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Patil JD, Mohamed YM, Farhan A, Corbally M. Outcomes Assessment of Hypospadias Repair. Cureus 2023; 15:e48808. [PMID: 38098936 PMCID: PMC10721355 DOI: 10.7759/cureus.48808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Hypospadias is a congenital malformation, which involves the displacement of the urethral orifice on the underside of the penis. The mainstay treatment of hypospadias is surgery. Currently, there is no literature broadly assessing hypospadias repair outcomes in the Kingdom of Bahrain. This study aims to provide descriptive data on cosmetic, functional, and surgical outcomes of hypospadias repair at a single medical institute in the Kingdom of Bahrain. METHOD Data on patients who underwent hypospadias repair from January 2012 to December 2020 by a single surgeon were reviewed. Parents of patients were contacted via telephone for consent. All consenting participants returned for an outpatient assessment of functional and cosmetic outcomes using an original questionnaire and the Pediatric Penile Perception Score, respectively. All responses were recorded using a four-point Likert scale. Surgical outcomes were assessed by reviewing postoperative notes. All collected data were anonymized. The study was approved by the King Hamad University Hospital institutional review board. RESULTS Of the 29 patients who underwent surgical repair for hypospadias, 15 patients consented to participate. The mean age of the study population was 2.466 (SD = 0.496). Both parent and physician cosmetic assessments had similar results with the majority of participants very satisfied with all cosmetic parameters. Physician assessment reported higher satisfaction compared to parents. There were no reported cases of poor satisfaction. In terms of functional outcomes, there were no reported cases of straining on initiation, and a smooth and continuous urinary stream was reported in 80%. Only four patients reported post-void dribbling. When assessing surgical outcomes, 53.30% had coronally located urethra with no cases of postoperative complications. More than half of our patients were discharged after one day. CONCLUSION Our study noted overall high satisfaction in terms of surgical, cosmetic, and functional outcomes. Physicians reported better cosmetic outcomes when compared to parents. Further analysis with a larger sample size across various medical institutes will be required to better assess post-repair outcomes.
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Affiliation(s)
- Jayaditya Devpal Patil
- Department of Medicine, Royal College of Surgeons in Ireland - Medical University of Bahrain, Busaiteen, BHR
| | - Yusuf Mahdi Mohamed
- Department of Medicine, Royal College of Surgeons in Ireland - Medical University of Bahrain, Busaiteen, BHR
| | - Abeer Farhan
- Department of Surgery, King Hamad University Hospital, Busaiteen, BHR
| | - Martin Corbally
- Department of Surgery, King Hamad University Hospital, Busaiteen, BHR
- Department of Surgery, Royal College of Surgeons in Ireland - Medical University of Bahrain, Busaiteen, BHR
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Sharma SP, Chowdhary S, Kumar R, Yadav MK, Sharma SP, Panigrahi P. Urinary flow rates in anterior hypospadias: Before and after repair and its clinical implication. Afr J Paediatr Surg 2023; 20:102-105. [PMID: 36960503 DOI: 10.4103/ajps.ajps_125_21] [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] [Indexed: 01/06/2023] Open
Abstract
Context Hypospadias is a common urological anomaly which could be surgically corrected with good cosmetic results. Aims We aimed to detect changes in urinary flow parameters both before and after tubularised incised plate urethroplasty (TIPU) using uroflowmetry. Settings and Design Data collected were clinically implemented hypothesising the probability of urethrocutaneous fistula following stricture with Qmax variation. Materials and Methods This study is a prospective analysis done from December 2017 to October 2019. A total of 104 cases of anterior hypospadias were included in the study. A single surgical unit did TIPU. Pre-operative and post-operative uroflowmetry was done, and Qmax was recorded at 3 months, 6 months and 1 year after surgery. Mean Qmax was calculated for all intervals. A significant decrease in Qmax of a child (<2 standard deviation) was ascertained. Urethral calibration was done in those cases with a significant decrease of Qmax and analysed statistically. Results The mean age was 6.97 ± 2.41 years. Out of 104 children, 73 (70.2%) and 31 (29.8%) had distal and mid-shaft hypospadias, respectively. The pre-operative mean Qmax of the population was 6.20 ± 0.42 ml/s. Arithmetic mean Qmax at 3 months, 6 months and 1 year was 8.53 ± 0.42, 11.18 ± 0.47 and 13.71 ± 0.44 ml/s, respectively. On comparing the pre-operative with post-operative mean Qmax, a significant increase was found postoperatively (P < 0.0001). Twenty-four patients had significantly decreased Qmax value after 6 months. In these patients, follow-up urethral dilation was done with significant improvement. Conclusion The changes in maximum flow rate (Qmax) are suitable for use in routine follow-up. A significant decrease in Qmax over time indicates the onset of urethral stricture. These cases are to be intervened before venturing to redo urethroplasty.
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Affiliation(s)
| | - Sarita Chowdhary
- Department of Paediatric Surgery, IMS Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rakesh Kumar
- Department of Paediatric Surgery, IGIMS, Patna, Bihar, India
| | - Manoj Kumar Yadav
- Department of Paediatric Surgery, IMS Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - S P Sharma
- Department of Paediatric Surgery, IMS Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Pranay Panigrahi
- Department of Paediatric Surgery, IMS Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Halaseh SA, Halaseh S, Ashour M. Hypospadias: A Comprehensive Review Including Its Embryology, Etiology and Surgical Techniques. Cureus 2022; 14:e27544. [PMID: 36060359 PMCID: PMC9428502 DOI: 10.7759/cureus.27544] [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] [Accepted: 07/31/2022] [Indexed: 11/22/2022] Open
Abstract
Hypospadias is among the most prevalent urogenital malformations in male newborns. It is characterized by the displacement of the urethral meatus to the ventral side of the penis, an aberrant ventral curve of the penis referred to as "chordee," and an abnormally arranged foreskin with a "hood" found dorsally and lacking foreskin ventrally. Patients may have an extra genitourinary abnormality based on the area of the lesion. In around 70% of cases, the urethral meatus is positioned distally to the shaft, representing a milder form of the disease. The remaining 30% of cases are located proximally, are more complicated, and require further evaluation. Although the origin of hypospadias is mostly obscure, several suggestions exist about genetic susceptibility and hormonal factors. The objective of hypospadias restoration is to restore aesthetic and functional regularity, and surgery is currently advised at a young age, mostly between six and 18 months. At any age, hypospadias can be repaired with an equivalent risk of complications, functional outcomes, and aesthetic outcomes. However, the best age of treatment is still undetermined. Even though the long-term effects on appearance and sexual function are usually good, males may be less likely to make the first move after rectification. Also, people who have hypospadias treated are twice as likely to have problems with their lower urinary tract. These problems can last for years after the initial repair.
