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Evaluation of Double-Faced Tubularized Preputial Flap versus Duckett’s Procedure for Repair of Penoscrotal Hypospadias with Significant Penile Curvature: A Comparative Study. Adv Urol 2022; 2022:6996933. [PMID: 36187436 PMCID: PMC9519334 DOI: 10.1155/2022/6996933] [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: 07/18/2022] [Accepted: 08/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background Proximal hypospadias, with significant curvature, is one of the most challenging anomalies. Great diversity and a large number of procedures described over the last 4 decades confirmed the fact that no single procedure has been universally accepted or successful. So, the aim of this study is to evaluate double-faced tubularized preputial flap (DFPF) versus transverse tubularized inner preputial flap (Duckett's procedure) as regards surgical outcomes, complications rate, and cosmetic results for repair of penoscrotal hypospadias with chordee. Patients and Methods. This was a prospective comparative study on 144 children with primary penoscrotal hypospadias with moderate or severe chordee, conducted at New Damietta and Assuit hospitals, Al-Azhar University, from March 2016 to March 2022. The patients were randomly divided into two equal groups; group A (n = 72) underwent DFPF, and group B (n = 72) underwent Duckett's procedure. Results No significant difference was identified as regards demographic data. The follow-up period ranged from 20 to 66 months (mean of 28 months after DFPF and 31 months after Duckett's repair), and the complication rate was 20.1% (29 of 144 children). There were statistically significant differences between the two groups as regards the urethral stricture, penile rotation, and total complication rate. HOSE score was adopted for assessment of surgical outcomes, urine stream, and cosmetic results. Conclusions The DFPF technique is feasible and reliable for one-stage repair of penoscrotal hypospadias with chordee and can be considered as a good option as it ensures better surgical and cosmetic outcomes with lower incidence of complications.
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Moriya K, Nakamura M, Kon M, Nishimura Y, Kanno Y, Kitta T, Shinohara N. Risk factors affecting post-pubertal high serum follicle-stimulating hormone in patients with hypospadias. World J Urol 2019; 37:2795-2799. [PMID: 30820650 PMCID: PMC6867975 DOI: 10.1007/s00345-019-02687-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 02/15/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose The factors affecting spermatogenesis in adulthood in patients with hypospadias (HS) are not clearly understood. In the present study, risk factors affecting post-pubertal high serum follicle-stimulating hormone (FSH) were evaluated in patients with HS. Materials and methods Among those with a history of HS surgery, patients in whom endocrinological evaluation regarding pituitary–gonadal axis was performed at 15 years of age or older between March 2004 and April 2018 were enrolled in the present study. High serum FSH was defined as greater than 10 mIU/ml. The severity of HS was divided into mild and severe. Factors affecting the post-pubertal high serum FSH were estimated. Results Seventy-nine patients were included in the present study. The severity of HS was mild in 35 and severe in 44. History of undescended testis (UDT) was confirmed in 12. High serum FSH was detected in nine. On logistic regression model analysis, a history of UDT was the only significant factor for high serum FSH. The incidence of high serum FSH in patients with UDT was significantly higher than that in those without UDT (58.3% vs 7.5%, p < 0.01). When stratified by severity of HS and the presence of UDT, high serum FSH was detected in 70% in patients with severe HS and UDT, whereas less than 10% in other groups. Conclusions A history of UDT was a significant factor for post-pubertal high serum FSH in patients with HS. Accordingly, the presence of UDT may be a marker for impaired spermatogenesis in patients with HS, especially in severe cases.
