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Vu TH, Viet Nguyen H, Quy Hong Q, Quang Pham H, Thanh Pham T, Hai Do Đ, Đo Truong T. Results of the one-stage proximal hypospadias repair with modified Koyanagi technique: A prospective cohort study in a single Vietnam centre. Ann Med Surg (Lond) 2021; 71:103012. [PMID: 34840761 PMCID: PMC8606834 DOI: 10.1016/j.amsu.2021.103012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 10/30/2021] [Accepted: 10/31/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Proximal hypospadias is the most severe type of hypospadias. Our approach to Koyanagi technique for proximal hypospadias aims to improve the blood supply to the neourethral flaps and reduce meatal complications. Methods Our prospective study included 75 patients who were operated for proximal hypospadias by our Koyanagi technique at Viet Duc hospital between January 2019 and December 2020. The clinical information obtained included a detailed medical history; preoperative, intraoperative, and postoperative data; short-term outcomes by the HOSE score were evaluated by a different physician. Results The mean (range) age was 3.59 ± 2.41 years (1.5–14), 86.7% under 5 years old. There are 31 penoscrotal, 31 scrotal, and 13 perineal hypospadias. The length of the neourethra ranged from 3.5 to 8 cm, mean 5.02 ± 0.88 cm. Evaluation of the surgeon at 6 months after surgery: primary success 81.3%. Complications occurred in 14 cases (18.7%), included 10 urethrocutaneous fistula and 4 dehiscence of the urethra. No cases of meatal stenosis or recession, urethral stricture, urethral diverticula. The mean HOSE score was found to be 14.47 ± 1.35, ranged 11 to 16. 57 patients (76%) had a total HOSE 14 and above and 18 patients had score below 14 (24%) Conclusion Our modified Koyanagi technique give us a good result for one-stage reconstruction of proximal hypospadias. Applying the HOSE score makes postoperative evaluation of hypospadias more objective and reliable. Proximal hypospadias is one of the most challenging conditions. Modified Koyanagi techniques improve the blood supply to the neourethral flaps. The HOSE score is an objective appraisal of the outcome of hypospadias repair.
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Affiliation(s)
- Tuan Hong Vu
- Department of Pediatric Surgery, Viet Duc Hospital, 40 TrangThi, Hoankiem, Hanoi, Viet Nam
- Department of General Surgery, Hanoi Medical University, Viet Nam
- Corresponding author. Department of Pediatric surgery, Viet Duc hospital, No. 40, Trangthi street, Hoankiem district, Hanoi, 100000, Viet Nam. Tel.: +84916123602.
| | - Hoa Viet Nguyen
- Department of Pediatric Surgery, Viet Duc Hospital, 40 TrangThi, Hoankiem, Hanoi, Viet Nam
| | - Quan Quy Hong
- Department of Pediatric Surgery, Viet Duc Hospital, 40 TrangThi, Hoankiem, Hanoi, Viet Nam
| | - Hung Quang Pham
- Department of Pediatric Surgery, Viet Duc Hospital, 40 TrangThi, Hoankiem, Hanoi, Viet Nam
- Department of General Surgery, Hanoi Medical University, Viet Nam
| | - Tung Thanh Pham
- Department of General Surgery, Hanoi Medical University, Viet Nam
| | - Đang Hai Do
- Department of General Surgery, Hanoi Medical University, Viet Nam
| | - Thanh Đo Truong
- Department of General Surgery, Hanoi Medical University, Viet Nam
- Department of Urology, Viet Duc Hospital, 40 TrangThi, Hoankiem, Hanoi, Viet Nam
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Koyanagi urethroplasty for proximal hypospadias: A stage procedure? Prog Urol 2021; 32:312-318. [PMID: 34688536 DOI: 10.1016/j.purol.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To report experience and technical refinements with the Koyanagi urethroplasty for proximal hypospadias. METHODS A retrospective study was conducted between 2004 and 2017. Medical records of patients treated by the Koyanagi technique were investigated. The penile ventral skin was closed either with a Byars flap or using an "Ombredanne's chasuble" (OC). The cohort was divided chronologically into two groups of the same number of patients (early -E- and late experience group-LEG-). Demographics, anatomical findings and surgical outcomes were compared between groups using univariate analysis. A logistic regression was performed to assess factors associated with the occurrence of a postoperative urethrocutaneous fistula or urethroplasty dehiscence (UD). RESULTS The Koyanagi urethroplasty was performed in 67 patients, 33 in the EEG and 34 in the LEG. The overall surgical complication rate was 64.2% (n=43), including 42 fistula or UD, higher in the EEG (81.8%) than in the LEG (44.1%, P<0.01). However, in the LEG, patients underwent the surgery older and the use of OC more frequent. After multivariate analyses, factors associated with a postoperative fistula or UD were the year of surgery (OR=0.71 [0.53-0.96] P=0.02), the age at surgery (OR=1.11 [1.01-1.22], P=0.03); contrary to the skin coverage method or the stenting duration (P>0.05). An urethral stenosis occurred in 1 patient (1.5%). At last follow-up, 64.2% of patients required a further procedure and 80.6% of urethral meatus were glandular. CONCLUSION In this study the complication rate, particularly the urethrocutaneous fistula, remained high. Urethral stenosis, were rare but the follow-up was too short to clearly identified them. Considering as a 2 stage procedure koyanagi uretroplasty allows to obtain finally good results. LEVEL OF EVIDENCE III.
