile block with minimum 1 month follow up were included. Records were reviewed to determine the type of local anesthesia, type of hypospadias repair, all complications, and time to complication. Association between any complication and local anesthesia type was evaluated by univariate and multivariate logistic regression analysis controlling for age at surgery and type of repair. A sub-analysis was performed for complications occurring ≤30 days. RESULTS Overall, 1008 boys, 832 (82.5%) who received caudal and 176 (17.5%) penile block, were included. Median age at surgery was 8.1 months and median follow up was 13 months. Overall complication rate was 16.4% with 13.8% of patients requiring repeat operation. Median time to complication was 10.59 months and was significantly shorter in the caudal group (8.45 vs. 25.2 months). Caudal anesthesia was associated with higher likelihood of complication on univariate analysis; however, this was not true on multivariate analysis when controlling for age and type of repair. Caudal anesthesia was not associated with increased likelihood of complication within 30 days. DISCUSSION Since the association between caudal anesthesia and hypospadias complications was first suggested, several studies have tried to answer this question with variable results. Our findings add to the evidence that there is no association between caudal anesthesia and increased hypospadias complications in either the short or long term. The major strengths of our study are a large, homogenous study population, robust follow up and inclusion of data from 14 surgeons over 14 years. Limitations include the study's retrospective nature as well as lack of standardized follow up protocol throughout the study period. CONCLUSIONS After controlling for possible confounders, caudal nerve block was not associated with increased risk of postoperative complications following distal hypospadias repair.
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Affiliation(s)
- Katherine M Fischer
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jason Van Batavia
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nathan Hyacinthe
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dana A Weiss
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Connie Tan
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Steve A Zderic
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sameer Mittal
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Aseem R Shukla
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas F Kolon
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Arun K Srinivasan
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Douglas A Canning
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark R Zaontz
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher J Long
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Zhang Y, Wang X, Wu Y, Li S, Zhang D, Ma X, Wang C, Zhang Z, Ma Y, Wei B, Guan Y. Grafts vs. flaps: a comparative study of Bracka repair and staged transverse preputial island flap urethroplasty for proximal hypospadias with severe ventral curvature. Front Pediatr 2023; 11:1214464. [PMID: 37416816 PMCID: PMC10321133 DOI: 10.3389/fped.2023.1214464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction Bracka repair and staged transverse preputial island flap urethroplasty are both significant methods in treating proximal hypospadias. They utilize the flap and graft techniques, respectively, to achieve a satisfactory success rate. This study aimed to compare the outcomes of these 2 methods in the treatment of proximal hypospadias with severe ventral curvature. Methods We retrospectively analyzed 117 cases of proximal hypospadias with severe ventral curvature who had undergone either Bracka repair (n = 62) or staged transverse preputial island flap urethroplasty (n = 55). All operations were performed by a single surgeon, and the choice of method was determined by the surgeon's preference based on his experience. Cosmetic outcome was evaluated with Pediatric Penile Perception Score (PPPS). Patients' characteristics including age, penis length, glans diameter, length of the urethral defect and ventral curvature degree, cosmetic outcomes, and complication rates were all compared. Results There was no significant difference in age, penis length, glans diameter, length of the urethral defect, or ventral curvature degree. In the Bracka group, there were 5 patients with fistula, 1 patient with stricture, and 1 case of dehiscence. In the staged transverse preputial island flap urethroplasty group, there were 4 patients with fistula, 1 with stricture, and 2 with diverticulum. The scores of shaft skin and general appearance were consistently higher in the Bracka group than in the staged transverse preputial island flap urethroplasty group. The differences in complication rate and cosmetic outcome were not statistically different (P > 0.05). Conclusions Bracka repair and staged transverse preputial island flap urethroplasty are both satisfactory staged surgical options for proximal hypospadias with severe ventral curvature and have similar complication rates. Bracka repair may create a better appearance, but more studies are needed to confirm this finding. Pediatric surgeons should consider additional factors, such as the patient's specific condition, parents' inclination, and personal experience, rather than safety, to make the best choice between the 2 methods.
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Harris TGW, Mudalegundi S, Haney NM, Morrill CC, Khandge P, Yang R, Redett RJ, Gearhart JP. The Role of Tissue Expanders in the Reconstruction of Proximal Hypospadias. Urology 2023; 176:150-155. [PMID: 36944401 DOI: 10.1016/j.urology.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/16/2023] [Accepted: 03/01/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To report the technique and outcomes of tissue expansion (TE) for generating additional penile skin for urethroplasty and/or skin coverage during primary or redo hypospadias repair in penoscrotal transposition (PST) patients with a proximal hypospadias. METHODS Proximal hypospadias and PST patients with a lack of penile skin, congenitally or after failed repair, who underwent TE assisted reconstruction were reviewed. TE were placed under the penile shaft and expanded skin was used for tubularized incised plate repair. Success was defined as urethral advancement to the corona or more distal with tension free skin coverage. RESULTS A total of 24 patients underwent reconstruction including 16 as part of primary repair and for redo repairs in 8. Nine patients experienced expander extrusion and posturethroplasty complications occurred in 43.8% of primary repairs and 75.0% of redo repairs; a urethrocutaneous fistula was most common (n = 8). Overall, success was achieved in 87.5% of patients with postoperative meatal locations almost all coronal (45.8%) or glanular (50.0%). CONCLUSION Proximal hypospadias reconstruction is challenging, and complications are not infrequent. TE is a useful alternative for complex patients with a skin paucity such that cutaneous coverage would be difficult following urethroplasty. Although the complication rate was 43.8% for primary repair, TE generated sufficient residual skin for success after additional reconstruction. For redo repair early use is most beneficial as there is more expandable skin. The pseudocapsules provide vascularized coverage to reinforce the urethra while there is sufficient skin to minimize the need for a skin graft for penile coverage.
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Affiliation(s)
- Thomas G W Harris
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shwetha Mudalegundi
- Department of Urology, Jeffs Division of Pediatric Urology, Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD
| | - Nora M Haney
- Department of Urology, Jeffs Division of Pediatric Urology, Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD
| | - Christian C Morrill
- Department of Urology, Jeffs Division of Pediatric Urology, Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD
| | - Preeya Khandge
- Department of Urology, Jeffs Division of Pediatric Urology, Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD
| | - Robin Yang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Richard J Redett
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - John P Gearhart
- Department of Urology, Jeffs Division of Pediatric Urology, Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD.
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AbouZeid AA. Reply to Letter to Editor: Chordee Excision for Correction of Hypospadias Curvature: Fact or Fiction? J Pediatr Surg 2023:S0022-3468(23)00283-X. [PMID: 37211505 DOI: 10.1016/j.jpedsurg.2023.04.019] [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: 04/18/2023] [Accepted: 04/22/2023] [Indexed: 05/23/2023]
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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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Shukla AR, Kolon TF. Douglas Arthur Canning: A Tribute. J Pediatr Urol 2022; 18:S1477-5131(22)00530-7. [PMID: 36464566 DOI: 10.1016/j.jpurol.2022.11.016] [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: 12/04/2022]
Affiliation(s)
- Aseem R Shukla
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Thomas F Kolon
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Zhou G, Wang R, Zhu W, Yin J, Yang Z, Li S. Risk factors for postoperative complications in children with proximal hypospadias with severe chordee who underwent urethral plate transection. Int J Urol 2022; 29:1310-1314. [PMID: 35858758 PMCID: PMC9796588 DOI: 10.1111/iju.14986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/03/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To identify the risk factors associated with developing complications after transection of the urethral plate for proximal hypospadias with severe chordee. METHODS We used a prospective database to identify patients with proximal hypospadias and severe chordee who underwent transection of the urethral plate and primary hypospadias repair in 2011 and 2021. All patients underwent urethroplasty with a follow-up period of >12 months. The association between variables (age, surgical technique, length of urethral defect, and surgeon volume) and postoperative complications (fistulas, urethral strictures, diverticula and glans dehiscence) was analyzed. RESULTS Altogether, 493 patients were included, of whom 133 (26.9%) had postoperative complications. Univariate and multivariate analyses revealed that the preoperative proximal meatal position, one-stage repair, longer urethral defect length, and low surgeon volume were significant risk factors for postoperative complications with proximal hypospadias with severe chordee who underwent transection of the urethral plate. A urethral defect length of ≥4.55 cm was considered the best cutoff value for predicting postoperative complications. CONCLUSIONS Preoperative proximal meatal location, one-stage repair, longer urethral defect length, and low surgeon volume were associated with postoperative complications in patients with proximal hypospadias with severe chordee who underwent transection of the urethral plate. A urethral defect length of ≥4.55 cm was significantly associated with the development of complications.