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Affiliation(s)
- Kimihiko Moriya
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo, 060-8638, Japan.
| | - Michiko Nakamura
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Masafumi Kon
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Yoko Nishimura
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Yukiko Kanno
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Takeya Kitta
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo, 060-8638, Japan
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Abstract
Many classifications of hypospadias have been published, mainly based on the position of the ectopic meatus, which is an insufficient criterion to define the severity of this malformation. What really marks the proximal landmark of this malformation is the level of division of the corpus spongiosum, which is always proximal to the ectopic meatus. In this article, we will focus on the most severe forms of hypospadias which include those with a proximal division of corpus spongiosum (below the midshaft), important chordee and a poor development of the ventral radius, reflecting a marked hypovirilization of the genital tubercle, and cripple hypospadias resulting from several previous failed surgical procedures. The principle of hypospadias surgery will be reviewed together with the outcome of the current surgical techniques. Furthermore, common complications will be outlined. There is no minor or major hypospadias and all forms require a solid experience of the surgeon, as minor looking hypospadias may turn out to be far more complex to repair than they appear once the ventral radius of the penis has been dissected.
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Affiliation(s)
- Massimo Catti
- Department of Pediatric Urology, Debrousse Hospital, Claude-Bernard University, Lyon, France
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Kiss A, Sulya B, Szász AM, Romics I, Kelemen Z, Tóth J, Merksz M, Kemény S, Nyírády P. Long-Term Psychological and Sexual Outcomes of Severe Penile Hypospadias Repair. J Sex Med 2011; 8:1529-39. [DOI: 10.1111/j.1743-6109.2010.02120.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Castagnetti M, El-Ghoneimi A. Surgical Management of Primary Severe Hypospadias in Children: Systematic 20-Year Review. J Urol 2010; 184:1469-74. [DOI: 10.1016/j.juro.2010.06.044] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Indexed: 11/24/2022]
Affiliation(s)
- Marco Castagnetti
- Section of Pediatric Urology, Urology Unit, Department of Oncological and Surgical Sciences, University Hospital of Padova, Padua, Italy
| | - Alaa El-Ghoneimi
- Department of Pediatric Surgery and Urology, Hôpital Robert Debré, APHP, University of Paris VII, René Diderot, Paris, France
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Moriya K, Mitsui T, Tanaka H, Nakamura M, Nonomura K. Long-Term Outcome of Pituitary-Gonadal Axis and Gonadal Growth in Patients With Hypospadias at Puberty. J Urol 2010; 184:1610-4. [DOI: 10.1016/j.juro.2010.04.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Kimihiko Moriya
- Department of Urology, Hokkaido University Graduate School of Medicine
| | - Takahiko Mitsui
- Department of Urology, Hokkaido University Graduate School of Medicine
| | - Hiroshi Tanaka
- Department of Urology, Hokkaido University Graduate School of Medicine
| | - Michiko Nakamura
- Department of Urology, Hokkaido University Graduate School of Medicine
| | - Katsuya Nonomura
- Department of Urology, Hokkaido University Graduate School of Medicine
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Long-term sexual activity status and influencing factors in men after surgery for hypospadias. Asian J Androl 2009; 11:417-22. [PMID: 19377489 DOI: 10.1038/aja.2008.60] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to compare the long-term postoperative status of hypospadiac patients by analysing their sexual psychology, sexual behaviour, sexual function and influencing factors. A total of 130 hypospadiac patients hospitalized between January 1988 and December 2007 were followed up with questionnaires using Zung's Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), a self-designed sexual function questionnaire and a 5-item version of the International Index of Erectile Function (IIEF-5). The surveys served to evaluate the effects of hypospadias type, number of operations and surgical procedures on sexual psychology, sexual behaviour and sexual function. The control group consisted of 50 healthy adults. The postoperative SDS / SAS scores and occurrences of depression/anxiety in hypospadiac patients were significantly higher than those of normal controls (P < 0.001). Patients with proximal hypospadias and multiple procedures differed from those with distal hypospadias and a single procedure in all parameters of sexual psychology (P < 0.05). The average penile lengths and circumferences of hypospadiac patients under either erect or flaccid conditions were significantly shorter than those of normal controls (P < 0.001). A similar difference existed between patients with distal and proximal hypospadias (P < 0.01). There was no significant difference in any parameter of sexual function between patients with different numbers of operations and surgical procedures. Hypospadiac patients were clearly impaired in sexual psychology and penile development. The severity of hypospadias and number of operations were key factors that influenced the sexual psychology of patients. This finding indicated the importance of long-term follow-up and psychological counselling for hypospadiac patients postoperatively.