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Misra D, Elbourne C, Vareli A, Banerjee D, Joshi A, Friedmacher F, Skerritt C. Challenges in managing proximal hypospadias: A 17-year single-center experience. J Pediatr Surg 2019; 54:2125-2129. [PMID: 31079867 DOI: 10.1016/j.jpedsurg.2019.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND There are only a few publications in the medical literature reporting on complication rates in proximal hypospadias surgery, particularly with regard to long-term follow-up. METHODS Over a 17.5-year period, we operated 100 patients with penoscrotal, scrotal and perineal hypospadias. Sixty-four had a single-stage repair, including 15 who received a buccal mucosa inlay "Snodgraft" repair. Thirty-six had a two-stage Bracka repair of which 19 received buccal or lower lip grafts and 17 had preputial grafts. Overall, 34 patients received buccal grafts. The median follow-up was eight years (range 1-16 years). Three patients were operated for residual chordee years later. RESULTS Urethral fistulae occurred in a total of 26/100 (26.0%) cases, meatal stenosis in 16/100 (16.0%), wound breakdown in six (6.0%) and graft failure in one (1.0%). The fistula rate after the single-stage approach was 15/64 (23.4%), whereas it was 11/36 (30.6%) following two-stage repair (P = 0.4811). CONCLUSIONS Proximal hypospadias remains a challenging condition to treat. It is possible to perform a single-stage repair in 64.0% of cases. This brings down the median number of operations to only two. Lower lip grafts were used in 34.0% but are now used in redo-surgeries only. Our fistula rate was 26.0% but has decreased significantly in recent years. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Devesh Misra
- Department of Paediatric Urology and Paediatric Surgery, The Royal London Hospital, London, United Kingdom.
| | - Ceri Elbourne
- Department of Paediatric Urology and Paediatric Surgery, The Royal London Hospital, London, United Kingdom
| | - Anastasia Vareli
- Department of Paediatric Urology and Paediatric Surgery, The Royal London Hospital, London, United Kingdom
| | - Debasish Banerjee
- Department of Paediatric Urology and Paediatric Surgery, The Royal London Hospital, London, United Kingdom
| | - Ashwini Joshi
- Department of Paediatric Urology and Paediatric Surgery, The Royal London Hospital, London, United Kingdom
| | - Florian Friedmacher
- Department of Paediatric Urology and Paediatric Surgery, The Royal London Hospital, London, United Kingdom
| | - Clare Skerritt
- Department of Paediatric Urology and Paediatric Surgery, The Royal London Hospital, London, United Kingdom
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Hadidi AT. Perineal hypospadias: back to the future Chordee Excision & Distal Urethroplasty. J Pediatr Urol 2018; 14:424.e1-424.e9. [PMID: 30297228 DOI: 10.1016/j.jpurol.2018.08.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 08/11/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Perineal hypospadias correction has swung from two-stage repair in the 1960s to one-stage repair in the 1980s and back to two-stage repair in the 2000s. The author's experience with a technique in which Chordee Excision and Distal Urethroplasty (CEDU) was performed at the first operation leaving a 1-cm segment as perineal urethrotomy to be reconstructed at the second operation is presented. PATIENTS AND METHODS Between January 2013 and December 2016, the CEDU technique was performed in 63 patients with perineal hypospadias. The records of 59 patients who maintained regular follow-up were reviewed. The principle is to excise the hypoplastic urethral plate, atretic corpus spongiosum, and longitudinal layer of tunica albuginea; split the glans in the midline; and reconstruct a healthy urethral plate using preputial and lateral skin flaps to the tip of the glans. Distal urethroplasty was performed leaving 1 cm at the proximal end to be reconstructed 3-6 months later. This