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Affiliation(s)
- Guanglun Zhou
- Department of Urology and Laboratory of Pelvic Floor Muscle FunctionShenzhen Children's HospitalShenzhenGuangdongP.R. China
| | - Ruifeng Wang
- Department of Gastroenterology and Zhengzhou Key Laboratory of Children's Digestive DiseasesChildren's Hospital affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's HospitalZhengzhouHenanP.R. China
| | - Wenbin Zhu
- Department of Urology and Laboratory of Pelvic Floor Muscle FunctionShenzhen Children's HospitalShenzhenGuangdongP.R. China
| | - Jianchun Yin
- Department of Urology and Laboratory of Pelvic Floor Muscle FunctionShenzhen Children's HospitalShenzhenGuangdongP.R. China
| | - Zhilin Yang
- Department of Urology and Laboratory of Pelvic Floor Muscle FunctionShenzhen Children's HospitalShenzhenGuangdongP.R. China
| | - Shoulin Li
- Department of Urology and Laboratory of Pelvic Floor Muscle FunctionShenzhen Children's HospitalShenzhenGuangdongP.R. China
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He Z, Yang B, Tang Y, Mao Y. Analysis of factors associated with postoperative complications after primary hypospadias repair: a retrospective study. Transl Androl Urol 2022; 11:1577-1585. [PMID: 36507491 PMCID: PMC9732705 DOI: 10.21037/tau-22-691] [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] [Received: 09/27/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background To determine the risk factors for postoperative complications after primary hypospadias repair. Hypospadias has a high postoperative complication rate, and the risk factors of postoperative complications have attracted extensive attention. Methods A total of 857 children who received primary surgical repair for hypospadias in our center between 3 January 2017 and 29 January 2021 were retrospectively analyzed. The collected data included age at time of surgery, type of hypospadias, body mass index (BMI), surgeon, operation time, length of reconstructed urethra, method of anesthesia (general anesthesia or general anesthesia combined with caudal anesthesia), and postoperative constipation. The risk factors for postoperative complications were analyzed by multivariate analysis. Results The follow-up time in this study was 6-54 months, with a mean follow-up time of 29 months. A total of 96 (11.2%) of the 857 pediatric patients had postoperative complications, including 44 (45.8%) cases of urethral fistula, 14 (14.6%) cases of urethral stricture, 5 (5.2%) cases of urethral diverticula, 5 (5.2%) cases of distal dehiscence, 3 (3.1%) cases of poor exposure, 2 (2.1%) cases of residual curvature, 1 (1.0%) case of penoscrotal transposition, 6 (6.3%) cases of urethral stricture and diverticulum, 6 (6.3%) cases of urethral fistula and diverticulum, 3 (3.1%) cases of urethral fistula and postoperative residual curvature, 2 (2.1%) cases of urethral fistula and distal dehiscence, and 1 (1.0%) case each of urethral fistula and transposition, urethral diverticulum and poor exposure, urethral stricture and poor exposure, distal dehiscence and transposition, and residual curvature and transposition. After univariate analysis, type of hypospadias (P=0.038), operation time (P<0.001), length of reconstructed urethra (P=0.007), and postoperative constipation (P=0.019) were included in the multivariate logistic regression analysis. The results showed that postoperative constipation was an independent risk factor for complications [P=0.027, odds ratio (OR) =1.793, confidence interval (CI): 1.067 to 3.012]. Conclusions Postoperative constipation is an important influencing factor for postoperative complications following primary hypospadias repair. Therefore, defecation management should be strengthened for hypospadias patients during the perioperative period.
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Affiliation(s)
- Zirong He
- Department of Pediatric Surgery of Children's Medical Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital & Affiliated Hospital of the University of Electronic Science and Technology of China, Chengdu, China
| | - Bo Yang
- Department of Pediatric Surgery of Children's Medical Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital & Affiliated Hospital of the University of Electronic Science and Technology of China, Chengdu, China
| | - Yunman Tang
- Department of Pediatric Surgery of Children's Medical Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital & Affiliated Hospital of the University of Electronic Science and Technology of China, Chengdu, China
| | - Yu Mao
- Department of Pediatric Surgery of Children's Medical Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital & Affiliated Hospital of the University of Electronic Science and Technology of China, Chengdu, China
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Cousin I, Basmaison C, Cousin E, Lebonvallet N, Germouty I, Leven C, De Vries P. Complication rates of proximal hypospadias: meta-analyses of four surgical repairs. J Pediatr Urol 2022; 18:587-597. [PMID: 36058812 DOI: 10.1016/j.jpurol.2022.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/28/2022] [Accepted: 08/12/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Proximal hypospadias surgery is impacted by a high complication rate. The goal of this work was to assess the overall composite complication rate, fistula rate and stenosis rate following proximal hypospadias surgery realized according to onlay urethroplasty, Duckett, Koyanagi and Bracka techniques. METHODS The databases MEDLINE, EMBASE, SCOPUS, Cochrane Library, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (CENTRAL) and Sciencedirect were searched. Studies had to report data about the mean age of population, the average duration of patient follow-up and the number of procedures required for surgical treatment of primary and proximal hypospadias. Two independent including one urologist reviewers screened all the articles and selected the articles to be included. RESULTS Overall composite complication rates were 32%, 34%, 49%, and 43%, for Onlay urethroplasty, Duckett's tubularized flaps urethroplasty, Koyanagi repair and Bracka 2 stages repair, respectively. Fistula rates were 13%, 18%, 21% and 23% respectively. The heterogeneity of complication rates reported in the different studies was not moderated by age, country, or patient's continent origin. DISCUSSION The classifications of complications used in articles were disparate and make comparisons between techniques difficult. The report of post-surgical complications in the literature is often poorly coded and follow-up times were often too short. CONCLUSION This meta-analysis attempts to determine to the extent possible, given the serious weaknesses in the hypospadias literature, plausible estimates of complication rates after skin flap urethroplasty. The patched onlay skin flap, the Duckett's tubularized skin flap technique, the Koyanagi's technique, and the Bracka's two-stage urethroplasty procedure lead to very high complication rates. Reported complication rates are comparable across techniques.
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Affiliation(s)
- Ianis Cousin
- Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire de Brest, Hôpital Augustin Morvan, 4 Avenue Foch, 29200 Brest, France; Laboratoire Intéraction épithéliums Neurones, Université de Bretagne Occidentale, 6 Rue Colbert, 29200 Brest, France.
| | - Camille Basmaison
- Laboratoire Intéraction épithéliums Neurones, Université de Bretagne Occidentale, 6 Rue Colbert, 29200 Brest, France
| | - Elie Cousin
- Department of Pediatry, Centre Hospitalier Universitaire de Rennes, 16 Boulevard de Bulgarie 35200 Rennes, France
| | - Nicolas Lebonvallet
- Laboratoire Intéraction épithéliums Neurones, Université de Bretagne Occidentale, 6 Rue Colbert, 29200 Brest, France
| | - Isabelle Germouty
- Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire de Brest, Hôpital Augustin Morvan, 4 Avenue Foch, 29200 Brest, France
| | - Cyril Leven
- Department of Pharmacology, Centre Hospitalier Régional Universitaire de Brest, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Philine De Vries
- Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire de Brest, Hôpital Augustin Morvan, 4 Avenue Foch, 29200 Brest, France; Laboratoire Intéraction épithéliums Neurones, Université de Bretagne Occidentale, 6 Rue Colbert, 29200 Brest, France
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Fang Y, Sun N, Song H, Zhang W, Tang Y, Huang L, Yang Y, Chao M, Ma H, Zhang J, Zhang X, Li S, Li N, Chen C, He D, Wu W, Xie H, Guan Y. A multicenter study on surgical procedure selection and risk factor analysis of postoperative complications after TIP and Duckett hypospadias repair. BMC Urol 2022; 22:131. [PMID: 36008856 PMCID: PMC9413801 DOI: 10.1186/s12894-022-01051-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypospadias is a common congenital malformation in pediatric urology with surgery being the only curative treatment. Although there are hundreds of surgical methods for hypospadias, no single method can treat all types, and there are still high rates of postoperative complications. We performed this study to investigate surgical procedure selection and perform risk factor analysis of postoperative complications in hypospadias repair. METHODS Retrospective analysis was performed of complete clinical and follow-up data of children with hypospadias who were treated and followed up at 15 children's clinical centers in Mainland China from December 2018 to December 2019. Children were divided into groups according to Barcat classification and surgical methods in order to analyze the surgical choice for different types of hypospadias and the influencing factors of different surgical methods for complications. RESULTS In total, 1011 patients were followed up for 26 months. According to Barcat classification, there were 248 cases of distal type hypospadias, 214 of intermediate, and 549 of proximal type. Transverse preputial island flap urethroplasty (Duckett) and tubularized incised plate urethroplasty (TIP) were performed in 375 (37.1%) and 336 cases (33.2%), respectively. The postoperative complication rate of distal hypospadias was 23.4% (15.8-57.1%), mid shaft 29.0% (22.7-40.0%), and proximal 43.7% (30.2-52.9%). Among the 375 patients in Duckett group, 192 had complications. Multivariate logistic analysis showed that the length of prepuce island flap (OR = 3.506, 95% CI: 2.258-5.442) was an independent risk factor for complications after Duckett operation (P < 0.001). In TIP group, there were 336 cases with 84 complications. Multivariate logistic analysis showed that the width of urethral plate after longitudinal resection (OR = 0.836, 95% CI: 0.742-0.942) and glans width (OR = 0.851, 95% CI: 0.749-0.965) were independent risk factors for postoperative complications after TIP (P = 0.003, P = 0.012). CONCLUSION Several anatomical features play a role during the selection process among the different surgical approaches, including glans size, urethral plate width, and the meatal position. The width of the urethral plate and glans width were risk factors for postoperative complications after TIP. The length of prepuce island flap was a risk factor for complications after Duckett operation.
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Affiliation(s)
- YiWei Fang
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital of Capital Medical University, Beijing, 100045, China
| | - Ning Sun
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital of Capital Medical University, Beijing, 100045, China.
| | - HongCheng Song
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital of Capital Medical University, Beijing, 100045, China.
| | - WeiPing Zhang
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital of Capital Medical University, Beijing, 100045, China
| | - YunMan Tang
- Department of Pediatric Surgery, Department of Pediatric Surgery, Sichuan Academy of Medical Sciences - Sichuan Provincial People's Hospital (SAMSPH), Chengdu, 610072, China
| | - LuGang Huang
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610044, China
| | - Yi Yang
- Department of Pediatric Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Min Chao
- Department of Pediatric Urology, Anhui Children's Hospital, Hefei, 230022, China
| | - Hong Ma
- Department of Pediatric Urology and General Thoracic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, China
| | - JingTi Zhang
- Department of Urology, Xi'an Children's Hospital, Xi'an, 710002, China
| | - XuHui Zhang
- Department of Urology, Shanxi Children's Hospital, Taiyuan, 030006, China
| | - ShouLin Li
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, 518034, China
| | - Ning Li
- Department of Pediatric Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 230022, China
| | - Chao Chen
- Department of Pediatric Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - DaWei He
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400015, China
| | - WenBo Wu
- Department of Urology, Children's Hospital of Jiangxi Province, Nanchang, 330006, China
| | - Hua Xie
- Department of Urology, Shanghai Children's Hospital, Shanghai, 200062, China
| | - Yong Guan
- Department of Urology, Tianjin Children's Hospital, Tianjin, 300134, China
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Long-term Complications of Hypospadias Repair. CURRENT SEXUAL HEALTH REPORTS 2022. [DOI: 10.1007/s11930-022-00336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Yu J, Sun N, Song H, Li M, Li L, Gong C, Zhang W. Analysis in the influence factors of urethroplasty in DSD. BMC Urol 2022; 22:124. [PMID: 35948888 PMCID: PMC9367162 DOI: 10.1186/s12894-022-01080-x] [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] [Received: 03/07/2022] [Accepted: 07/28/2022] [Indexed: 11/28/2022] Open
Abstract
Background At present, there is no specific research on the factors affecting the success rate of urethroplasty in patients with DSD. The purpose of this study is to explore the factors affecting the success of urethroplasty in DSD patients, and to provide some reference for the surgical treatment of DSD patients undergoing urethroplasty.