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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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Moriya K, Kakizaki H, Tanaka H, Furuno T, Higashiyama H, Sano H, Kitta T, Nonomura K. Long-Term Cosmetic and Sexual Outcome of Hypospadias Surgery: Norm Related Study in Adolescence. J Urol 2006; 176:1889-92; discussion 1892-3. [PMID: 16945681 DOI: 10.1016/s0022-5347(06)00600-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Indexed: 11/22/2022]
Abstract
PURPOSE Even if performed early in life, hypospadias surgery may have a significant impact on self-esteem and sexual behavior in adolescence. We evaluated the long-term cosmetic and sexual outcomes of hypospadias surgery performed in childhood. MATERIALS AND METHODS A detailed questionnaire was mailed to 33 patients with hypospadias who were 18 to 26 years old and had undergone the first operation at age 6 years or younger. It was also mailed to 50 age matched controls. RESULTS A total of 22 patients (66.7%) and 38 controls (76.0%) returned the questionnaire. Mean age in the hypospadias and control groups was 20.6 and 21.0 years, respectively. Eight of the 22 patients had mild hypospadias and 11 had severe hypospadias. Severity was unknown in 3 patients. Age at the first and final operations was 31 to 75 (mean 46) and 35 to 81 months (mean 53). The number of operation was 1 in 10 patients, 2 in 10 and 3 in 2. The rate of dissatisfaction with penile appearance was slightly higher in the hypospadias group than in the control group (40.9% vs 34.2%). The single reason for dissatisfaction in the hypospadias group was inadequate penile size, whereas in the control group penile size, phimosis and curvature were the major reasons for dissatisfaction (69.2%, 46.2% and 23.1%, respectively). Experience with masturbation (100% and 97.4%) and sexual intercourse (52.4% and 55.3%), and mean age at first masturbation (13.4 and 13.0 years) and first sexual intercourse (16.6 and 17.3 years) were similar in the hypospadias and control groups, respectively. CONCLUSIONS Although patients with hypospadias had a slightly higher rate of dissatisfaction with penile size, their sexual behavior was not different from that in control subjects.
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Affiliation(s)
- Kimihiko Moriya
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15 West-7, Kita-Ku, Sapporo 060-0824, Japan.
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Affiliation(s)
- C R J Woodhouse
- The Institute of Urology and Nephrology, University College London, and The Hospital for Children, Great Ormond Street, London, UK.
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BOEHMER ANNEMIEL, NIJMAN RIENJ, LAMMERS BRIGITTEA, DE CONINCK SJEFJ, VAN HEMEL JANO, THEMMEN AXELP, MUREAU MARCA, DE JONG FRANKH, BRINKMANN ALBERTO, NIERMEIJER MARTINUSF, DROP STENVERTL. ETIOLOGICAL STUDIES OF SEVERE OR FAMILIAL HYPOSPADIAS. J Urol 2001. [DOI: 10.1016/s0022-5347(05)66505-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- ANNEMIE L.M. BOEHMER
- From the Division of Endocrinology, Departments of Pediatrics and Pediatric Urology, Sophia Children’s Hospital, Department of Endocrinology and Reproduction, Erasmus University Rotterdam and Departments of Clinical Genetics, Plastic and Reconstructive Surgery and Internal Medicine III, University Hospital Rotterdam, Rotterdam The Netherlands
| | - RIEN J.M. NIJMAN
- From the Division of Endocrinology, Departments of Pediatrics and Pediatric Urology, Sophia Children’s Hospital, Department of Endocrinology and Reproduction, Erasmus University Rotterdam and Departments of Clinical Genetics, Plastic and Reconstructive Surgery and Internal Medicine III, University Hospital Rotterdam, Rotterdam The Netherlands
| | - BRIGITTE A.S. LAMMERS