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Tubularized Reconstructed Plate Urethroplasty: An Alternative Technique for Distal Hypospadias Repair. Urology 2020; 148:243-249. [PMID: 33080256 DOI: 10.1016/j.urology.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To report current results of a new surgical technique, tubularized reconstructed plate urethroplasty (TRPU) in distal hypospadias repair which allows the tubularization of urethral plate without incision or grafting. METHODS This study is a prospective single surgeon series. Between January 2019 and March 2020, total of 158 patients underwent hypospadias repair, and 29 selected patients had TRPU procedure. Demographic data, duration of follow-up, complications were recorded. A vertical incision is made starting from halfway up the glans. This incision creates a diamond like defect which enables wedge removal of a segment of spongiosum tissue from the base of urethral plate extending to the hypospadiac meatus. Vertical incision is closed horizontally. The urethral plate is stretched and loosened from the base and re-secured into its bed using quilting stitches. Reconstructed urethral plate ensures the required width to allow the formation of neourethra of adequate circumference, followed by a formal glansplasty. RESULTS Preoperative glans width was 13.4 ± 0.9 mm, urethral plate width was 6.1 ± 0.9 mm. Mean postoperative follow-up period was 13.6 months. All patients had successful functional outcome and cosmetically satisfying appearance. None of the patients required meatal calibration. The total complication rate was 3.4%. CONCLUSION Native urethral plate itself is used as a natural flap to increase the surface area of the urethral plate in this new perspective of urethroplasty method. We believe that TRPU procedure provides an alternative approach for the formation of neourethra and it is a successful and relatively simple procedure with low complication rates, good cosmetic results and promising successful functional short-term outcome.
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Bao X, Huang Y, Lyu Y, Xi Z, Xie H, Fu Q, Song L, Chen F. A Histomorphological Study of the Divergent Corpus Spongiosum Surrounding the Urethral Plate in Hypospadias. Urology 2020; 144:188-193. [DOI: 10.1016/j.urology.2020.04.139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 12/21/2022]
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Winberg H, Anderberg M, Arnbjörnsson E, Stenström P. Urinary flow measurement in hypospadias correlated to surgical procedure and risk of development of urethra-cutaneous fistula. J Pediatr Urol 2020; 16:306.e1-306.e8. [PMID: 32295743 DOI: 10.1016/j.jpurol.2020.03.004] [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: 11/27/2019] [Accepted: 03/07/2020] [Indexed: 10/24/2022]
Abstract
AIM To explore the correlation between fistula development and urinary flow measurements after hypospadias repair with emphasis on patients with urethrocutaneous fistula complications and to identify risk factors for fistula development. METHODS Urinary flow was examined in boys operated on for hypospadias. Outcome of maximum urinary flow (ml/s) (Qmax), voided volume for age (ml) (Volume), and pathological flow pattern (n) (Curve) was compared between the Byars, Mathieu, and Tubularized Incised Plate (TIP) surgical repair methods and between the groups of those who had and had not developed a fistula. Logistic regression analysis was performed for age at operation, genetics, comorbidity, or urinary flow measurements regarding the development of urethrocutaneous fistula. RESULTS Seventy-three boys underwent hypospadias repair. Overall, the urinary flow measurements differed significantly between the three reconstructive methods, being favorable for the Mathieu procedure regarding Qmax (p < 0.01), volume (p = 0.04), and frequency of pathological voiding curve (p < 0.01; Table). The frequency of urethrocutaneous fistula was 18% (13/73) and did not differ significantly between the three different reconstructive surgery methods (Byar 33%, Mathieu 32%, and TIP 12%; p = 0.22). Urinary flow measurements did not differ between patients with and without fistula complications regarding Qmax 10 ml/s (4-16) vs. 8 ml/s (2-18), voided volume 74 ml (35-171) vs. 71 ml (9-270), or abnormal urinary flow pattern (23% vs. 30%). On logistic regression analysis, age at operation, genetics, comorbidity, and urinary flow measurement parameters did not turn out to be independent risk factors for development of urethrocutaneous fistula after hypospadias repair. DISCUSSIONS The study demonstrated significant differences between the urinary flow measurement results between the three different repair methods, favoring the Mathieu procedure. A low Qmax was a common postoperative finding. Urinary flow measurements did not differ between boys developing fistula and those who did not. No risk factors for fistula development were identified. The study did not support that it would be possible, at an early postoperative stage, to identify those with an upcoming postoperative fistula neither with urinary flow measurements nor through risk factors. No similar reports have studied the possibility of using postoperative urinary flow measurements to determine patients at risk of fistula development after hypospadias repair. CONCLUSIONS Urinary flow measurements were favorable after hypospadias reconstruction with Mathieu compared with Byars and TIP. Furthermore, urinary flow measurements did not differ between reconstructed with and without a fistula complication. No risk factor for fistula development was identified.
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Affiliation(s)
- Hans Winberg
- Department of Pediatric Surgery, Skåne University Hospital, 221 85, Lund, Sweden; Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden.
| | - Magnus Anderberg
- Department of Pediatric Surgery, Skåne University Hospital, 221 85, Lund, Sweden; Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden.
| | - Einar Arnbjörnsson
- Department of Pediatric Surgery, Skåne University Hospital, 221 85, Lund, Sweden; Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden.
| | - Pernilla Stenström
- Department of Pediatric Surgery, Skåne University Hospital, 221 85, Lund, Sweden; Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden.
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Pan P. Can Grafted Tubularized Incised Plate Urethroplasty be Used to Repair Narrow Urethral Plate Hypospadias? Its Functional Evaluation Using Uroflowmetry. J Indian Assoc Pediatr Surg 2019; 24:247-251. [PMID: 31571754 PMCID: PMC6752077 DOI: 10.4103/jiaps.jiaps_151_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Aim: Using uroflowmetry, the aim of this study is to determine the functional results of the grafted tubularized incised plate (GTIP) urethroplasty used to repair poor urethral plate hypospadias. Settings and Design: Seventy-one patients (mean age: 5.7 years, follow-up: 1–5.5 years) were selected from those who underwent surgery using the GTIP technique from 2013 to 2015 at our institution. Methods: Patients included were able to void voluntarily and had no fistula. The flow pattern, maximum urinary flow rate (Qmax), voided volume (vv), average flow rate, and voiding time were measured. The results were expressed as percentiles and interpreted according to Siroky nomogram. The Qmax was considered normal if >25th percentile, as equivocally obstructed when in the 5th–25th percentile, and obstructed if <5th percentile. Results: Hypospadias was distal in 45, mid penile in 17 and proximal penile in 9. The uroflow curve was bell-shaped in 24 (30%), interrupted in 9 (14%), slightly flattened in 31 (46%), and a plateau in 7 (10%). Flow rate nomograms revealed that 49 (68%) were above the 25th percentile, 9 (17%) were below the 5th percentile, and 13 (15%) were between these ranges. Eleven patients showed improvement in the flow curve and maximum urinary flow rate (Qmax) in follow-up uroflowmetry. Conclusion: GTIP repair provides satisfactory functional results. A long-term follow-up is needed to confirm these results.