Method We reviewed patients with DSD who underwent urethroplasty from January 2016 to December 2019 retrospectively. Patients were divided into four groups: the successful group, the urethrocutaneous fistula group, the urethral diverticulum group, and the urethral stricture group. Risk factors were determined from the following data included the DSD classification, the age of first operation, length of urethral defect, degree of hypospadias, cryptorchidism, micropenis, gonad type, hormone therapy before operation, transposition of penis and scrotum, surgical strategy, urethral covering material, and postoperative catheter removal time. We explored the difference of each factor between four groups through the comparative study of single factor and multifactor logistic regression analysis of related factors. Result 122 cases were enrolled in this group (n = 122), 12 cases were lost to follow-up. Median follow-up was 28 months (12–55 months).We found the success rate of operation decreased with longer urethral defect (B = − 0.473, P = 0.005). The success rate of operation was higher in staged operation and TPIT (TPIT = Transverse Preputial Island Tube operation)-related operation than primary operation (B = 1.238, P = 0.006) and TPIT-nonrelated operation (B = 2.293, P = 0.001). Although there was a significant difference between the age of the first operation and the occurrence of urethrocutaneous fistula (P = 0.006 < 0.05), there was no significant difference in logistic regression analysis (P = 0.161 > 0.05). The incidence of urethrocutaneous fistula was lower in TPIT-related operation than in TPIT-nonrelated operation (B = − 2.507, P = 0.000). The incidence of postoperative urethral diverticulum was lower in staged operation than in primary operation (B = − 1.737, P = 0.015). Conclusion For patients with disorder of sex development undergoing urethroplasty, the length of urethral defect is an independent risk factor affecting both the success rate of operation and the urethrocutaneous fistula. The age of the first operation has a statistically significant effect on the occurrence of postoperative urethrocutaneous fistula, but it is not an independent factor. Urethrocutaneous fistula is less found in TPIT-related operation in the study. Staged operation is an independent protective factor for postoperative urethral diverticulum compared with one-stage operation but isn’t related to urethrocutaneous fistula.
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Affiliation(s)
- Jing Yu
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, 100045, China
| | - Ning Sun
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, 100045, China
| | - Hongcheng Song
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, 100045, China
| | - Minglei Li
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, 100045, China
| | - Lele Li
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, 100045, China
| | - Chunxiu Gong
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, 100045, China.
| | - Weiping Zhang
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, 100045, China.
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Gama M, Abitew B, Abebe K. Clinical Profiles and Surgical Outcome of Hypospadias Repair at a Teaching Hospital in Ethiopia. Ethiop J Health Sci 2022; 32:613-622. [PMID: 35813675 PMCID: PMC9214746 DOI: 10.4314/ejhs.v32i3.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/04/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hypospadias repair is one of the commonest and challenging surgery done in pediatric age groups. This study was conducted to assess clinical profiles and surgical outcomes of hypospadias repair. METHODS A retrospective analysis of pediatric hypospadias repairs at St. Paul's hospital millennium medical college from September 2015 to August 2019 was conducted. RESULTS A total of 277 patients with hypospadias repair were investigated. The mean age was 3.7+/- 3.5 years (Range, 0.5-14 years) and only one-third (98,35.4%%) of patients were operated on in the recommended age group (6-18 months). Anterior/distal hypospadias was the commonest (123,44.4%) variant identified. The majority (176,63.5%) had chordee and 105(37.9%) were severe forms. Tubularized incised plate repair was the major (164,59.2%) surgical technique employed followed by staged urethroplasty (61,22%). Post-operative complications occurred in 135(48.7%) patients and the commonest was urethrocutanous fistula (95,34.3%). No significant correlation was found between the occurrence of these complications and factors such as age at repair, the severity of hypospadias, presence of concomitant urogenital anomaly, type of procedure and duration of urinary diversion. However, the presence of severe chordee (AOR=3.09; 95%CI 1.21-7.54; p=0.013) was an independent factor found to be associated with postoperative complications on multivariate analysis. CONCLUSION Higher rate of complications following hypospadias repair was observed in our study. Our study also demonstrated no significant advantage of any repair technique in reducing operative complications. Extensive preoperative evaluation, proper operative plan and regular follow-up of such patients is paramount for a better outcome.
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Affiliation(s)
- Maru Gama
- Pediatric surgery unit, Department of surgery, St. Paul's hospital millennium medical college, Addis Ababa, Ethiopia
| | - Birhan Abitew
- Pediatric surgery unit, Department of surgery, St. Paul's hospital millennium medical college, Addis Ababa, Ethiopia
| | - Kirubel Abebe
- Department of surgery, St. Paul's hospital millennium medical college, Addis Ababa, Ethiopia
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A meta-analysis comparing dorsal plication and ventral lengthening for chordee correction during primary proximal hypospadias repair. Pediatr Surg Int 2022; 38:389-398. [PMID: 35048166 DOI: 10.1007/s00383-022-05065-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Recurrent chordee (RC) is an important complication of proximal hypospadias repair. In this meta-analysis we compared RC incidence following dorsal plication (DP) versus ventral lengthening (VL). METHODS We searched the databases to identify all papers between 2001 and 2021 pertaining to proximal hypospadias and recurrent chordee. Duplicate publications, review articles and incomplete articles were excluded. Meta-analysis of heterogeneity was reported with I2 statistics. The pooled outcomes were compared to Chi square/Fishers exact test. RESULTS A total of 17 articles were included covering 582 patients. The I2 statistics for prevalence of RC among different publications showed no heterogeneity for DP (I2 = 0%) and low heterogeneity for VL (I2 = 26%). RC was noticed in 31/122 (25.4%; 95% CI 18%-33%) among patients who had DP alone while it was significantly lower, 24/460 (5.3%; 95% CI 4%-8%) when VL was used (p = 0.0001). When compared to DP, all VL techniques had significantly lower incidence of RC. Among the VL techniques lowest incidence of RC was found for ventral corporotomies (4%) followed by small-intestinal- submucosa (SIS 4.2%) and tunica vaginalis flap (TVF)/free graft-TVFG (5%). Among the VL subtypes: the proportion of RC with use of TVF (4/70, 5.7%) and TVFG (3/69, 4.3%) for corporoplasty was comparable (p = 1); single-layer SIS was associated with significantly less RC (1/90, 1.1%) than 4-layer SIS (5/51, 9.8%; p = 0.02). CONCLUSION For correction of severe ventral chordee during primary proximal hypospadias repair, dorsal plication carries a higher risk of recurrence compared to ventral lengthening procedures.
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Sandberg DE, Gardner M. Differences/Disorders of Sex Development: Medical Conditions at the Intersection of Sex and Gender. Annu Rev Clin Psychol 2022; 18:201-231. [PMID: 35216524 PMCID: PMC10170864 DOI: 10.1146/annurev-clinpsy-081219-101412] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Defined as congenital conditions in which development of chromosomal, gonadal, or anatomic sex is atypical, differences or disorders of sex development (DSDs) comprise many discrete diagnoses ranging from those associated with few phenotypic differences between affected and unaffected individuals to those where questions arise regarding gender of rearing, gonadal tumor risk, genital surgery, and fertility. Controversies exist in numerous areas including how DSDs are conceptualized, how to refer to the set of conditions and those affected by them, and aspects of clinical management that extend from social media to legislative bodies, courts of law, medicine, clinical practice, and scholarly research in psychology and sociology. In addition to these aspects, this review covers biological and social influences on psychosocial development and adjustment, the psychosocial and psychosexual adaptation of people born with DSDs, and roles for clinical psychologists in the clinical management of DSDs. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- David E Sandberg
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, Michigan, USA;
| | - Melissa Gardner
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, Michigan, USA;
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Sennert M, Wirmer J, Hadidi AT. Preoperative glans & penile dimensions in different hypospadias grades. J Pediatr Urol 2022; 18:47-53. [PMID: 34674950 DOI: 10.1016/j.jpurol.2021.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 09/12/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To report glans and penile dimensions in 1023 consecutive boys with hypospadias. PATIENTS & METHODS Boys admitted for hypospadias surgery between 2016 and 2018 were included in this study. Age ranged between 6 and 36 months. Boys who underwent previous surgery, received hormone therapy or older than 36 months were excluded. The hypospadias was classified according to ICD and WHO classification into glanular (Grade I), distal (Grade II), proximal (Grade III) and perineal (Grade IV). The flaccid penile length (PL), the dorsal glans length (DGL), the ventral glans length (VGL) and the glans width (GW) were measured in the operating room under anaesthesia just before operative correction. Small (GW) in this study was defined as less than 14 mm. RESULTS 1023 boys were included. 273 had glandular, 468 distal, 194 proximal and 88 perineal hypospadias. The mean glans width was 14 mm with a range of 8 to 20 mm. The mean glans width for glanular hypospadias was 14.0 mm (range 9-19 mm), 14.0 mm (range 10-20 mm) for distal hypospadias (p > 0.05), 13.1 mm (range 9-19 mm) for proximal hypospadias (p < 0.0001) and 11.1 mm (range 8-16 mm) for perineal hypospadias (p < 0.0001). 460 (45.0%) of all patients presented with a small glans width. In glanular hypospadias it was 99 (36.3%), 167 (35.7%) in distal hypospadias, 111 (57.5%) in proximal hypospadias and 83 (94.3%) in perineal hypospadias. There was no significant difference in the glans size between the age of 6 and 24 months (p > 0.2), but there was a difference when compared to patients older than 25 months (p < 0.05). CONCLUSIONS A small glans is found in about a third of distal, two thirds in proximal and more than 90% of perineal hypospadias.