- From the Division of Endocrinology, Departments of Pediatrics and Pediatric Urology, Sophia Children’s Hospital, Department of Endocrinology and Reproduction, Erasmus University Rotterdam and Departments of Clinical Genetics, Plastic and Reconstructive Surgery and Internal Medicine III, University Hospital Rotterdam, Rotterdam The Netherlands
| | - SJEF J.F. DE CONINCK
- From the Division of Endocrinology, Departments of Pediatrics and Pediatric Urology, Sophia Children’s Hospital, Department of Endocrinology and Reproduction, Erasmus University Rotterdam and Departments of Clinical Genetics, Plastic and Reconstructive Surgery and Internal Medicine III, University Hospital Rotterdam, Rotterdam The Netherlands
| | - JAN O. VAN HEMEL
- From the Division of Endocrinology, Departments of Pediatrics and Pediatric Urology, Sophia Children’s Hospital, Department of Endocrinology and Reproduction, Erasmus University Rotterdam and Departments of Clinical Genetics, Plastic and Reconstructive Surgery and Internal Medicine III, University Hospital Rotterdam, Rotterdam The Netherlands
| | - AXEL P.N. THEMMEN
- From the Division of Endocrinology, Departments of Pediatrics and Pediatric Urology, Sophia Children’s Hospital, Department of Endocrinology and Reproduction, Erasmus University Rotterdam and Departments of Clinical Genetics, Plastic and Reconstructive Surgery and Internal Medicine III, University Hospital Rotterdam, Rotterdam The Netherlands
| | - MARC A.M. MUREAU
- From the Division of Endocrinology, Departments of Pediatrics and Pediatric Urology, Sophia Children’s Hospital, Department of Endocrinology and Reproduction, Erasmus University Rotterdam and Departments of Clinical Genetics, Plastic and Reconstructive Surgery and Internal Medicine III, University Hospital Rotterdam, Rotterdam The Netherlands
| | - FRANK H. DE JONG
- From the Division of Endocrinology, Departments of Pediatrics and Pediatric Urology, Sophia Children’s Hospital, Department of Endocrinology and Reproduction, Erasmus University Rotterdam and Departments of Clinical Genetics, Plastic and Reconstructive Surgery and Internal Medicine III, University Hospital Rotterdam, Rotterdam The Netherlands
| | - ALBERT O. BRINKMANN
- From the Division of Endocrinology, Departments of Pediatrics and Pediatric Urology, Sophia Children’s Hospital, Department of Endocrinology and Reproduction, Erasmus University Rotterdam and Departments of Clinical Genetics, Plastic and Reconstructive Surgery and Internal Medicine III, University Hospital Rotterdam, Rotterdam The Netherlands
| | - MARTINUS F. NIERMEIJER
- From the Division of Endocrinology, Departments of Pediatrics and Pediatric Urology, Sophia Children’s Hospital, Department of Endocrinology and Reproduction, Erasmus University Rotterdam and Departments of Clinical Genetics, Plastic and Reconstructive Surgery and Internal Medicine III, University Hospital Rotterdam, Rotterdam The Netherlands
| | - STENVERT L.S. DROP
- From the Division of Endocrinology, Departments of Pediatrics and Pediatric Urology, Sophia Children’s Hospital, Department of Endocrinology and Reproduction, Erasmus University Rotterdam and Departments of Clinical Genetics, Plastic and Reconstructive Surgery and Internal Medicine III, University Hospital Rotterdam, Rotterdam The Netherlands
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13
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Abstract
An infant born with ambiguous genitalia requires an accurate and prompt diagnosis so that a management plan can be formulated. This article discusses the signaling cascade of genes that controls sexual differentiation. Clinical disorders involving sex reversal or ambiguous genitalia are discussed in relation to the genes regulating sexual development. An approach to the treatment of these disorders is outlined.