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Affiliation(s)
- Pradyumna Pan
- Ashish Hospital and Research Centre, Pediatric Surgery Unit, Jabalpur, Madhya Pradesh, India
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Faurschou I, Ernst A, Zhao J, Liao D, Olsen LH. The biomechanical properties of the urethra in boys with hypospadias: a preliminary study. J Pediatr Urol 2019; 15:62.e1-62.e7. [PMID: 30482497 DOI: 10.1016/j.jpurol.2018.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 09/08/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE The ventral aspect of the penis in boys with hypospadias is composed of dysplastic tissue of the skin and the urethra. The aim of this study was to assess the pre-operative size and biomechanical properties of urethrae in boys with and without hypospadias using a more objective catheter-based system. MATERIALS & METHODS In this non-blinded clinical observation study, the study population consisted of 19 boys with hypospadias-the case group (median age 13.9 months [range: 12.2-21.3])-and seven boys without hypospadias-the control group (median age 8.5 months [range: 3.8-18.1]). Modified measurements of impedance were used to assess the size, compliance and viscoelasticity of the urethrae under stepwise increased pressures (between 0, 40 and 60 cmH2O) using a customised Endolumenal Functional Lumen Imaging probe (EndoFLIP®). RESULTS The sizes of the urethrae in boys with hypospadias are variable but tend towards being narrower and less compliant than those of the control subjects i.e. median diameter for meatus urethra was 3.2 mm (range: 2.98-3.92) in the hypospadias group compared with 3.64 (range: 3.22-4.44) in the control group at 40 cmH2O, and the median change in diameter at meatus urethra was 0.08 mm (range: -0.02 to 0.52) in the hypospadias group compared with 0.23 mm (range: -0.02 to 0.34) when the pressure was increased from 40 to 60 cmH2O. This biomechanical analysis found that there was no significant viscoelasticity of the urethral meatus in both the groups, whereas the remainder of the urethral structure generally had viscoelastic properties in the control group, seen as a creep on the time/diameter curves (Figure). In the group of boys with hypospadias, evaluations of the urethrae revealed varying viscoelastic abilities, ranging from abilities that were comparable with those of the control subjects to no sign of viscoelasticity at all. CONCLUSIONS This study is the first to measure the biomechanical properties of the urethra in children, which might help to provide an understanding as to the structural and functional changes associated with hypospadias. The urethrae in the subjects with hypospadias were variable in diameter but tended to be narrower overall, especially in the distal portion of the urethra. Furthermore, the urethrae in boys with hypospadias were frequently less viscoelastic than those of controls. CLINICAL RELEVANCE The EndoFLIP® system may be a future way of objectively estimating the severity of a urethral obstruction and could potentially be included in the postoperative assessment of patients with signs of hampered voiding.
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Affiliation(s)
- I Faurschou
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, DK-8200 Aarhus N, Denmark; Department of Urology, Section of Paediatric Urology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, DK-8200 Aarhus N, Denmark.
| | - A Ernst
- Department of Urology, Section of Paediatric Urology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, DK-8200 Aarhus N, Denmark; Department of Public Health, Section for Epidemiology, Aarhus University, Bartholins Allé 2 - Building 1260, DK-8000 Aarhus C, Denmark
| | - J Zhao
- Giome Academia, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, DK-8200 Aarhus N, Denmark
| | - D Liao
- Giome Academia, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, DK-8200 Aarhus N, Denmark
| | - L H Olsen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, DK-8200 Aarhus N, Denmark; Department of Urology, Section of Paediatric Urology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, DK-8200 Aarhus N, Denmark
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Abstract
Aims: To study the role of uroflowmetry in the preoperative and early postoperative period in children undergoing hypospadias repair. Materials and Methods: Twenty-six cases undergoing hypospadias repair over 1 year (tubularized incised plate [TIP] Snodgrass [17 patients], TIP with Snodgraft [5 patients], Duckett's onlay flap [2 patients], and Duckett's tube [2 patients] urethroplasty) were prospectively evaluated with preoperative ultrasound and uroflowmetry and postoperative uroflowmetry at 3 months after the surgery and at 6 and 9 months interval if these dates fell within the study period on follow-up. The parameters studied were maximum flow rate (Qmax), average flow rate (Qav), total voided volume, voiding time, and type of curve. Preoperative and postoperative uroflow data were compared. Results: Twenty-six cases comprised of anterior hypospadias (n = 8), mid penile (n = 11), and posterior hypospadias (n = 7). Fourteen patients had obstructed flow rates preoperatively. While 69% patients (18/26) had obstructed flow rates at 3 months postoperatively, it dropped to 43% at 9 months. Following TIP (Snodgrass) repair, 88% (15/17) had obstructed flow rates postoperatively. Best results were seen in patients undergoing circumferentially epithelialized urethral reconstruction (TIP with Snodgraft, Duckett's onlay flap, and Duckett's tube). Conclusions: Abnormal uroflow is an inherent aspect of hypospadias in 50% of the cases. Both preoperative and postoperative uroflow evaluation is necessary for meaningful conclusion. Patients with preoperative normal flow rates but obstructed postoperative flow rates need clinical evaluation. Obstructive flow rates are more common after TIP (Snodgrass) repair. The urinary flow rates improve with time.
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Affiliation(s)
- Rajat Piplani
- Department of Paediatric Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Satish K Aggarwal
- Department of Paediatric Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Simmi K Ratan
- Department of Paediatric Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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Abstract
Hypospadias is one of the most common congenital anomalies in men. The condition is typically characterized by proximal displacement of the urethral opening, penile curvature, and a ventrally deficient hooded foreskin. In about 70%, the urethral meatus is located distally on the penile shaft; this is considered a mild form that is not associated with other urogenital deformities. The remaining 30% are proximal and often more complex. In these cases, endocrinological evaluation is advised to exclude disorders of sexual differentiation, especially in case of concomitant unilateral or bilateral undescended testis. Although the etiology of hypospadias is largely unknown, many hypotheses exist about genetic predisposition and hormonal influences. The goal of hypospadias repair is to achieve cosmetic and functional normality, and currently, surgery is recommended between 6 and 18 months of age. Hypospadias can be corrected at any age with comparable complication risk, functional, and cosmetic outcome; however, the optimal age of repair remains conclusive. Although long-term overall outcome concerning cosmetic appearance and sexual function is fairly good, after correction, men may more often be inhibited in seeking sexual contact. Moreover, lower urinary tract symptoms occur twice as often in patients undergoing hypospadias repair and can still occur many years after the initial repair. CONCLUSION This study explores the most recent insights into the management of hypospadias. What is Known: • Guidelines advise referral for treatment between 6 and 18 months of age. • Cosmetic outcome is considered satisfactory in over 70% of all patients. What is New: • Long-term complications include urinary tract symptoms and sexual and cosmetic issues. • New developments allow a more individualized approach, hopefully leading to less complications and more patient satisfaction.