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Affiliation(s)
- Michael Sennert
- Hypospadias Centre, Department of Pediatric Surgery, Emma Klinik Seligenstadt and Sana Klinikum Offenbach, Germany
| | - Johannes Wirmer
- Hypospadias Centre, Department of Pediatric Surgery, Emma Klinik Seligenstadt and Sana Klinikum Offenbach, Germany
| | - Ahmed T Hadidi
- Hypospadias Centre, Department of Pediatric Surgery, Emma Klinik Seligenstadt and Sana Klinikum Offenbach, Germany.
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Castagnetti M, El-Ghoneimi A. Surgical management of primary severe hypospadias in children: an update focusing on penile curvature. Nat Rev Urol 2022; 19:147-160. [PMID: 35039660 DOI: 10.1038/s41585-021-00555-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 11/09/2022]
Abstract
Over the past two decades, assessment and treatment of associated curvature has emerged as a major issue in treating patients with proximal hypospadias. However, the cut-off for defining a curvature as clinically significant is still unclear, as not all patients are bothered by the same degree of curvature and, although the need for a method to assess the curvature objectively has been emphasized, no standard method yet exists. Curvature is multifactorial. The same degree of curvature can be due to any possible combination of skin and/or subcutaneous dartos tethering, a short urethral plate and an intrinsic corpora disproportion. Different strategies can be used to treat curvature, depending on the underlying cause, surgeon preferences, and the goals of the repair. In the past 10 years, use of urethral plate transection and ventral lengthening procedures has increased, although the lack of long-term follow-up data on ventral lengthening procedures suggests that the use of such procedures should be selective. Furthermore, straightening manoeuvres are influenced by the technique used for subsequent urethroplasty and, in turn, may influence the success rate of the urethroplasty. This Review provides a comprehensive overview of the major developments from the past 10 years in the management of severe proximal hypospadias in children.
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Affiliation(s)
- Marco Castagnetti
- Paediatric Urology Unit, Department of Surgery, Bambino Gesù Children Hospital and Research Institute, Rome, Italy. .,Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padua, Italy.
| | - Alaa El-Ghoneimi
- Department of Paediatric Surgery and Urology, Reference Centre for Rare Urinary Tract Malformations (MARVU), Hôpital Robert Debré, APHP, Université de Paris, Paris, France
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Roshandel MR, Aghaei Badr T, Kazemi Rashed F, Salomon S, Ghahestani SM, Ferrer FA. Hypospadias in toddlers: a multivariable study of prognostic factors in distal to mid-shaft hypospadias and review of literature. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000225. [DOI: 10.1136/wjps-2020-000225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 11/15/2021] [Indexed: 11/04/2022] Open
Abstract
BackgroundTubularized incised plate urethroplasty is the most common hypospadias repair technique. However, there are unanswered questions and debates about the anatomical prognostic factors affecting the repair outcomes. This study tried to address some of the problems in the studies compromising the results of the current body of literature.MethodsA prospective cohort of 101 males aged 1–3 years undergoing primary distal to mid-shaft hypospadias repair were enrolled in the study. Complications including edema, erection, inadvertent removal of the urethral stent, surgical wound infection, bladder spasm, hematoma, and hemorrhage were evaluated. Studies in the current literature were reviewed to achieve a better perspective for future investigations.ResultsPersistent complications were found in 16 cases (15.8%) including fistula formation, the persistence of chordee, meatal stenosis, glans, and urethral dehiscence. The mean follow-up time was 6.6±3.4 months. In the single-variable analysis, the meatal location, the length and width of the urethral plate, and the reversible acute postoperative events were significantly associated with the complications. Furthermore, fistula formation was associated with acute surgical site infection (p<0.001). However, the multivariable regression study revealed the presurgical meatal location to be the only statistically significant factor (p=0.03). Notably, the glans diameter or glanular groove shape, urethral plate dimensions, or presence of mild chordee were not independently associated with the outcomes (p>0.05).ConclusionsOur study on the toddlers with hypospadias surgery revealed that the location of urethral meatal was the main predicting factor in the development of major complications. Furthermore, the fistula formation at the infected surgical site emphasizes the importance of postsurgical care.
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Wu Y, Wang J, Wei Y, Chen J, Kang L, Long C, Wu S, Shen L, Wei G. Contribution of prenatal endocrine-disrupting chemical exposure to genital anomalies in males: The pooled results from current evidence. CHEMOSPHERE 2022; 286:131844. [PMID: 34392196 DOI: 10.1016/j.chemosphere.2021.131844] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/13/2021] [Accepted: 08/06/2021] [Indexed: 06/13/2023]
Abstract
The etiology of hypospadias and cryptorchidism, which are the two most common genital anomalies in males, has not been elucidated. Although prenatal exposure to endocrine-disrupting chemicals (EDCs) may increase the risks of hypospadias and cryptorchidism, the associations have not been confirmed. Therefore, we performed a meta-analysis to establish the relationships between prenatal exposure to EDCs and male genital anomalies. A systematic search of PubMed, EMbase, and Cochrane Library CENTRAL for relevant published studies providing quantitative data on the associations between prenatal EDCs exposure and hypospadias/cryptorchidism in humans was conducted. In total, sixteen case-controlled studies were included. Prenatal exposure to overall EDCs was associated with an increased risk of hypospadias in males (OR, 1.34, 95 % CI 1.12 to 1.60). Although there was no statistically significant association between overall EDCs exposure and cryptorchidism (OR, 1.11, 95 % CI 0.99 to 1.24), exposure to phenol substances was associated with an increased risk of cryptorchidism (OR, 1.81, 95 % CI, 1.12 to 2.93). Using the GRADE tool, we found the overall evidence to be of moderate certainty. In conclusion, the current evidence suggests prenatal EDCs exposure may increase the risk of hypospadias in males.
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Affiliation(s)
- Yuhao Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Junke Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yuexin Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jiadong Chen
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lian Kang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Chunlan Long
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Shengde Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lianju Shen
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
| | - Guanghui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
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Bar-Yosef Y, Ben-Chaim J, Ekstein M, Ben-David R, Savin Z, Yossepowitch O, Mano R, Dekalo S. Concomitant repair of meatal stenosis and urethral fistula does not increase the risk of fistula recurrence post-hypospadias surgery. Urology 2021; 160:187-190. [PMID: 34896481 DOI: 10.1016/j.urology.2021.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/23/2021] [Accepted: 11/29/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate whether meatal stenosis treated concomitantly with urethral fistula repair alters the results of fistula closure. METHODS A retrospective cohort study, included were all children who underwent local fistula closure following hypospadias repair between 2006-2017. Patients who underwent reoperative urethroplasty were excluded. Data were extracted from electronic records, and missing data were supplied by telephone interviews. Characteristics of patients and fistulas were compared between children who underwent fistula closure only and those who underwent meatoplasty for meatal stenosis during the same surgery. The primary endpoint was fistula recurrence. RESULTS In total, 106 local repairs of urethrocutaneous fistulas were performed during the study period, and 25 of them included concomitant meatoplasty for meatal stenosis. There was no difference in terms of location, size, and number of fistulas or the number of recurrent fistulas between the 81 patients who underwent fistula closure only and the 25 who underwent concomitant meatoplasty. The fistula recurrence rate was 17/81 (21%) for the fistula only group and 5/25 (20%) for the fistula and meatoplasty group after a median follow-up of 7 and 8 years, respectively. Meatoplasty was required in a subsequent procedure in 5/81 in the former group vs. 3/25 patients in the latter group. CONCLUSIONS The presence and repair of meatal stenosis does not alter the recurrence rate of urethrocutaneous fistulas repaired concomitantly following hypospadias repair.
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Affiliation(s)
- Yuval Bar-Yosef
- Pediatric Urology Department, Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Jacob Ben-Chaim
- Pediatric Urology Department, Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Margaret Ekstein
- Pediatric Urology Department, Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Reuben Ben-David
- Pediatric Urology Department, Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ziv Savin
- Pediatric Urology Department, Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ofer Yossepowitch
- Pediatric Urology Department, Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roy Mano
- Pediatric Urology Department, Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Snir Dekalo
- Pediatric Urology Department, Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Babu R, Chandrasekharam VVS. Meta-analysis comparing the outcomes of single stage (foreskin pedicled tube) versus two stage (foreskin free graft & foreskin pedicled flap) repair for proximal hypospadias in the last decade. J Pediatr Urol 2021; 17:681-689. [PMID: 34099397 DOI: 10.1016/j.jpurol.2021.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/08/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite many technical advances the debate continues on single versus staged procedures for proximal hypospadias. In this systematic review and meta-analysis we have compared the contemporary outcomes of proximal hypospadias repair: single stage foreskin pedicle tube (FPT) versus two stage foreskin free graft (FFG) and two-stage foreskin pedicled flap (FPF) over the last decade. METHODS A systematic literature review of publications in English of the following electronic databases was conducted: Cochrane Database, PUBMED, MEDLINE and EMBASE. The following keywords were used: (proximal) AND (hypospadias) AND (repair OR urethroplasty) AND (outcomes OR complications). The publication date range for studies was from January 2010 to December 2020. Outcomes analyzed were complications like urethro-cutaneous fistula (UCF), glans dehiscence (GD), meatal stenosis (MS), urethral stricture (US), urethral diverticulum (UD), recurrent curvature or residual chordee (RC), buried penis (BP) and poor cosmesis (PC) as per objective assessment scores, or poor graft uptake (PGF) during first stage. We also divided the papers based on case load into two groups: < 5 cases or >5 cases operated per year and compared the post-operative outcomes. RESULTS The I 2 statistics for prevalence of total complications showed high heterogeneity with I 2 of 88% for one stage repair and 92% & 98% for two stage repairs. The pooled data from 26 articles covered a total of 2664 patients; mean follow-up of 4.5 years (1.8-14 years). One stage repair (FPT) was used in 680 (25%) patients while two stage repair was used in 1984 (75%) patients. Complications were encountered in 285/680 (42%) of those who underwent single stage repair (FPT) and this was significantly higher (Fishers; p = 0.001) than 414/1984 (21%) complication rate seen in two stage repair. Among the two different techniques of two stage operations over-all complication rate was not significantly different (Fisher's; p = 0.1) between FFG (155/674; 23%) and FPF (259/1310; 20%). FFG was superior to FPF in terms of individual complications UCF, MS, GD and UD. For two-stage FPT and FPF repairs the complication rate significantly reduced (p = 0.01) with increasing case load. For single stage repairs the complication rate remained high despite the increasing case load. CONCLUSIONS Two-stage repair of proximal hypospadias had significantly less complications compared to single stage repair. Among two-stage repairs specific complications were significantly less for FFG, although total complications were not significantly different from that seen with FPF. The results of two-stage repairs improved with higher case load supporting the concept of dedicated hypospadias centres.