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Affiliation(s)
- G L Warne
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Victoria, Australia
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Etiologic Classification of Severe Hypospadias. J Urol 1998. [DOI: 10.1097/00005392-199804000-00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Albers N, Ulrichs C, Gluer S, Hiort O, Sinnecker F, Mildenberger H, Brodehl J. Etiologic Classification of Severe Hypospadias: Implications for Prognosis and Management. J Urol 1998. [DOI: 10.1016/s0022-5347(01)63642-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- N. Albers
- Department of Pediatrics, University of Bonn, Departments of Pediatric Nephrology and Metabolic Diseases, and Pediatric Surgery, Medical School Hannover, Hannover and Department of Pediatrics, Medical University of Lubeck, Lubeck, Germany
| | - C. Ulrichs
- Department of Pediatrics, University of Bonn, Departments of Pediatric Nephrology and Metabolic Diseases, and Pediatric Surgery, Medical School Hannover, Hannover and Department of Pediatrics, Medical University of Lubeck, Lubeck, Germany
| | - S. Gluer
- Department of Pediatrics, University of Bonn, Departments of Pediatric Nephrology and Metabolic Diseases, and Pediatric Surgery, Medical School Hannover, Hannover and Department of Pediatrics, Medical University of Lubeck, Lubeck, Germany
| | - O. Hiort
- Department of Pediatrics, University of Bonn, Departments of Pediatric Nephrology and Metabolic Diseases, and Pediatric Surgery, Medical School Hannover, Hannover and Department of Pediatrics, Medical University of Lubeck, Lubeck, Germany
| | - F.H.G. Sinnecker
- Department of Pediatrics, University of Bonn, Departments of Pediatric Nephrology and Metabolic Diseases, and Pediatric Surgery, Medical School Hannover, Hannover and Department of Pediatrics, Medical University of Lubeck, Lubeck, Germany
| | - H. Mildenberger
- Department of Pediatrics, University of Bonn, Departments of Pediatric Nephrology and Metabolic Diseases, and Pediatric Surgery, Medical School Hannover, Hannover and Department of Pediatrics, Medical University of Lubeck, Lubeck, Germany
| | - J. Brodehl
- Department of Pediatrics, University of Bonn, Departments of Pediatric Nephrology and Metabolic Diseases, and Pediatric Surgery, Medical School Hannover, Hannover and Department of Pediatrics, Medical University of Lubeck, Lubeck, Germany
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Svensson H, Reychman M, Troëng T, Aberg M. Staged reconstruction of hypospadias with chordee: outcome and costs. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 1997; 31:51-5. [PMID: 9075288 DOI: 10.3109/02844319709010505] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
One-hundred-and-forty patients with hypospadias and chordee were reviewed from the points of view of surgical results and hospital costs. Ninety cases constituted a historical series, and 50 patients a current personal series. All were operated on by Byars' two-staged protocol with release of the chordee followed by urethral reconstruction. Complementary surgery was necessary in a total of 37 instances, particularly in cryptohypospadias with tight chordee and in penoscrotal hypospadias. Increasing personal experience with the operative technique has gradually reduced the need for such procedures. The final results were satisfactory in all but one patient, who has had recurring strictures. The hospital cost for a patient according to basic assumptions was 100,280 SEK (about US$ 14,000). If the time in operating theatre could be shortened by 10 minutes, the stay in hospital reduced by one day, and the complication rate halved, the overall cost would be reduced by 14.3%. Consequently we believe that staged reconstruction remains an attractive alternative in cases of hypospadias with marked curvation of the penis.