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Affiliation(s)
- H. J. R. van der Horst
- Department of Urology, VUmc, De Boelelaan 1117, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - L. L. de Wall
- Department of Urology, Radboudumc, Geert Grooteplein 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Abstract
Purpose We report our complications and success rate in adult hypospadias repair. Patients and Methods This was a retrospective study of patients aged ≥17 years who underwent hypospadias repair during 2006-2014. We analyzed two groups, one with primary repair and the other that had secondary repair after failed childhood hypospadias surgery. Outcome was compared between the two groups and among different surgical procedures. Descriptive statistics and Fisher's exact test were used and significance level was set at P < 0.05. Results Forty patients were included, of which 26 presented for a secondary repair and 14 for primary repair. The meatus was distal in 15 patients, mid-penile in 16, and penoscrotal in 9. The median age of patients at the time of surgery was 21 years (standard deviation [SD] =4, range 17-30). The median follow-up period was 37 months (SD = 8, range 5-75). In the primary repair group, the success rate was 71% (10/14), whereas in the secondary repair group, the success rate was 55% (14/26). The overall complication rate was 60%. Following a subsequent repair, the overall success rate reached 95% (38/40). There was no significant difference in success or complications between patients who presented with primary or secondary hypospadias or between methods of repair. Conclusion Delayed hypospadias repair in adults is associated with a high success rate of 95% with no difference between primary and secondary repair. Secondary repair however may require more than one procedure most of the time.
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Affiliation(s)
- Waleed M AlTaweel
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Raouf M Seyam
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Ghidini F, Sekulovic S, Castagnetti M. Parental Decisional Regret after Primary Distal Hypospadias Repair: Family and Surgery Variables, and Repair Outcomes. J Urol 2015; 195:720-4. [PMID: 26518112 DOI: 10.1016/j.juro.2015.10.118] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Decisional regret is defined as distress after making a health care choice and can be an issue for parents electing distal hypospadias repair for their sons. We assessed the influence on decisional regret of variables related to the family, surgery and outcomes. MATERIALS AND METHODS Charts for 372 patients undergoing primary distal hypospadias repair between 2005 and 2012 were reviewed, and validated questionnaires, including the Decisional Regret Scale, Pediatric Penile Perception Score and Dysfunctional Voiding and Incontinence Scoring System, were administered to parents. RESULTS Data were available for 172 of 372 families (response rate 46.2%). Of 323 parents 128 (39.6%) presented with moderately strong decisional regret, with good agreement within couples. Predictors of decisional regret included intermediate parental educational level (OR 3.19, 95% CI 1.52-6.69), patient not being the first born (OR 2.01, 95% CI 1.07-3.78), family history of hypospadias (OR 4.42, 95% CI 1.96-9.97), initial desire to avoid surgery (OR 2.07, 95% CI 1.04-4.12), younger age at followup (OR 0.81, 95% CI 0.72-0.91), presence of lower urinary tract symptoms (OR 4.92, 95% CI 1.53-15.81) and lower Pediatric Penile Perception Score (OR 0.86, 95% CI 0.75-0.99). Decisional regret was unrelated to parental desire to avoid circumcision, surgical variables, development of complications and duration of followup. CONCLUSIONS Decisional regret is a problem in a significant proportion of parents electing distal hypospadias repair for their sons. In our experience family variables seemed to be predictors of decisional regret, while surgical variables did not. Predictors of decisional regret included worse parental perception of penile appearance and the presence of lower urinary tract symptoms. However, the latter could be unrelated to surgery. Irrespective of the duration of followup, decisional regret seems decreased in parents of older patients.
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Affiliation(s)
- Filippo Ghidini
- Section of Pediatric Urology, Urology Unit, University Hospital of Padova, Padua, Italy
| | - Sasa Sekulovic
- Section of Pediatric Urology, Urology Unit, University Hospital of Padova, Padua, Italy
| | - Marco Castagnetti
- Section of Pediatric Urology, Urology Unit, University Hospital of Padova, Padua, Italy.
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Andersson M, Doroszkiewicz M, Arfwidsson C, Abrahamsson K, Sillén U, Holmdahl G. Normalized Urinary Flow at Puberty after Tubularized Incised Plate Urethroplasty for Hypospadias in Childhood. J Urol 2015; 194:1407-13. [PMID: 26087380 DOI: 10.1016/j.juro.2015.06.072] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE An obstructive urinary flow pattern is frequently seen after tubularized incised plate urethroplasty for hypospadias. However, the significance of this finding has not been determined and long-term results are few. We describe postoperative long-term uroflowmetry results after puberty in males who underwent tubularized incised plate urethroplasty in childhood. MATERIALS AND METHODS A total of 126 boys underwent tubularized incised plate urethroplasty for distal penile to mid shaft hypospadias at Queen Silvia Children's Hospital in Gothenburg between 1999 and 2003. Of the patients 48 were toilet trained at surgery. We report on 40 patients who had data available at 2 and 12 months postoperatively, 7 years postoperatively and at puberty (median age 15.0 years, range 13.7 to 17.1). Of the patients 31 had distal and 9 had mid penile hypospadias. Clinical examination, urinary medical history, uroflowmetry and ultrasound measuring residual urine were performed. Maximum urinary flow was correlated to age and voided volume, using Miskolc nomograms for comparison of percentiles. RESULTS At 1 year postoperatively 15 boys (37.5%) had normal urinary flow (above 25th percentile), compared to 16 (40%) at 7 years and 38 (95%) at puberty (p <0.0001). Improvement was significant in patients with distal (p <0.0001) and mid penile hypospadias (p = 0.008), as well as in patients who did (p = 0.0078) and did not undergo intervention (p <0.0001). During followup 5 patients underwent meatotomy due to obstructive symptoms and 4 underwent dilation. Three of these 9 patients had lichen sclerosus. CONCLUSIONS There is great potential for normalization of urinary flow at puberty for boys with hypospadias treated with tubularized incised plate urethroplasty. Unless symptoms occur, a conservative approach seems preferable.