principle was used by Duplay in the 1880s. Patient age ranged between 6 months and 2 years (mean 8 months). All the patients had perineal hypospadias and bifid scrotum with severe deep chordee. Follow-up period ranged from 17 to 53 months (mean 36). A transurethral Silastic catheter was inserted for 4 days. Three months later, the remaining 1 cm of the new urethra was reconstructed, and final adjustment of the glans and foreskin was performed. RESULTS Satisfactory results were obtained in 54 patients (90%). Three children experienced glans dehiscence that was corrected in the second stage, one child developed fistula after the second operation, and one developed diverticulum. The fistula and diverticulum were corrected at the third operation successfully. DISCUSSION It was necessary in this series to divide the urethral plate and excise the hypoplastic corpus spongiosum and the outer longitudinal layer of tunica albuginea to correct the associated deep chordee. The lateral skin flaps receive double blood supply from the base of the penis and the preputial vessels. This natural urinary diversion allows early removal of the catheter, reduces the discomfort of the patient, and allows the new urethra to heal without urine irritation for 3 months. Long-term follow-up for 15 years is necessary to assess the technique objectively. CONCLUSIONS The CEDU technique diverts urine away from the site of urethroplasty for 3 months without a catheter. It reduces the hospital stay and patient discomfort. It produces satisfactory results and has become a the standard technique in perineal hypospadias.
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Affiliation(s)
- A T Hadidi
- Hypospadias Centre, Department of Pediatric Surgery, Emma and Sana Klinikum Offenbach Hospitals, Germany.
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Elsaied A. Onlay urethroplasty with unilatreral parameatal penopreputial flap. ANNALS OF PEDIATRIC SURGERY 2018. [DOI: 10.1097/01.xps.0000527069.15885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Acimi S. What is the pathogenesis of proximal hypospadias? Turk J Urol 2018; 44:357-361. [PMID: 29799398 DOI: 10.5152/tud.2018.85530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 12/23/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To report the information concerning the pathogenesis of proximal hypospadias and causes of curvature associated with it. MATERIAL AND METHODS From January 2009 to December 2015, 74 patients underwent repair of proximal hypospadias. In 70 patients we performed a systematic biopsies in the lateral areas of the urethral plate, as well as under this plate. The study of the histological structure of these areas was performed using routine staining with hematoxylin and eosin, and the Masson's trichrome which color the collagen fibers in blue and monoclonal antibody against alpha-smooth muscle actin. RESULTS This prospective study shows that the fibrotic tissue abnormally present on the ventral side of the penis consists of a mixture of fibrous connective tissue, nerve nets, short vessels, and smooth muscle fibers. In contrast to the scrotal dartos, penile dartos fascia does not contain smooth muscle fibers. Therefore, these fibers may come from a blood vessel or spongy tissue which existed during neonatal period in the distal part of the penis before disappearing. In addition, in 13 cases, the presence downstream of the urethral meatus, of a bifurcation of corpus spongiosum into two branches supposes that the corpus spongiosum is form by fusion around the urethra of two mesenchymal bodies. The arterial supply of this purely masculine formation originates from a new vascularization and it is probably, developed under secretion of androgens (angiogenic substances in target tissues). CONCLUSION These findings allow us to suggest that the proximal hypospadias is due to avascular necrosis of the distal part ie. poorly vascularized part of the corpus spongiosum.