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Affiliation(s)
- H Svensson
- Department of Plastic and Reconstructive Surgery, Malmö University Hospital, Sweden
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Abstract
PURPOSE To report the complication rates after hypospadias surgery, with stratification according to the type of suture used for the urethral anastomosis (rapid/intermediate absorbable v prolonged absorbable.) MATERIAL AND METHODS During a 7-year period (1986 to 1992), 117 boys aged 5 to 124 months (mean, 14) underwent surgical correction of hypospadias. The urethral anastomoses were performed with chromic sutures before 1987 (n = 15), with polydioxanone (PDS) between 1987 and 1990 (n = 46), and with polyglycolic acid (PgA) after 1990 (n = 56). The patients were separated into two groups: those whose operations were performed before 1987 and after 1990 (using chromic or PgA sutures), and those whose surgery occurred in the intervening 3 years (using PDS). A successful result was defined as good cosmesis without urethral stricture or urethrocutaneous fistula on long-term follow up (mean follow-up period, 15.9 months). RESULTS Of the cases that had PgA or chromic sutures, 76.1% were corrected in a single operation, as opposed to 50.9% when PDS was used (P = .002). In the chromic/PgA group, 6.8% had strictures, compared with 23.6% of the PDS group (P < .02). This contrast was most evident in cases with pedicled tube flaps; strictures occurred in 43.8% of the PDS group but in only 9.5% of the chromic/ PgA group (P < .02). There was no significant difference in the incidence of postoperative fistulas between the two groups. In some patients, the PDS sutures remained present in the urethra, without absorption, up to 7 months after the initial repair. CONCLUSION Sutures with rapid or intermediate absorption rates provide the best results for hypospadias surgery. The extreme delay in in vivo absorption of polydioxanone should preclude its use as an interrupted suture in small-caliber urethral anastomoses.
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Affiliation(s)
- M DiSandro
- Department of Urology, University of California, Davis, School of Medicine, Sacramento 95817, USA
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Mureau MA, Slijper FM, Slob AK, Verhulst FC, Nijman RJ. Satisfaction with Penile Appearance after Hypospadias Surgery: The Patient and Surgeon View. J Urol 1996. [DOI: 10.1016/s0022-5347(01)66504-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Marc A.M. Mureau
- Departments of Child and Adolescent Psychiatry and Pediatric Urology, Sophia Children's Hospital, University Hospital Rotterdam, Department of Plastic and Reconstructive Surgery, Dijkzigt Hospital, and Department of Endocrinology and Reproduction, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, The Netherlands
| | - Froukje M.E. Slijper
- Departments of Child and Adolescent Psychiatry and Pediatric Urology, Sophia Children's Hospital, University Hospital Rotterdam, Department of Plastic and Reconstructive Surgery, Dijkzigt Hospital, and Department of Endocrinology and Reproduction, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, The Netherlands
| | - A. Koos Slob
- Departments of Child and Adolescent Psychiatry and Pediatric Urology, Sophia Children's Hospital, University Hospital Rotterdam, Department of Plastic and Reconstructive Surgery, Dijkzigt Hospital, and Department of Endocrinology and Reproduction, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, The Netherlands
| | - Frank C. Verhulst
- Departments of Child and Adolescent Psychiatry and Pediatric Urology, Sophia Children's Hospital, University Hospital Rotterdam, Department of Plastic and Reconstructive Surgery, Dijkzigt Hospital, and Department of Endocrinology and Reproduction, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, The Netherlands
| | - Rien J.M. Nijman
- Departments of Child and Adolescent Psychiatry and Pediatric Urology, Sophia Children's Hospital, University Hospital Rotterdam, Department of Plastic and Reconstructive Surgery, Dijkzigt Hospital, and Department of Endocrinology and Reproduction, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, The Netherlands
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Mureau MAM, Slijper FME, Nijman RJM, van der Meulen JC, Verhulst FC, Slob AK. Psychosexual Adjustment of Children and Adolescents After Different Types of Hypospadias Surgery. J Urol 1995. [DOI: 10.1097/00005392-199511000-00094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mureau MA, Slijper FM, Nijman RJ, van der Meulen JC, Verhulst FC, Slob AK. Psychosexual Adjustment of Children and Adolescents After Different Types of Hypospadias Surgery: A Norm-related Study. J Urol 1995. [DOI: 10.1016/s0022-5347(01)66823-x] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Marc A.M. Mureau