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Affiliation(s)
- Marie Andersson
- Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Monika Doroszkiewicz
- Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Charlotte Arfwidsson
- Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Kate Abrahamsson
- Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Ulla Sillén
- Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Gundela Holmdahl
- Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden
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Grosos C, Bensaid R, Gorduza DB, Mouriquand P. Is it safe to solely use ventral penile tissues in hypospadias repair? Long-term outcomes of 578 Duplay urethroplasties performed in a single institution over a period of 14 years. J Pediatr Urol 2014; 10:1232-7. [PMID: 25104421 DOI: 10.1016/j.jpurol.2014.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/03/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Urethral plate tubulization (Thiersch-Duplay procedure) is a widespread procedure mostly used for distal hypospadias. Concerns of long-term outcome have led to this review of the results of a series of 578 cases. PATIENTS AND METHODS A retrospective review was conducted of 578 patients treated in a single institution following the same procedure and with the same follow-up. Most patients had distal hypospadias (517/578) and were operated on between 12 and 24 months of age (343 patients). The mean follow-up was 25.6 months (6 months-17 years). Evaluation was focused on urethral complications related to inadequate healing of the reconstructed urethra (fistula, urethral dehiscence, urethral stenosis and clinical dysuria). Complications were arbitrarily categorized into early (when occurring less than one year after surgery) and late (after one year). All data were submitted to statistical analysis. RESULTS Of the 578 patients, 153 (26.5%) had unsatisfactory outcomes, of which 118 (20.4%) had inadequate urethral healing. Of these, 97 appeared early (57%) and 73 appeared late (43%). Fistula and dehiscence were significantly more frequent in the first post-operative year (p<0.0001), whereas stenosis of the reconstructed urethra was more frequent after one year. Follow-up and age at last consultation were significantly higher in patients with complications. Limits and flaws of this study focused on the absence of consensus on evaluation of hypospadias surgery. The paucity of literature on long-term outcomes of urethral plate tubulization was highlighted. A possible explanation of late stenosis of the reconstructed urethra was the poor growth capacity of the dysplastic tissues located beyond the division of the corpus spongiosum. Urethroplasties solely using ventral tissues may represent an additional risk of late failure, as they may not grow with the rest of the genital tubercle. CONCLUSION Significant short and late complications occur with techniques tubularizing the urethral plate, mostly fistulae in the first post-operative year and urethral stenosis after 1 year following surgery. Urethroplasties using ventral tissues may not grow at the same pace as the rest of the genital tubercle and may explain late urethral dysfunction. This series confirms the necessity of long-term follow-up of hypospadias reconstructions.
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Affiliation(s)
- C Grosos
- Department of Pediatric Urology, Hôpital Mère-Enfant, Hospices Civils de Lyon and Claude Bernard University, Lyon 1, France.
| | - R Bensaid
- Department of Pediatric Urology, Hôpital Mère-Enfant, Hospices Civils de Lyon and Claude Bernard University, Lyon 1, France.
| | - D-B Gorduza
- Department of Pediatric Urology, Hôpital Mère-Enfant, Hospices Civils de Lyon and Claude Bernard University, Lyon 1, France.
| | - P Mouriquand
- Department of Pediatric Urology, Hôpital Mère-Enfant, Hospices Civils de Lyon and Claude Bernard University, Lyon 1, France.
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Abstract
Hypospadias is a challenging field of urogenital reconstructive surgery with different techniques being currently used. Modern surgery claims that it is possible to create a functionally and cosmetically normal penis. Continuous re-evaluation and assessment of outcome may have a major impact on future clinical practice. Assessment of outcome includes: complication rate, cosmetic appearance of the penis, functional outcome (micturition, sexuality), and psychological factors such as quality of life and psychosexual life. This article briefly reviews current strategies of outcome assessment. Somehow in the future, we will be able to give an accurate estimation of the long-term consequences of being born with hypospadias.
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Affiliation(s)
- Alexander Springer
- Department of Pediatric Surgery, Medical University of Vienna , Vienna , Austria
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17
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Chandrasekharam VVS. Single-stage repair of hypospadias using longitudinal dorsal island flap: Single-surgeon experience with 102 cases. Indian J Urol 2013; 29:48-52. [PMID: 23671365 PMCID: PMC3649600 DOI: 10.4103/0970-1591.109984] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: There are many techniques of harvesting vascularized skin flaps from penile skin for hypospadias repairs. Here, we review our experience with the use of longitudinal dorsal island flap (LDIF) for mid- and proximal hypospadias repairs and to assess the results and complications of onlay and tubularized repairs. Materials and Methods: We retrospectively reviewed the data of all children with hypospadias operated by a single surgeon using the LDIF technique. The severity of hypospadias, technique, complications, and follow-up were assessed. Results: Over a 9.4-year period, 102 children (mean age 4.2 years, range 6 months to 11 years) were operated for primary hypospadias using the LDIF technique. All children had poorly formed urethral plates and hence were considered unsuitable for tubularized incised plate repair. The hypospadias was classified as midpenile, proximal penile/penoscrotal or perineal in 29, 64, and 9 children respectively. Onlay LDIF repair was done in 85 children, while in 17 children, tubularized LDIF repair was performed. At a mean follow-up of 1.8 years, complications occurred in 12 (12%) children. Complications were more common after tubularized repairs than onlay repairs (24% vs. 9.5%). All glans dehiscences occurred after onlay repairs, while meatal stenosis and diverticulum occurred after tubularized repairs. No child had urethral stenosis after onlay repair, and uroflow studies in 16 children demonstrated normal curves and flow rates. Conclusions: We report the use of LDIF for single-stage mid and proximal hypospadias repair with good success and an acceptable complication rate. Onlay repairs had fewer complications than tubularized repairs. Our results indicate that the specific advantages and versatility of LDIF make it a good option to consider in cases of hypospadias with poorly developed urethral plates where onlay or substitution urethroplasty is indicated.
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Affiliation(s)
- V V S Chandrasekharam
- Department of Pediatric Surgery and Pediatric Urology, Rainbow Children's Hospitals, Hyderabad, Andhra Pradesh, India
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18
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Filinte GT, Akan M, Temiz G, Aycicek Cardak GN, Gonullu E. Applications of triangular glanular flap in hypospadias repairs for different purposes. J Plast Surg Hand Surg 2013; 48:34-7. [PMID: 23639333 DOI: 10.3109/2000656x.2013.794422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hypospadias is a congenital anomaly of the penis with an ectopic, ventrally-placed meatus due to insufficient development of the anterior urethra. Tubularisation of glanular flaps without plate incision is performed with addition of a triangular flap in order to move the meatus more distally and avoid meatal stenosis. Subcoronally, mid-shaft, and coronally placed 41 hypospadias cases were treated with the tubularisation of the glanular flaps without incision of the urethral plate, a technique similar to TIP technique. Triangular flaps were added at the most distal end of one of the glanular flaps in all cases for different purposes. A medially-based triangular flap was elevated at the distal end of the right-sided longitudinal flap to carry the last suture more distally. The flap increased meatal diameter and carried the last suture more distally. No meatal stenosis was observed for an average of 18.02 (12-30) months. The final localisation of the meatus was satisfactory in all patients. Meatal stenosis, demonstrated after hypospadias repair, is a challenge for both the surgeon and the patient. A distal triangular glanular flap is planned to avoid this challenge. Besides, it helps to carry the meatus more distally. Promising results support the use of the glanular flap while longer follow-up is required for better evaluation.