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Affiliation(s)
- Ramesh Babu
- Pediatric Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
| | - V V S Chandrasekharam
- Pediatric Surgery, Pediatric Urology and MAS, Ankura Hospitals for Women and Children, Hyderabad, Telangana, India
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Shirazi M, Haghpanah A, Dehghani A, Haghpanah S, Ghahartars M, Rahmanian M. Comparison of post-urethroplasty complication rates in pediatric cases with hypospadias using Vicryl or polydioxanone sutures. Asian J Urol 2021; 9:165-169. [PMID: 35509477 PMCID: PMC9051349 DOI: 10.1016/j.ajur.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 02/22/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Hypospadias is a common congenital problem among male newborns. Both rapid absorbable sutures (polyglactin, Vicryl) and delayed absorbable sutures (polydioxanone, PDO) are used in hypospadias repair based on the surgeon's preference. This study was conducted to compare post-urethroplasty complication rates in pediatric patients with hypospadias using Vicryl or PDO sutures. Methods This is a retrospective study which was designed and performed on 583 children aged 1–7 years old who had undergone hypospadias repair from January 2012 to December 2018. Required data were obtained from the patients' medical records. Results Overall, post-surgical complications were observed in 60 (10.3%) patients comprising urethro-cutaneous fistula (n=39, 6.7%), meatal stenosis (n=10, 1.7%), urethral stricture (n=7, 1.2%), and glans dehiscence (n=4, 0.7%). The mean age of the children with complications was 3.0±1.3 years. According to Kaplan-Meier estimate, the interval between surgery and development of complications was significantly shorter in the Vicryl group (p=0.037). Overall, complications were more prevalent in Vicryl suture than PDO suture (15.1% vs. 5.3%, p<0.001). Regression model revealed that in comparison to the distal type, proximal hypospadias (odds ratio [OR]:103.9, 95% confidence interval [CI]: 32.2–334.9, p<0.001) and mid-shaft hypospadias (OR: 82.9, 95% CI: 25.9–264.6, p<0.001) while using Vicryl suture instead of PDO suture (OR: 62.4, 95% CI: 21.2–183.8, p<0.001) increased the odds of developing post-urethroplasty complications. Conclusion We suggest PDO suture in the repair of hypospadias due to its lower complication rate, especially in cases of proximal and mid-shaft hypospadias which can get more complicated than the distal type.
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Affiliation(s)
- Mehdi Shirazi
- Shiraz Nephro-urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolreza Haghpanah
- Shiraz Nephro-urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Corresponding author.
| | - Anahita Dehghani
- Shiraz Nephro-urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sezaneh Haghpanah
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Ghahartars
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Rahmanian
- Medical School, MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran
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Baskin LS, Hinman F. EDITORIAL COMMENT. Urology 2021; 152:134. [PMID: 34112336 DOI: 10.1016/j.urology.2020.11.061] [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]
Affiliation(s)
- Laurence S Baskin
- Chief Pediatric Urology UCSF Benioff Children's Hospitals, University of California, San Francisco, CA
| | - Frank Hinman
- Chief Pediatric Urology UCSF Benioff Children's Hospitals, University of California, San Francisco, CA
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Long CJ, Van Batavia J, Wisniewski AB, Aston CE, Baskin L, Cheng EY, Lakshmanan Y, Meyer T, Kropp B, Palmer B, Nokoff NJ, Paradis A, VanderBrink B, Scott Reyes KJ, Yerkes E, Poppas DP, Mullins LL, Kolon TF. Post-operative complications following masculinizing genitoplasty in moderate to severe genital atypia: results from a multicenter, observational prospective cohort study. J Pediatr Urol 2021; 17:379-386. [PMID: 33726972 PMCID: PMC8713352 DOI: 10.1016/j.jpurol.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Differences of sex development (DSD) are congenital conditions in which there is atypical chromosomal, gonadal and/or phenotypic sex. A phenotype of severe genital atypia in patients raised as male is a relatively rare occurrence and standards for management are lacking. Decision making for early surgical planning in these rare cases includes, but is not limited to, degree of atypia, location of testes, and presence of Mϋllerian remnants. In this study we describe surgical approaches and short-term outcomes for masculinizing genitoplasty in moderate to severe genital atypia in young patients raised male, for whom parents opted for early surgery. METHODS This NIH-sponsored study is an ongoing, observational, multicenter investigation assessing medical, surgical and psychological outcomes in children and their parents affected by atypical genitalia due to DSD. Participants were prospectively enrolled from 12 children's hospitals across the United States that specialize in DSD care. Criteria for child enrollment were a Quigley score of 3-6 in those with a 46, XY or 45,X/46, XY chromosome complement, age <3 years with no previous genitoplasty; patients were included independent of whether genitoplasty was performed. Cosmesis was graded according to a 4-point Likert scale and complications per the Clavian-Dindo classification. RESULTS Of the 31 participants, 30 underwent hypospadias repair and 1 patient did not undergo a genitoplasty procedure. The majority of participants (22) received a staged hypospadias repair. Seventeen complications were identified in 12 of the 31 children (41%) at 12 months of follow up. Glans dehiscence and urethrocutaneous fistula were the most common complications. Orchiopexy was performed in 14 (44%) and streak gonads were removed in 4 (13%) participants. Both parents and surgeons reported improved cosmesis after surgery when compared to baseline. CONCLUSION Genitoplasty was chosen by parents for the majority of children eligible for study. No single surgical approach for masculinizing moderate to severe genital ambiguity in young patients with 46, XY or 45,X/46, XY DSD was adopted by all surgeons. Complications occurred in 41% of those who underwent genitoplasty for severe hypospadias. Overall, appearance of the genitals, as determined by parents and surgeons, improved following genitoplasty. Outcomes of early genitoplasty are needed to guide families when making decisions about such procedures for their young children.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dix P Poppas
- New York Presbyterian Hospital/Weill Cornell Medicine, USA.
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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.
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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.
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Morgante D, Radford A, Abbas SK, Ingham E, Subramaniam R, Southgate J. Augmentation of the insufficient tissue bed for surgical repair of hypospadias using acellular matrix grafts: A proof of concept study. J Tissue Eng 2021; 12:2041731421998840. [PMID: 33959244 PMCID: PMC8060745 DOI: 10.1177/2041731421998840] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/10/2021] [Indexed: 12/28/2022] Open
Abstract
Acellular matrices produced by tissue decellularisation are reported to have
tissue integrative properties. We examined the potential for incorporating
acellular matrix grafts during procedures where there is an inadequate natural
tissue bed to support an enduring surgical repair. Hypospadias is a common
congenital defect requiring surgery, but associated with long-term complications
due to deficiencies in the quality and quantity of the host tissue bed at the
repair site. Biomaterials were implanted as single on-lay grafts in a
peri-urethral position in male pigs. Two acellular tissue matrices were
compared: full-thickness porcine acellular bladder matrix (PABM) and
commercially-sourced cross-linked acellular matrix from porcine dermis
(Permacol™). Anatomical and immunohistological outcomes were assessed 3 months
post-surgery. There were no complications and surgical sites underwent full
cosmetic repair. PABM grafts were fully incorporated, whilst Permacol™ grafts
remained palpable. Immunohistochemical analysis indicated a non-inflammatory,
remodelling-type response to both biomaterials. PABM implants showed extensive
stromal cell infiltration and neovascularisation, with a significantly higher
density of cells (p < 0.001) than Permacol™, which showed
poor cellularisation and partial encapsulation. This study supports the
anti-inflammatory and tissue-integrative nature of non-crosslinked acellular
matrices and provides proof-of-principle for incorporating acellular matrices
during surgical procedures, such as in primary complex hypospadias repair.