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Affiliation(s)
- Smail Acimi
- Department of Visceral Surgery, Children hospital Canastel, Faculty of Medicine, University of Oran, Oran, Algeria
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Abstract
PURPOSE To know the limits of the preservation of the urethral plate in the correction of the curvature associated with proximal hypospadias. METHODS From January 2002 to January 2015, we treated 224 patients of proximal hypospadias. In 182 cases, we used of the lateral pictures taken during the successive saline erection tests to measure the correction obtained after each stage. RESULTS The analysis of the lateral pictures taken at the successive saline erection tests clearly demonstrated that release of the skin and dartos fascia provides an important correction of the chordee. This correction is complete of all curvature lower than 45 degrees and in 3 fourths of cases for curvatures between 45 and 90 degrees. However, for angles 90 degree and more, the release of the skin and dartos fascia was insufficient in more than 73.7% of cases. And the mobilization of the urethral plate with resection of the underlying fibrous tissue realized gives a very low correction of the chordee (0-20 degrees). CONCLUSIONS The essential factor responsible of curvature associated with proximal hypopsadias is the fibrosis tissue present on the ventral side of the penis. However, in the severe forms, a short urethral plate must be transected to obtain a complete correction of the chordee.
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Koyanagi T. ACU lecture: One-stage hypospadias repair - Future is Asia the East. Int J Urol 2018; 25:314-317. [PMID: 29577435 DOI: 10.1111/iju.13548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/13/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Tomohiko Koyanagi
- Hokkaido University, Sapporo, Hokkaido, Japan.,Jinyukai Hospital, Sapporo, Hokkaido, Japan
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Abstract
UNLABELLED The evolution of hypospadias surgery can be classified under 3 periods that were closely related to advances in surgical instruments, introduction of anesthesia, and newer suture materials. Stretching dominated the early period, tunneling during the Middle Ages, and flaps during the modern period. Suture materials have included at various time silver wires, horsehair, and stainless steel. Examination and translation of the original manuscripts showed that Galen recommended stretching and suturing of glanular hypospadias and not amputation or partial penectomy as has been currently reported. The term chordee was first introduced in the 18th century in relation to gonorrhea and was defined as "painful imperfect erection of the penis during gonorrhea, with downward incurvation." This was a common complication of gonorrhea before the introduction of antibiotics. Mettauer, Duplay, Mayo, and others used the terms incurvation, ventral deformity, ventral curvature, and others. Clinton Smith in 1938 was the first surgeon to use the term congenital chordee in direct relation to hypospadias. The use of prepuce for urethroplasty, popular now, was first reported by Liston in 1838, Rochet in 1899, Russell in 1900, and Mayo in 1901. The two stage repair performed in the early 20th century differed from that in the early 21st century in that urethroplasty was performed in the first stage and only anastomosis to the original meatus was performed in the second stage. The two-stage repair, currently known as Bracka's two-stage repair, was first described in 1962 by Cloutier. The use of the urethral plate in epispadias was first described by Liston in 1838, Thiersch in 1869 and by Anger & Duplay in hypospadias in 1874. Partially epithelialized urethroplasty using the urethral plate was described by Duplay in 1880, Russell 1915, Denis Browne 1940, Reddy 1975, Orkiszewski 1987, Rich 1989, and Snodgrass in 1994. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Ahmed T Hadidi
- Hypospadias Centre, Department of Pediatric Surgery, Emma and Offenbach Hospitals, Offenbach, Germany.