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Affiliation(s)
- Gaye Taylan Filinte
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Dr. Lutfi Kirdar Kartal Research and Training Hospital , Istanbul , Turkey
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Jesus LE, Schanaider A, Patterson G, Marchenko A, Aitken KJ, Leslie B, Bagli DJ, Pippi-Salle JL. Urethral compliance in hypospadias operated by tubularized incised urethral plate (TIP) with and without a dorsal inlay graft: an experimental controlled study. World J Urol 2012; 31:971-5. [DOI: 10.1007/s00345-012-1004-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 11/28/2012] [Indexed: 11/29/2022] Open
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20
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Lorenzo AJ. Monitoring children after hypospadias repair: What is the best plan of action? Can Urol Assoc J 2012; 6:243-4. [PMID: 23093530 DOI: 10.5489/cuaj.12224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Armando J Lorenzo
- Division of Pediatric Urology, Hospital for Sick Children, University of Toronto, Toronto, ON
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21
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We read with interest the article by Shimotakahara et al. J Pediatr Surg 2012; 47:821; author reply 821-2. [PMID: 22498406 DOI: 10.1016/j.jpedsurg.2012.01.018] [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: 12/24/2011] [Revised: 01/01/2012] [Accepted: 01/04/2012] [Indexed: 11/23/2022]
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22
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González R, Ludwikowski BM. Importance of urinary flow studies after hypospadias repair: a systematic review. Int J Urol 2011; 18:757-61. [PMID: 21883491 DOI: 10.1111/j.1442-2042.2011.02839.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A systematic review was performed of publications relating to the results of urinary flow studies after hypospadias repair dating back to 1978, when what appears to be the first publication on this topic was found. The literature search was performed using the key words "hypospadias" combined with "urinary flow", "urine flow", "uroflow", "uroflowmetry", and "long-term". We also reviewed the abstracts and full-length articles cited in the reference list of selected articles. Criteria for inclusion in the present systematic review included descriptions of patient selection, surgical technique, the severity of disease (proximal vs distal), and the method used to determine uroflow, as well as a definition of urethral obstruction. In all, 339 article titles were found. Of these, 25 abstracts appeared relevant and the full text of these articles were reviewed, with 22 of the papers included in this review. Sixteen reports had appeared in the literature since 2001, compared with six between 1978 and 2000, suggesting an increasing interest in this topic. On the basis of the results of the present systematic review, we recommend that asymptomatic children operated on for hypospadias in infancy should have one flow study after toilet training, with that study repeated if the results are abnormal. It appears that early abnormal flows improve spontaneously, so that children operated on after toilet training who are asymptomatic should undergo their first uroflow measurement 1 year after surgery. Children with obstructed flow parameters or borderline flows should be followed until adulthood, until long-term follow up studies clarify the significance of abnormal flow parameters. Given the present findings, we anticipate that in the next two decades urologists will need to treat a number of men with strictures resulting from hypospadias repairs performed in childhood.
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Olsen LH, Grothe I, Rawashdeh YF, Jørgensen TM. Urinary flow patterns in infants with distal hypospadias. J Pediatr Urol 2011; 7:428-32. [PMID: 20598640 DOI: 10.1016/j.jpurol.2010.05.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 05/27/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate preoperative urinary flow patterns in hypospadic infants and compare them to those from normal infant boys. PATIENTS AND METHODS Twenty-one boys (median age 14.0, range 12.8-21.6 months) referred for distal hypospadias surgery were compared to 19 healthy boys (median age 12.0, 9.2-19.8 months). In both groups a 14-mm transit-time ultrasound flow probe mounted around the base of the penis continuously registered uroflow. RESULTS Median maximum flow rate (Q(max)) was significantly lower in hypospadics (2.4 vs 4.4 ml/s, P < 0.01) while there was no difference in the voided volume per micturition (19.0 vs 21.0 ml, P 0.33). Flow curve pattern analysis revealed plateau-shaped curves in 31% of hypospadics compared to none in normal infant boys. Interestingly, dyscoordinated flow curves (interrupted, staccato, spike-dome) were less common in the hypospadics (36% vs 64%, P < 0.01). Meatal size did not correlate to Q(max) (rho = 0.26, P = 0.26). CONCLUSIONS Infants with hypospadias void with a lower Q(max) and a lesser degree of dyscoordination as compared to normal infant boys. It can be speculated that decreased urethral compliance may contribute to the lower Q(max) and may act as a silencer for dyscoordination.
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Affiliation(s)
- L Henning Olsen
- Paediatric Urology, Department of Urology, Aarhus University Hospital - Skejby, 8200 N. Aarhus, Denmark.
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24
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Andersson M, Doroszkiewicz M, Arfwidsson C, Abrahamsson K, Holmdahl G. Hypospadias repair with tubularized incised plate: Does the obstructive flow pattern resolve spontaneously? J Pediatr Urol 2011; 7:441-5. [PMID: 20630805 DOI: 10.1016/j.jpurol.2010.05.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 05/12/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this prospective study was to evaluate whether urinary flow improves with time after tubularized incised plate (TIP) repair. PATIENTS AND METHOD Between 1999 and 2003, primary TIP was performed in 126 boys. In patients old enough (48 boys, mean age at surgery 46 months, range 18-103), uroflowmetry was performed 1 year and 7 (median, range 3-10) years post surgery. Miskolc nomograms were used to compare results from the two follow ups (Q(max) in relation to voided volume and age). RESULTS Eleven boys had symptoms of obstruction resulting in intervention. For the other 37 boys, the mean Q(max) was 13.6 ± 5.6 ml/s 1 year postoperatively (mean voided volume 107 ± 43 ml) and 49% had flows below the 5th percentile. Seven years postoperatively the mean Q(max) was 19.0 ± 8.1 ml/s (mean voided volume 235 ± 112 ml) and 32% had flows below the 5th percentile. In the group with flows below the 5th percentile at 1 year, all improved and 28% improved to above the 25th percentile. Proximal hypospadias was more often associated with obstructive flow than distal (75%/75% compared to 43%/21% 1/7 years postoperatively). CONCLUSION We found spontaneous improvement (P = 0.00022) 7 years after TIP repair, although many boys still had a Q(max) in the low normal or obstructive range.
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Affiliation(s)
- Marie Andersson
- Department of Pediatric Urology, Queen Silvia Children Hospital, The Sahlgrenska Academy, Gothenburg, Sweden.