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Affiliation(s)
- Debora Morgante
- Jack Birch Unit for Molecular Carcinogenesis, Department of Biology and York Biomedical Research Institute, University of York, Heslington, York, UK.,Hull York Medical School, Heslington, York, UK.,Paediatric Urology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Anna Radford
- Jack Birch Unit for Molecular Carcinogenesis, Department of Biology and York Biomedical Research Institute, University of York, Heslington, York, UK.,Hull York Medical School, Heslington, York, UK.,Paediatric Urology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Syed K Abbas
- Central Biomedical Services, University of Leeds, Leeds, UK
| | - Eileen Ingham
- School of Biomedical Sciences, Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Ramnath Subramaniam
- Paediatric Urology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Jennifer Southgate
- Jack Birch Unit for Molecular Carcinogenesis, Department of Biology and York Biomedical Research Institute, University of York, Heslington, York, UK
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Snodgrass W, Bush N. Recurrent ventral curvature after proximal TIP hypospadias repair. J Pediatr Urol 2021; 17:222.e1-222.e5. [PMID: 33339735 DOI: 10.1016/j.jpurol.2020.11.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/19/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
EXTENDED SUMMARY Most boys with proximal hypospadias have ventral curvature (VC) which must be straightened while preserving the urethral plate to use TIP repair. That is usually done by dorsal plication (DP). However, we reported recurrent VC was commonly found after DP in boys with proximal urethroplasty complications, and have diagnosed VC in patients similarly straightened by WS. We reviewed our proximal TIP patients and now report their recurrent VC. METHODS We used a prospectively-maintained database to identify all patients with proximal TIP by WS and document recurrent VC. Penile straightening was primarily done by midline DP using 5-0 or 6-0 polypropylene, and/or other maneuvers including combinations of urethral plate elevation off the corpora, mobilization of the urethra to the external sphincter, and ventral corporotomies. Recurrent VC was suspected by a characteristic 'hunched-over' appearance and resistance to lifting the glans cephalad (Figure), and confirmed in all cases by artificial erection intraoperatively. RESULTS 58 of the 77 patients with follow up had VC straightened. Recurrent VC was diagnosed in 26%. It was suspected during this review in another 10% who had recurrent urethroplasty complications which we now know often indicate VC, or urethral plate elevation with no treatment for corporal disproportion. This recurrent VC was objectively measured in nearly half those diagnosed, averaging 52 (30-75). It was diagnosed before puberty in all cases. There was no difference in recurrent VC in those managed with DP alone versus those straightened by DP and/or other maneuvers. DISCUSSION The finding that 1 of every 4 patients had recurrent VC after proximal TIP, and that as many as 1 of every 3 might have had that complication, is concerning. During most the study the extent of VC was visually estimated, and most patients were thought to have <45° with no tension on the UP after straightening. We reported 70% of patients operated elsewhere for proximal hypospadias and presenting with urethroplasty complications had recurrent VC ≥ 30° following earlier DP. In that series, in the current patients, and in an earlier report by Braga et al., an intact urethral plate correlated with increased risk for recurrent VC. Despite our improved ability to diagnose recurrent VC, we have not found it in boys who underwent STAG repair with urethral plate transection. CONCLUSIONS Recurrent VC after proximal TIP repair occurred in at least 1 of every 4 patients despite DP and/or additional maneuvers to straighten the penis while preserving the urethral plate. Accordingly, we now only perform proximal TIP when there is little (<30°) or no VC.
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Affiliation(s)
- Warren Snodgrass
- Hypospadias Specialty Center, 3716, Standridge Drive, Suite 200, Colony, TX, 75056, USA.
| | - Nicol Bush
- Hypospadias Specialty Center, 3716, Standridge Drive, Suite 200, Colony, TX, 75056, USA.
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Chan YY, D'Oro A, Yerkes EB, Rosoklija I, Balmert LC, Lindgren BW, Gong EM, Liu DB, Johnson EK, Chu DI, Cheng EY. Challenging proximal hypospadias repairs: An evolution of technique for two stage repairs. J Pediatr Urol 2021; 17:225.e1-225.e8. [PMID: 33388263 DOI: 10.1016/j.jpurol.2020.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Proximal hypospadias repair remains challenging. Our approach to the first stage of two-stage proximal hypospadias repairs has evolved from using Byars' flaps to preputial inlay grafts in anatomically suitable cases and pedicled preputial flaps in more complex repairs. We reviewed our outcomes, hypothesizing that inlay grafts and pedicled preputial flaps were associated with lower complication risks than Byars' flaps. STUDY DESIGN A single institution, retrospective, cohort study of consecutive two-stage, primary, proximal hypospadias repairs performed from 2007 to 2017 was conducted. Patients with <6 months follow-up and incomplete operative reports were excluded. Risk of complications (fistula, dehiscence, diverticulum, meatal stenosis, stricture) were evaluated following urethroplasty and stratified by first-stage repair technique. As technique refinements have been made since 2012, comparisons between two temporal subgroups (those who underwent repair in 2007-2012 and in 2013-2017) were made. RESULTS 78 of 127 patients met inclusion criteria. Overall complication rate was 47% (Summary Table). Median follow-up was 25.4 months (range 6.4-128.5 months) after urethroplasty. Pedicled preputial flaps (hazards ratio [HR] 0.30; 95% Confidence Interval [CI] 0.14-0.65) and inlay grafts (HR 0.32; 95% CI 0.11-0.95) were associated with lower complication risks compared to Byars' flaps (Summary Table). Median time to complication was significantly shorter for Byars' flaps (5.7 months) than for inlay grafts (40.6 months) and pedicled preputial flaps (79.2 months) by Kaplan Meier analysis. Temporal subgroup comparisons showed that overall complication rates decreased from 70% to 31% (p = 0.001), but differences in complication rates by first-stage technique were not statistically significant. DISCUSSION In our cohort, repairs with Byars' flaps had the highest complication rate, which is consistent with our observations that urethras tubularized from Byars' flaps lack appropriate backing and are hypermobile and irregular. To overcome these shortcomings, modifications were made to our approach to two-stage proximal hypospadias repairs with the use of inlay grafts and pedicled preputial flaps quilted to the underlying corporal bodies to optimize the stability of the urethral plate. Our preliminary results are promising. CONCLUSION Approach to the first stage of two-stage repairs affects outcomes. Pedicled preputial flaps and inlay grafts were associated with lower complication risks than Byars' flaps. Refinement of technique and patient selection may have resulted in fewer complications in the short term. However, long-term follow-up is needed.
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Affiliation(s)
- Yvonne Y Chan
- Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anthony D'Oro
- Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Elizabeth B Yerkes
- Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ilina Rosoklija
- Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Lauren C Balmert
- Department of Preventative Medicine/Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bruce W Lindgren
- Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Edward M Gong
- Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dennis B Liu
- Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emilie K Johnson
- Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David I Chu
- Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Earl Y Cheng
- Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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D'Oro A, Chan YY, Rosoklija I, Meyer T, Shannon R, Johnson EK, Liu DB, Gong EM, Maizels M, Matoka DJ, Yerkes EB, Lindgren BW, Cheng EY, Chu DI. Association between intra-operative meatal mismatch and urethrocutaneous fistula development in hypospadias repair. J Pediatr Urol 2021; 17:223.e1-223.e8. [PMID: 33339733 PMCID: PMC8068581 DOI: 10.1016/j.jpurol.2020.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The Glans-Meatus-Shaft (GMS) Score is a pre-operative phenotypic scoring system used to assess hypospadias severity and risk for post-operative complications. The 'M' component is based on pre-operative meatal location, but meatal location sometimes changes after penile degloving, resulting in 'meatal mismatch.' OBJECTIVE To identify: 1) the incidence and clinical predictors of meatal mismatch, and 2) the association of meatal mismatch with post-operative urethrocutaneous fistula development. STUDY DESIGN We performed a retrospective cohort study on patients who underwent primary hypospadias repair at a single center from 2011 to 2018. Meatal mismatch was defined as: upstaging (meatus moving more proximally after degloving), downstaging (moving more distally after degloving), or none. Covariates included: pre-degloving meatal location, chordee severity, penoscrotal anatomy, pre-operative testosterone, and number of stages for repair. To test the association between meatal mismatch and fistula development, we constructed two, nested, multivariable Cox proportional hazards regression models with and without meatal mismatch and compared them with the likelihood ratio test. A sensitivity analysis excluded patients with <6 months of follow-up. RESULTS Of 485 patients, 99 (20%) exhibited meatal mismatch, including 75 (15%) with upstaging and 24 (5%) patients with downstaging (Figure). Meatal mismatch was significantly associated with penoscrotal webbing, number of stages for repair, and pre-degloving meatal location, with downstaging being associated with more proximal meatal location. Over a median follow-up of 7.3 months (interquartile range 2.0-20.9), fistulae developed in 56 (12%) patients. On multivariable analysis, meatal upstaging was associated with a 3-fold increased risk of fistula development (Hazards Ratio [HR]: 3.04, 95% Confidence Interval [CI]: 1.44-6.45) compared to no mismatch. Meatal downstaging had similar risk of fistula development compared to no mismatch (HR: 0.99, 95% CI: 0.29-3.35). Multi-stage compared to single-stage repair was associated with reduced risk of fistula development (HR: 0.24, 95% CI: 0.09-0.66). The likelihood ratio test favored the model that included meatal mismatch. The sensitivity analysis showed similar findings. DISCUSSION Our short-term results suggest that meatal mismatch may be an important additional consideration to the GMS score as a tool to assess hypospadias severity, counsel families, and predict outcomes. Longer-term studies are needed to enhance the precision of risk stratification in hypospadias. CONCLUSIONS Meatal mismatch occurred in 20% of patients undergoing hypospadias repair. Among this cohort, meatal upstaging was associated with a 3-fold increased risk of post-operative urethrocutaneous fistula development.
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Affiliation(s)
- Anthony D'Oro
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA.
| | - Yvonne Y Chan
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA.
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Feinberg School of Medicine at Northwestern University, 633 N. St. Clair Street, Chicago, IL 60611, USA.
| | - Theresa Meyer
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA.
| | - Rachel Shannon
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA.
| | - Emilie K Johnson
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Feinberg School of Medicine at Northwestern University, 633 N. St. Clair Street, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Dennis B Liu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Edward M Gong
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Max Maizels
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Derek J Matoka
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Elizabeth B Yerkes
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Bruce W Lindgren
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Earl Y Cheng
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - David I Chu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Feinberg School of Medicine at Northwestern University, 633 N. St. Clair Street, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
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Chan YY, Bury MI, Fuller NJ, Nolan BG, Gerbie EY, Hofer MD, Sharma AK. Effects of Anti-Inflammatory Nanofibers on Urethral Healing. Macromol Biosci 2021; 21:e2000410. [PMID: 33690953 DOI: 10.1002/mabi.202000410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/06/2021] [Indexed: 11/08/2022]
Abstract
Protracted postsurgical inflammation leading to postoperative complications remains a persistent problem in urethral reconstruction. Nanofibers in the form of peptide amphiphiles expressing anti-inflammatory peptides (AIF-PA) have positively modulated local inflammatory responses. Urethroplasty is performed to repair 5 mm ventral urethral defects with: uncoated small intestinal submucosa (SIS); SIS dip-coated with AIF-PA1 (anti-inflammatory treatment), or SIS dip-coated with AIF-PA6 (control) on 12-week-old male Sprague Dawley rats (n = 6/group/timepoint). Animals are euthanized at 14 and 28 d postsurgery. Hematoxylin-eosin, Masson's Trichrome, and immunohistochemistry with primary antibodies against myeloperoxidase (MPO; neutrophils), CD68, CD86, CD206 (macrophages), and proinflammatory cytokines TNFα and IL-1β are performed. Complete urethral healing occurs in 3/6 uncoated SIS (50%), 2/6 SIS+AIF-PA6 (33.3%), and 5/6 SIS+AIF-PA1 (83.3%) animals at 14 d and all at 28 d. Application of AIF-PA1 to SIS substitution urethroplasty decreases MPO+ neutrophils, CD86+ M1 proinflammatory macrophages, TNFα, and IL-1β levels while concurrently increasing levels of CD206+ M2 proregenerative/anti-inflammatory macrophages at the anastomoses and the regenerated tissue at the wound bed (REGEN). AIF-PA1 treatment enhances the healing process, contributing to earlier, complete urethral healing, and increased angiogenesis. Further studies are needed to elucidate the specific mechanism of inflammatory response modulation on angiogenesis and overall urethral healing.