- Departments of Child and Adolescent Psychiatry and Pediatric Urology, Sophia Children's Hospital and Department of Plastic and Reconstructive Surgery, "Dijkzigt" Hospital, University Hospital Rotterdam, and Department of Endocrinology and Reproduction, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Froukje M.E. Slijper
- Departments of Child and Adolescent Psychiatry and Pediatric Urology, Sophia Children's Hospital and Department of Plastic and Reconstructive Surgery, "Dijkzigt" Hospital, University Hospital Rotterdam, and Department of Endocrinology and Reproduction, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Rien J.M. Nijman
- Departments of Child and Adolescent Psychiatry and Pediatric Urology, Sophia Children's Hospital and Department of Plastic and Reconstructive Surgery, "Dijkzigt" Hospital, University Hospital Rotterdam, and Department of Endocrinology and Reproduction, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jacques C. van der Meulen
- Departments of Child and Adolescent Psychiatry and Pediatric Urology, Sophia Children's Hospital and Department of Plastic and Reconstructive Surgery, "Dijkzigt" Hospital, University Hospital Rotterdam, and Department of Endocrinology and Reproduction, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Frank C. Verhulst
- Departments of Child and Adolescent Psychiatry and Pediatric Urology, Sophia Children's Hospital and Department of Plastic and Reconstructive Surgery, "Dijkzigt" Hospital, University Hospital Rotterdam, and Department of Endocrinology and Reproduction, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - A. Koos Slob
- Departments of Child and Adolescent Psychiatry and Pediatric Urology, Sophia Children's Hospital and Department of Plastic and Reconstructive Surgery, "Dijkzigt" Hospital, University Hospital Rotterdam, and Department of Endocrinology and Reproduction, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Bentvelsen FM, Brinkmann AO, van der Linden JE, Schröder FH, Nijman JM. Decreased immunoreactive androgen receptor levels are not the cause of isolated hypospadias. BRITISH JOURNAL OF UROLOGY 1995; 76:384-8. [PMID: 7551853 DOI: 10.1111/j.1464-410x.1995.tb07719.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To elucidate whether diminished levels of androgen receptor (AR) are the underlying cause for the development of hypospadias by determining AR levels in the foreskins of boys with hypospadias. PATIENTS AND METHODS The content of AR was determined by a sensitive immunoblotting technique in extracts from preputial tissue obtained from 15 patients (mean age 2.5, SD +/- 1.5 years) with hypospadias and from seven controls (mean age 2.5, SD +/- 1.5 years). Immunoreactivity of the protein was measured by densitometry. RESULTS No significant difference in mean AR content was found between those boys with hypospadias (2.1 +/- 0.9 fmol/mg protein, +/- SD) and the age-matched control group (2.2 +/- 0.3 fmol/mg protein). Stratification by the severity of hypospadias (distal and proximal on the shaft, and penoscrotal hypospadias) showed that the severity was not related to tissue AR levels. CONCLUSION It is unlikely that hypospadias is caused by a decreased expression of AR.
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Affiliation(s)
- F M Bentvelsen
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus University of Rotterdam, The Netherlands
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Sandberg DE, Meyer-Bahlburg HF, Yager TJ, Hensle TW, Levitt SB, Kogan SJ, Reda EF. Gender development in boys born with hypospadias. Psychoneuroendocrinology 1995; 20:693-709. [PMID: 8848516 DOI: 10.1016/0306-4530(95)00025-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fetal testicular androgens in several mammalian species are responsible for the sexual differentiation of both the genitalia and the brain, the latter effect being related to behavioral sex-dimorphisms. Because prenatal endocrine abnormalities can be inferred from genital defects, studies of individuals born with anomalies potentially elucidate the contribution of androgens to the development of gender-related variation in human behavior. This study concerns the gender-role behavior of middle childhood boys (ages 6-10 years; n = 175) born with hypospadias, an androgen-related genital anomaly. Parents completed standardized gender behavior questionnaires in a postal survey. Hypospadias subjects did not show consistent differences from a community control group (n = 333) in feminine behavior, but significant, small, increases in masculine behavior were found. Severity of the hypospadias was unrelated to gender-role behavior. A number of surgery-related hospitalizations, however, were correlated with increased gender-atypical behavior. It is concluded that the hypoandrogenization associated with hypospadias does not interfere with the development of gender-typical masculine behavior.
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Affiliation(s)
- D E Sandberg
- Department of Psychiatry, State University of New York at Buffalo, USA
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