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25
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Aptness and complications of labial mucosa grafts for the repair of anterior urethral defects in children and adults: single centre experience with 115 cases. World J Urol 2011; 27:799-803. [PMID: 19301012 DOI: 10.1007/s00345-009-0401-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 02/27/2009] [Indexed: 10/21/2022] Open
Abstract
PURPOSE We report a comprehensive review of our experience with labial mucosa graft urethroplasty to evaluate the indications for this kind of substitution urethroplasty, and the possible complications and risk factors for an untoward recipient site outcome both in children and adults. MATERIALS AND METHODS Complications were retrospectively assessed by chart review. Patients with and without complications were compared with respect to age at surgery, indication for surgery (epispadias vs. hypospadias vs. urethral stricture), graft length and configuration (tube vs. patch). Moreover, in cases with urethral stricture a comparison was made according to the level of the stricture (penile vs. bulbar). RESULTS After a median follow-up of 36 (6–90) months, the overall success rate was 66%. Complications were observed in 39 (34%) patients, of whom 18 (16%) required additional surgical procedures. Complications appeared to be unrelated to patient age at surgery, indication for surgery, graft length, and the urethral level of the stricture. Use of the graft as a tube was the single factor significantly more frequent in patients experiencing complications, particularly in the urethral defects associated with hypospadias where use of a tube corresponded to an odd ratio of 5.86 (95% CI 1.5–23.4). CONCLUSIONS Oral grafts harvested from the lower lip are a versatile tissue for the repair of urethral defects associated with either urethral malformations or strictures, both in children and adults. Use of the graft as an on-lay seems preferable particularly in hypospadias repairs.
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26
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Kim KH, Lee HY, Im YJ, Jung HJ, Hong CH, Han SW. Clinical course of vesicoureteral reflux in patients with hypospadias. Int J Urol 2011; 18:521-4. [DOI: 10.1111/j.1442-2042.2011.02777.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pandey A, Gangopadhyay AN, Kumar V, Sharma SP, Gupta DK, Gopal SC. Functional Evaluation of Mid and Distal Penile Hypospadias Surgery with Special Reference to Uroflowmetry. Curr Urol 2011. [DOI: 10.1159/000327473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Gupta L, Sharma S, Gupta DK. Is there a need to do routine sonological, urodynamic study and cystourethroscopic evaluation of patients with simple hypospadias? Pediatr Surg Int 2010; 26:971-6. [PMID: 20625749 DOI: 10.1007/s00383-010-2652-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To study the patients with hypospadias for urinary tract anomalies, bladder functions and the anatomical changes in the urethra, bladder and ureters. PATIENTS AND METHODS 65 cases of untreated hypospadias (14 anterior, 46 mid penile, 5 posterior penile) presenting between 1 and 14 years age were evaluated with ultrasonography, urodynamic study, uroflowmetry and intraoperative cystourethroscopy. RESULTS Ultrasound showed abnormalities in 12/65 (18.46%) with mild unilateral hydronephrosis in 2, bilateral hydroureteronephrosis in 2, small dysplastic kidney in 1, single kidney in 1, epididymal cyst in 1 and cystitis in 5. Urodynamic study performed in 60/65 (narrow meatus in 5) showed median maximum voiding pressure 32 (8-75) cmH(2)O. The median average and maximum urinary flow rates were 7 (1-19) and 11 (5-28) ml/s, respectively. Normal capacity with normal bladder pressure was seen in 34 children (56.6%). 13 children (21.6%) had large capacity bladder with normal pressure. Two children showed large capacity bladder with high pressure, three showed a large capacity with low pressure and small capacity with high pressure was seen in eight children (13.3%). Detrusor over activity was seen in 28 (46%) patients, 11 of these had meatal stenosis. Cystourethroscopy done in 60 revealed 34 abnormalities in 18 (30%) patients (single ureteric orifice in 1, dilatation of unilateral ureteric unilateral in 3 and bilateral in 2, ectopic ureteric orifice in 2, trabeculated bladder in 8, bladder diverticula in 2, prominent vertical ridges in posterior urethra in 2, annular posterior urethral valve in 1, posterior urethral diverticulum in 1, enlarged prostatic utriculus in 4, mucosal tag at verumontanum in 1, prominent cristae in 3, hypertrophied verumontanum in 3 and a small verumontanum in 1). With the hypospadias repair, VUR (Deflux) and bladder abnormalities were also treated. CONCLUSION Preoperative ultrasonography, urodynamic study and cystourethroscopy detect associated abnormalities in children with hypospadias, albeit asymptomatic, irrespective of location of meatus.
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Affiliation(s)
- Lucky Gupta
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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29
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Scarpa MG, Castagnetti M, Berrettini A, Rigamonti W, Musi L. Urinary function after Snodgrass repair of distal hypospadias: comparison with the Mathieu repair. Pediatr Surg Int 2010; 26:519-22. [PMID: 20169443 DOI: 10.1007/s00383-010-2569-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate urinary function in patients with distal hypospadias undergoing repair by the tubularized incised-plate urethroplasty (TIP or Snodgrass), compare the results with those in patients treated by the Mathieu technique, and show the potential issues inherent to the evaluation of such results. PATIENTS AND METHODS A cross-sectional assessment was performed of uncomplicated distal hypospadias operated on during a 3-year period, already toilet trained, and able to void volitionally. Evaluation included clinical assessment urinary symptoms and urinary stream, and uroflowmetry. RESULTS Out of 83 patients operated on during the study period, 10 (12%) developed complication and 32 were not toilet trained or refused to participate in the study. Median follow-up in the remaining 41 patients included in the study was 20 (3-36) months. None of these patients presented voiding symptoms or urinary stream abnormalities. Uroflowmetry was normal in 30 cases and obstructive in 11 (27%). An obstructive flow pattern was more common in patients undergoing TIP versus Mathieu repair, 8 of 19 (42%) versus 3 of 22 (14%), respectively (P = 0.07). Four TIP cases with an obstructive uroflow pattern were managed conservatively. CONCLUSIONS Although both the TIP and the Mathieu repair allow good results in terms of urinary function after distal hypospadias repairs, the TIP technique seems more likely to be associated with urine flow pattern abnormalities. The actual clinical relevance of this finding remains ill defined.
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Purves T, Novak T, King J, Gearhart JP. Modified Young-Dees-Leadbetter bladder neck reconstruction after exstrophy repair. J Urol 2009; 182:1813-7. [PMID: 19692028 DOI: 10.1016/j.juro.2009.03.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Indexed: 10/20/2022]
Abstract
PURPOSE We describe the application and results of modified Young-Dees-Leadbetter bladder neck reconstruction after successful complete primary repair in the newborn period. MATERIALS AND METHODS The records of 34 patients referred for a continence procedure after successful exstrophy closure were extracted from an institutionally approved database. Patient characteristics and surgical outcomes were assessed. RESULTS A total of 31 male and 3 female patients were identified, of whom 27 and 1, respectively, underwent osteotomy at initial closure. No patients attained urinary continence and so they were referred for a continence procedure. Nine patients did not have adequate bladder capacity for bladder neck repair (mean bladder capacity 63 ml, range 20 to 80). In those with suitable capacity mean capacity was 119 ml (range 85 to 180) and they underwent bladder neck reconstruction at a mean age of 4.9 years. Of the 25 patients who underwent bladder neck repair 14 (56%) were dry during the day and night, 5 (20%) were dry during the day but wet at night and 6 (24%) were totally incontinent. Pelvic osteotomies were performed at initial closure in 14 totally continent patients (100%) and in 4 (80%) with daytime continence but in no totally incontinent patients. All continent patients underwent hypospadias repair before age 1 year and none required ureteral reimplantation before bladder neck repair. CONCLUSIONS A number of patients require bladder neck reconstruction to achieve continence after successful initial closure with complete primary repair. The modified Young-Dees-Leadbetter technique provides reasonable results with daytime and nighttime dryness attained by more than half of the patients.