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Affiliation(s)
- Yvonne Y Chan
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave. Box 24, Chicago, IL, 60611, USA
| | - Matthew I Bury
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave. Box 24, Chicago, IL, 60611, USA
| | - Natalie J Fuller
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave. Box 24, Chicago, IL, 60611, USA
| | - Bonnie G Nolan
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave. Box 24, Chicago, IL, 60611, USA
| | - Emily Yura Gerbie
- Department of Urology, Northwestern University Feinberg School of Medicine, 676 N S. Clair Suite 2300, Chicago, IL, 60611, USA
| | - Matthias D Hofer
- Department of Urology, Northwestern University Feinberg School of Medicine, 676 N S. Clair Suite 2300, Chicago, IL, 60611, USA
| | - Arun K Sharma
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave. Box 24, Chicago, IL, 60611, USA.,Department of Urology, Northwestern University Feinberg School of Medicine, 676 N S. Clair Suite 2300, Chicago, IL, 60611, USA.,Simpson Querrey Institute, Northwestern University, 303 East Superior Street, Chicago, IL, 60612, USA.,Department of Biomedical Engineering, Northwestern University McCormick School of Engineering, 2145 Sheridan Road E310, Evanston, IL, 60208, USA.,Stanley Manne Children's Research Institute, Lurie Children's Hospital, 303 East Superior Street, Chicago, IL, 60612, USA.,Center for Advanced Regenerative Engineering, Northwestern University, 2145 Sheridan Road B371, Evanston, IL, 60208, USA
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Ding Y, Gu S, Xia X, Yu Z. Comparison of Penile Appearance and Outcomes Between Prefabricated Urethra and Pre-implanted Urethral Plate for Treatment of Children With Severe Hypospadias: A Retrospective Study. Front Pediatr 2021; 9:719551. [PMID: 34595144 PMCID: PMC8476890 DOI: 10.3389/fped.2021.719551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To compare the effect of prefabricated urethra and pre-implanted urethral plate in the treatment of severe hypospadias in children. Methods: We retrospectively analyzed the clinical data of 53 patients who diagnosed as severe hypospadias underwent staging urethroplasty from January 2015 to January 2018 in the Department of Pediatric Surgery, First People's Hospital, Zunyi City. The patients were divided into two groups: group A (n = 25) were treated with prefabricated urethra and group B (n = 28) were treated with pre-implanted urethral plate. After the second stage surgery, the ratios of complications such as urethral fistula, urethral stenosis, urethrocele, and recurrence chordee were compared. The penis was scored from meatus, glans, shaft skin, general appearance by the parents, blinded urologists according to The Pediatric Penile Perception Score, and the scores were compared too. Results: All patients were followed up after two stage operations for an average of 28 months. Glans dehiscence occurred in two patients (8%), urethral orifice stenosis occurred in one (4%) and urethral fistula occurred in three (12%) in group A. No urethral stenosis, urethrocele and recurrence chordee was observed. One patient presented urethral plate inactivation (3.6%), two patients presented urethral fistula (7.1%) and one patient presented urethral stenosis (3.6%) in group B. No urethrocele, glans dehiscence and recurrence chordee was observed. The total complication rate in group A was 24 and 14.3% in group B, respectively, and the difference was not statistically significant (P = 0.582). The differences between two groups scored by parents in glans (P = 0.030) was statistically significant. The differences between two groups scored by operators in meatus (P = 0.041), shaft skin (P = 0.000), glans (P = 0.001), and general appearance (P = 0.007) were statistically significant. The differences between two groups scored by counterparts in meatus (P = 0.006), shaft skin (P = 0.003), glans (P = 0.010), and general appearance (P = 0.014) were statistically significant. Conclusion: Both prefabricated urethra and pre-implanted urethral plate methods are suitable for correction of severe hypospadias as staging surgery in children. In general, pre-implanted urethral plate is more worthy of spread because it is much more applied in patients with small glans and achieve good appearance of penis.
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Affiliation(s)
- Yuan Ding
- Pediatric Surgery, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
| | - Shengli Gu
- Pediatric Surgery, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
| | - Xingrong Xia
- Pediatric Surgery, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
| | - Zhengbo Yu
- Pediatric Surgery, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
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Wu Y, Wang J, Zhao T, Wei Y, Han L, Liu X, Lin T, Wei G, Wu S. Complications Following Primary Repair of Non-proximal Hypospadias in Children: A Systematic Review and Meta-Analysis. Front Pediatr 2020; 8:579364. [PMID: 33363061 PMCID: PMC7756017 DOI: 10.3389/fped.2020.579364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/13/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose: The aim of this study was to systematically review the literature on the complications and postoperative outcomes of children with non-proximal hypospadias. Methods: Electronic databases including PubMed, Embase, and Cochrane Library CENTRAL were searched systematically from January 1990 to June 2020 for the literature that reported the postoperative outcomes of patients with non-proximal hypospadias. Non-proximal hypospadias encompassed distal and mid-penile hypospadias. Results: We included 44 studies involving 10,666 subjects. Urethrocutaneous fistula (UCF) was the most common complication with an incidence of 4.0% (95% CI, 3.1-5.0%). Incidence of overall complications was 8.0% (95% CI, 6.3-9.8%). Meta-regression analysis revealed that length of urethral stent indwelling (coefficient 0.006; 95% CI, 0.000-0.011; p = 0.036) and penile dressing (coefficient 0.010; 95% CI, 0.000-0.021; p = 0.048) were two risk factors for UCF. Multivariate meta-regression analysis did not identify any independent risk factors for UCF. No differences were found between stent and stentless groups in non-proximal hypospadias regarding incidences of UCF (OR, 0.589; 95% CI, 0.267-1.297), meatal stenosis (OR, 0.880; 95% CI, 0.318-2.437), and overall complications (OR, 0.695; 95% CI, 0.403-1.199). No differences were found between foreskin preservation and circumcision in terms of complications either. Conclusions: UCF is the most common complication following hypospadias repair with an incidence of 4.0%. Independent risk factors for UCF were not identified in the current research. Distal hypospadias repair without stent indwelling is not likely to compromise the postoperative outcome. Further studies should be designed to explore the differences between different surgical approaches and the potential risk factors for complications following hypospadias repair.
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Affiliation(s)
- Yuhao Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Junke Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Tianxin Zhao
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Yuexin Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Lindong Han
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Xing Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Tao Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Guanghui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Shengde Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
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Mohammed M, Bright F, Mteta A, Mbwambo J, Ngowi BN, Mbwambo O, Yongolo S, Mganga A. Long-Term Complications of Hypospadias Repair: A Ten-Year Experience from Northern Zone of Tanzania. Res Rep Urol 2020; 12:463-469. [PMID: 33117746 PMCID: PMC7567991 DOI: 10.2147/rru.s270248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/17/2020] [Indexed: 11/23/2022] Open
Abstract
Background Hypospadias is one of the commonest congenital penile abnormalities in newborn males. The external urethral opening can be located anywhere from the glans penis along the ventral aspect of the shaft of the penis up to the scrotum or the perineum in extreme cases. The condition has a huge impact on the patient’s psychological, emotional and sexual well-being. Aim To determine the proportion of patients who develop long-term complications after hypospadias repair and its associated risk factors. Methods This was a hospital-based analytical cross-sectional study, conducted at KCMC Urology Institute from January 2009 to December 2018 and all children were followed up for 1-year post-operatively. A structural data sheet was used to collect information from patients’ files. Study parameters include age, location of hypospadias, surgical technique, surgeon experience, chordee, suture size, materials to assess the association with long-term complications. Results A total of 254 patients were included in the study, the majority were aged more than 2 years (71.83%) with mean age at operation (SD) of 4.74 ± 2.99 years. Distal types were the most common type of hypospadias (125 patients; 50%), and 51 patients (20%) had severe chordee. Tubularized incised plate (TIP) repair was the most common technique (130 patients; 51.59%). The number of patients with long-term complications following hypospadias repair was 156 (61.60%) and urethrocutaneous fistula
(UCF) accounted for 40.5%. The surgeon’s experience, location of hypospadias, surgical technique and associated chordee were significant predictors of long-term complications of hypospadias repair. Conclusion Tubularized incised plate urethroplasty is a safe and reliable method of hypospadias repair. Proximal hypospadias with severe chordee still remain a challenge.
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Affiliation(s)
- Mbarouk Mohammed
- Department of Urology, Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Frank Bright
- Department of Urology, Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Alfred Mteta
- Department of Urology, Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jasper Mbwambo
- Department of Urology, Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Bartholomeo Nicholaus Ngowi
- Department of Urology, Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Orgeness Mbwambo
- Department of Urology, Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sidney Yongolo
- Department of Urology, Faculty of Medicine, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Andrew Mganga
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Andersson M, Sjöström S, Doroszkiewicz M, Örtqvist L, Abrahamsson K, Sillén U, Holmdahl G. Urological results and patient satisfaction in adolescents after surgery for proximal hypospadias in childhood. J Pediatr Urol 2020; 16:660.e1-660.e8. [PMID: 32800709 DOI: 10.1016/j.jpurol.2020.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Proximal hypospadias repair is associated with a considerable complication risk. Long-term follow-up is required to present realistic expectations in pre-operative counseling. OBJECTIVE To investigate adolescents after childhood surgery for proximal hypospadias in a prospective cohort study describing the urological outcome, complication rates and patient satisfaction with penile appearance. STUDY DESIGN 39 adolescents ≥14 years with penoscrotal to perineal hypospadias and primary urethroplasty (tubularized incised plate (TIP), preputial flap as Onlay or tubularized (Duckett)) from 1996 to 2005 at a single center were evaluated. The clinical assessment, at Md 16.5 years (14-25), included voiding history, genital examination including the Hypospadias Objective Scoring Evaluation (HOSE), uroflowmetry plus chart data from previous urinary flows and evaluation of patient satisfaction using the Penile Perception Score (PPS). RESULTS Twenty-nine patients with penoscrotal and 10 with scrotal/perineal hypospadias underwent surgery with TIP (N = 14), Onlay (N = 14) and Duckett (N = 11). Uroflows improved significantly compared with prepubertal maximal flows. Impaired flow rate (<10 mL/s) was found in 14% (5/36). Fifty-one percent (20/39) required reoperations, 29% (4/14) of TIP, 50% (7/14) of Onlay and 82% (9/11) of Duckett (p = 0.0062). Median penile length in adolescence was 8.7 cm (4.0-11.0). Forty-four percent (12/27) of patients were dissatisfied with penile length. Patients were 'satisfied' or 'very satisfied' with meatal position and shape despite HOSE for meatal position being 11% (4/38) distal, 76% (29/38) proximal glanular and 13% (5/38) coronal. TIP patients had more curvature at puberty than Duckett (p = 0.0062). Patients that had a decurvature procedure had shorter penile length (p = 0.019). DISCUSSION A high complication rate is previously described, predominantly within the first years. Our study shows 50% of reoperations were performed after >3 years, illustrating the need for long-term follow-up. Patient satisfaction with a deviant meatal position is rarely reported [1,2]. Our results support a conservative approach to an asymptomatic retracted meatus. Limitations of this descriptive study are the non-comparable groups and the retrospective data for correlation, impeding evaluation of prognostic outcome-factors. The shorter penile length found in patients after plication, and increased curvature after TIP, is therefore merely descriptive. However, the findings are in line with earlier publications suggesting limited use of TIP, and plication (recommending ventral lengthening instead) to avoid penile shortening and curvature in these cases [3-5]. CONCLUSIONS The urological long-term outcome after proximal hypospadias repair is good, although late reoperations are common. In adolescence, patients were dissatisfied with the short penile length but satisfied with meatal position, indicating that in proximal hypospadias, preserving penile length and correcting curvature are prioritized over a distal meatus.
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Affiliation(s)
- Marie Andersson
- Sahlgrenska Academy, Women's and Children's Health, Gothenburg, Sweden; The Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia's Children's Hospital, Gothenburg, Sweden.
| | - Sofia Sjöström
- Sahlgrenska Academy, Women's and Children's Health, Gothenburg, Sweden; The Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia's Children's Hospital, Gothenburg, Sweden.
| | - Monika Doroszkiewicz
- The Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia's Children's Hospital, Gothenburg, Sweden.
| | - Lisa Örtqvist
- Department of Women's and Children's Health and Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
| | - Kate Abrahamsson
- Sahlgrenska Academy, Women's and Children's Health, Gothenburg, Sweden; The Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia's Children's Hospital, Gothenburg, Sweden.
| | - Ulla Sillén
- Sahlgrenska Academy, Women's and Children's Health, Gothenburg, Sweden; The Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia's Children's Hospital, Gothenburg, Sweden.
| | - Gundela Holmdahl
- Sahlgrenska Academy, Women's and Children's Health, Gothenburg, Sweden; The Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia's Children's Hospital, Gothenburg, Sweden.
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Wang C, Zhang W, Song H. Recurrent Ventral Curvature with Long-Term Follow-up after Transverse Preputial Island Urethroplasty. Eur J Pediatr Surg 2020; 30:429-433. [PMID: 31079413 DOI: 10.1055/s-0039-1688479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study was aimed to assess the long-term outcomes of recurrent ventral curvature (VC) repaired in early childhood after transverse preputial island flap urethroplasty. MATERIALS AND METHODS A total of 378 patients underwent transverse preputial island flap urethroplasty between January 2000 and January 2005 at our hospital. Of these patients, 43 were invited for assessment of VC after puberty. The age at surgery, types of hypospadias, degrees of recurrent VC, and surgical procedures were analyzed. RESULTS The study included 43 patients with a mean age of 15.9 years (range, 12.3-17.9). The average age at the time of primary surgery was 1.9 years (range, 1.2-3.6). Of 43 patients, recurrent VC was identified in 14 (32.5%). In total, 8 out of 16 patients (50.0%) were successfully treated by urethral plate transection with skin release during the primary surgery, and 6 out of 27 patients (28.6%) underwent additional dorsal plication (DP; p = 0.093). Severe recurrent VC was observed in four, moderate curvature was observed in four, and mild curvature was observed in six cases. Recurrent VC was present more often in patients with complications (34.6 vs. 24.1%, p = 0.331), especially in severe urethral strictures that required open surgical reconstruction (p = 0.039). CONCLUSION Although the patients in our study represent only a small portion of the overall hypospadias population, it is notable that 32.5% of these patients showed recurrent VC, including 28.6% of patients with transection plus DP. We suggest long-term follow-up of hypospadias at least during adolescence or even into adulthood.
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Affiliation(s)
- Chaoxu Wang
- Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
| | - Weiping Zhang
- Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
| | - Hongcheng Song
- Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
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Cui X, He Y, Huang W, Chen L, Wang Y, Zhou C. Clinical efficacy of transverse preputial island flap urethroplasty for single-stage correction of proximal hypospadias: a single-centre experience in Chinese patients. BMC Urol 2020; 20:118. [PMID: 32758190 PMCID: PMC7404920 DOI: 10.1186/s12894-020-00686-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 07/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background This study was designed to summarize the clinical outcomes of transverse preputial island flap urethroplasty for single-stage correction of proximal hypospadias in our hospital. Method This study retrospectively analysed the clinical data, including the preoperative general information, intraoperative and postoperative data, and follow-up data, of 155 children with proximal hypospadias who were admitted to our hospital from January 2009 to January 2019. Results During follow-up, a total of 92 postoperative complications occurred, and 41 patients underwent reoperation. There were 49 patients with urinary fistula, 26 patients with urethral stricture, 9 patients with urethral diverticulum and 8 patients with urinary tract infection. Regarding the family members’ satisfaction with the cosmetic appearance of the penis, the satisfaction rate with the urinary meatus was 85.2%, the satisfaction rate with the glans appearance was 87.7%, the satisfaction rate with the the appearance of the foreskin of the penis was 92.3%, and the satisfaction rate with the overall penis shape was 89.0%. Conclusion Proximal hypospadias is a serious condition that is often combined with severe chordee, and transverse preputial island flap urethroplasty for single-stage correction is an effective surgical procedure for treating this condition.
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Affiliation(s)
- Xu Cui
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Yuanbin He
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Wenhua Huang
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Liu Chen
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Yunjin Wang
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Chaoming Zhou
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China.
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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.
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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
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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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Neheman A, Rappaport YH, Verhovsky G, Bush N, Snodgrass W, Lang E, Zisman A, Efrati S. Hyperbaric oxygen therapy for pediatric "hypospadias cripple"-evaluating the advantages regarding graft take. J Pediatr Urol 2020; 16:163.e1-163.e7. [PMID: 32171667 DOI: 10.1016/j.jpurol.2020.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 01/07/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Hypospadias cripple patients pose a major surgical challenge with high complication rates attributed mainly to graft contraction. Hyperbaric oxygen therapy (HBOT) is an established treatment for compromised grafts and used extensively as a salvage therapy for compromised grafts and ischemic non-healing wounds. OBJECTIVE We evaluated the graft-take rates in hypospadias cripple cases undergoing a staged tubularized autograft repair (STAG) and compared between patients treated with or without preemptive HBOT. MATERIALS AND METHODS All patients underwent a STAG. Patients receiving preemptive HBOT were compared with patients receiving the standard surgical procedure without HBOT. The HBOT protocol included a daily session, 5 days per week for four weeks before the surgery and 10 additional daily sessions immediately after first-stage surgery. Each HBOT session included 90 min exposure to 100% O2 at 2 atmospheres absolute with 5 min air breaks every 20 min. The primary endpoint was graft take. Sequential tubularization without tension at second stage was defined as success. RESULTS Seven boys received HBOT and 14 boys comprised the control group. All patients in the HBOT group had good graft take with no graft contraction. In the control group, 57% had good graft take and could proceed to the second-stage surgery and 43% had graft contraction (Table). Except for one patient who had claustrophobia while entering the chamber, no significant side-effects developed during the HBOT. DISCUSSION The basic pathophysiology of compromised flaps includes both ischemia and reperfusion injury, which can be attenuated by HBOT. The beneficial effects of HBOT relates to several mechanisms, including hyperoxygenation, fibroblast proliferation, collagen deposition, angiogenesis, and vasculogenesis. Graft contraction is a well-known complication in hypospadias cripple population with reported failure rate of 39-63%. The HBOT procedure was found to be very effective and the entire HBOT group had a good graft take. Accordingly, all patients in the HBOT group proceeded to a successful second-stage tubularization. In addition, HBOT was found to be safe and generally well tolerated by this pediatric population. Study limitations were a relative small, non-homogenous sample size and lack of prospective randomization. Success was defined as sufficient graft elasticity sufficing for tubularization of the neourethra, and exact graft measurements are lacking in this study. CONCLUSIONS Preemptive HBOT can be used safely in the hypospadias cripple pediatric population and can potentially reduce the expected high surgical failure secondary to graft contraction.
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Affiliation(s)
- Amos Neheman
- Departments of Urology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yishai H Rappaport
- Departments of Urology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Guy Verhovsky
- Departments of Urology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel
| | | | | | - Erez Lang
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amnon Zisman
- Departments of Urology, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Efrati
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf-Harofeh) Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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The current state of tissue engineering in the management of hypospadias. Nat Rev Urol 2020; 17:162-175. [DOI: 10.1038/s41585-020-0281-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2020] [Indexed: 12/20/2022]
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