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Affiliation(s)
- Todd Purves
- Division of Pediatric Urology, Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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31
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Dodds PR. Re: The Pediatric Penile Perception Score: An Instrument for Patient Self-Assessment and Surgeon Evaluation After Hypospadias Repair. J Urol 2009; 181:1506; author reply 1506. [DOI: 10.1016/j.juro.2008.11.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Peter R. Dodds
- Department of Surgery, Norwalk Hospital, 34 Maple St., Norwalk, Connecticut 06856
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Kwon T, Song GH, Song K, Song C, Kim KS. Management of Urethral Fistulas and Strictures after Hypospadias Repair. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.1.46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Taekmin Kwon
- Department of Urology, University of Ulsan College of Medicine, Seoul, Korea
| | - Gee Hyun Song
- Department of Urology, University of Ulsan College of Medicine, Seoul, Korea
| | - Kanghyon Song
- Department of Urology, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheryn Song
- Department of Urology, University of Ulsan College of Medicine, Seoul, Korea
| | - Kun Suk Kim
- Department of Urology, University of Ulsan College of Medicine, Seoul, Korea
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Dodds PR, Batter SJ, Shield DE, Serels SR, Garafalo FA, Maloney PK. Adaptation of adults to uncorrected hypospadias. Urology 2008; 71:682-5; discussion 685. [PMID: 18279924 DOI: 10.1016/j.urology.2007.07.078] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Revised: 04/04/2007] [Accepted: 07/02/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Surgery has been advocated for children with hypospadias to improve the appearance of the penis, allow voiding in the standing position, and improve the chance of fertility. We undertook a survey of adults with hypospadias to determine their adaptation to this congenital anomaly without surgical correction. METHODS In a 2-year prospective study, six urologists in the general practice of urology identified 56 adult patients from their practices with hypospadias. The urethral meatus was glanular in 21 patients, subcoronal in 23, distal penile in 7, mid-penile in 4, and proximal penile in 1. Nine patients had undergone failed or incomplete hypospadias repairs as children. Seven patients had mild to moderate chordee. RESULTS Only 1 patient presented with a complaint referable to the hypospadias, and only 3 (5%) of the 56 patients expressed dissatisfaction with the appearance of their penis. Of the 56 patients, 18 (32%) stated that they were unaware that they had a congenital anomaly. The 2 patients who were known to be infertile were believed to be infertile on the basis of oligospermia. Although 20 (36%) of the 56 patients described angulation or spraying of the urinary stream, only 3 (5%) stated that they preferentially sat to void. No patient pursued an interest in corrective surgery. CONCLUSIONS Of the adults we surveyed with hypospadias, most stated that they were satisfied with the appearance of the penis, voided in the standing position, and did not have infertility associated with the abnormal position of the urethral meatus.
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Affiliation(s)
- Peter R Dodds
- Department of Surgery, Norwalk Hospital, Norwalk, Connecticut 06856, USA.
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Sedberry-Ross S, Stisser BC, Henderson CG, Rushton HG, Belman AB. Split prepuce in situ onlay hypospadias repair: 17 years of experience. J Urol 2007; 178:1663-7. [PMID: 17707028 DOI: 10.1016/j.juro.2007.03.198] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE We report our 17-year experience using split prepuce in situ onlay hypospadias repair, including long-term followup of the first 100 patients initially reported on in 1998. MATERIALS AND METHODS We identified 421 patients who underwent in situ onlay repair. Charts were retrospectively reviewed to determine preoperative management, intraoperative details and complications. RESULTS In situ onlay repair was used to repair glanular hypospadias in 22 cases (5.2%), coronal hypospadias in 184 (43.7%), distal shaft hypospadias in 152 (36.1%), mid shaft hypospadias in 51 (12.1%), proximal shaft hypospadias in 7 (1.6%) and hypospadias in the penoscrotal region in 5 (1.2%). Repair was successful with 1 procedure in 376 patients (89.4%), which increased to 99.8% after a second procedure. Complications were defined as any problem that gave the surgeon or family reason for concern. Functional complications requiring reoperation occurred in 45 patients (10.6%). Minor complications requiring simple procedures or early postoperative evaluation occurred in 17 patients (4%). Concerns not requiring intervention occurred in 27 patients (6.4%). There were no urethral strictures. Three patients (0.7%) were lost to followup. Repair is pending in 1 patient. CONCLUSIONS In situ onlay repair preserves the urethral plate and allows the formation of a well vascularized flap with adequate tissue to completely cover the neourethra, resulting in a low rate of major complications. With longer followup, inclusion of more mid shaft repairs and expansion to more proximal degrees of hypospadias our complication rates are higher than previously reported but there have been no urethral strictures in 17 years of experience. Since complications present at a median of 158 days (mean 570) after the procedure, long-term followup is indicated.
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Idzenga T, Kok DJ, Pel JJM, van Mastrigt R, Wolffenbuttel KP. Is the impaired flow after hypospadias correction due to increased urethral stiffness? J Pediatr Urol 2006; 2:299-303. [PMID: 18947625 DOI: 10.1016/j.jpurol.2005.11.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Accepted: 11/14/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE A low flow rate without clinical symptoms is commonly found in boys after hypospadias correction. Urethral calibration usually shows no abnormalities. We investigated whether this impairment might be caused by increased neo-urethral wall stiffness. METHODS From polyvinyl alcohol cryogel two models of the urethra were made, hypospadias and control; both had a constant and equal inner diameter and equal compliance. The hypospadias model had a less compliant distal segment mimicking the distal neo-urethra after hypospadias correction. In both models, flow rate was recorded as a function of bladder pressure. To test whether the length of the less compliant segment had an effect on the flow rate, both models were shortened by cutting off 1-cm segments. RESULTS In a physiological range of bladder pressures (10-130 cmH(2)O) the mean flow rate (+/-1 SEM) in the hypospadias model was 2.8+/-0.3 ml/s, significantly lower (P<0.05) than in the control model (5.4+/-0.6 ml/s). Shortening of the hypospadias model showed some increase in flow rate, but this was not statistically significant. In the control model there was also no significant variation in flow rate. CONCLUSION A low-compliant segment of a urethral model reduced the flow rate. Extrapolating these results to asymptomatic boys with a low urinary flow rate after hypospadias repair might justify a watchful waiting policy.
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Affiliation(s)
- Tim Idzenga
- Department of Urology, Sector Furore, Erasmus MC Rotterdam, The Netherlands.
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