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Acimi S. Commentary: Management of High-Grade Penile Curvature Associated with Hypospadias in Children. Front Pediatr 2017; 5:261. [PMID: 29270397 PMCID: PMC5725401 DOI: 10.3389/fped.2017.00261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/23/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Smail Acimi
- Visceral Surgery, Children's Hospital Canastel, University of Oran, Oran, Algeria
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Two-stage graft urethroplasty for proximal and complicated hypospadias in children: A retrospective study. J Pediatr Urol 2016; 12:286.e1-286.e7. [PMID: 27020542 DOI: 10.1016/j.jpurol.2016.02.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/18/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Although two-stage graft urethroplasty is widely used, the literature regarding the complication rates and functional characteristics of reconstructed neourethra is relatively modest. OBJECTIVES The aim was to analyze the complication rates and uroflow data of boys who have previously undergone a two-stage graft urethroplasty procedure for proximal and complicated hypospadias. PATIENTS AND METHODS We retrospectively reviewed the clinical outcomes of 52 boys with proximal (n = 44) and complicated (n = 8) hypospadias who underwent two-stage graft urethroplasty repair (median age of 15 months and 3 years respectively) between 2004 and 2015. Fifteen toilet-trained boys without fistulas underwent uroflowmetry. The uroflow data were plotted on age-volume-dependent normograms with normal controls. The median follow-up was 34 months (8 months-8 years). RESULTS AND COMPLICATIONS Complications were identified in three patients (6%) after the first stage (i.e. contracture of the graft) and in 20 patients (38.4%) after the second stage, including meatal stenosis (n = 8, 15.3%), urethral stricture (n = 4, 7.6%), urethrocutaneous fistula (n = 8, 15.3%), glandular dehiscence (n = 1, 1.9%), and diverticulum (n = 1, 1.9%). The patients with failed hypospadias experienced fewer complications than those who underwent the two-stage procedure for primary repair (25% and 45%, respectively). The reoperation rate was 36.8%. Eleven of the 15 toilet-trained boys were asymptomatic but exhibited flow rates below the normal range (median Qmax = 7 mL/s, range 3.5-16.7). Only one of the boys with a low flow rate was confirmed to have urethral stenosis under general anesthesia. DISCUSSION In our study, primary hypospadias repair requiring urethral plate transection elicited worse outcomes than those observed in the prior failed hypospadias cases. However, because of our study's retrospective design, we were unable to accurately assess the initial position of the meatus in the redo hypospadias cases. Our data also demonstrated that the majority of cases without any voiding symptoms exhibited flow rates that were below the normal range despite no urethral stricture under general anesthesia. These findings indicate that urethras reconstructed via two-stage graft urethroplasty repair are not functionally equivalent to normal urethras, at least prior to puberty. CONCLUSION Two-stage graft urethroplasty repair was successful in 62% of cases after the second-stage procedure, but one-third of the boys required a reoperation after the two-stage planned repair. We demonstrated that although we used a urethral tissue substitute, the urine flow patterns of the patients without strictures were abnormal.
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A New Modification of the Koyanagi Technique for the One-stage Repair of Severe Hypospadias. Urology 2016; 93:175-9. [PMID: 27041473 DOI: 10.1016/j.urology.2016.03.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 03/09/2016] [Accepted: 03/17/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To describe a new modification of the Koyanagi technique for the one-stage repair of severe hypospadias and its short-term outcomes. PATIENTS AND METHODS Our modified Koyanagi technique was performed in 24 patients with severe hypospadias between February 2012 and January 2015. The age of the patients ranged from 1.9 to 11.9 years (mean = 3.5 years). The flap design was similar to the Koyanagi technique, but our modified technique highlighted the following points: after the chordee was completely corrected, the urethral plate was recreated using foreskin, and then a U-shaped incision was made on the original and recreated urethral plate (as in the Duplay technique); a pedicled flap of the tunica vaginalis or scrotal dartos was used for additional coverage of the neourethra. RESULTS The operation time lasted from 120 to 150 minutes (mean = 140 minutes). There were 5 patients (20.8%) who developed complications: 4 patients (16.7%) developed a fistula and 1 patient (4.2%) developed dehiscence of the urethra. There were no reported urethral strictures, meatal stenosis, or urethral diverticula. The complications in the 5 patients were successfully addressed with secondary repair, and all patients achieved satisfactory cosmetic and urethral functional results. CONCLUSION The modified Koyanagi technique simplified the operation and better preserved the blood supply to the flap. The additional coverage of the neourethra using a pedicled flap of the tunica vaginalis or scrotal dartos significantly decreased the rate of fistula formation. This technique is highly suitable for the one-stage repair of severe hypospadias with penoscrotal transposition.
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Dason S, Wong N, Braga LH. The contemporary role of 1 vs. 2-stage repair for proximal hypospadias. Transl Androl Urol 2016; 3:347-58. [PMID: 26813851 PMCID: PMC4708137 DOI: 10.3978/j.issn.2223-4683.2014.11.04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This review discusses the most commonly employed techniques in the repair of proximal hypospadias, highlighting the advantages and disadvantages of single versus staged surgical techniques. Hypospadias can have a spectrum of severity with a urethral meatus ranging from the perineum to the glans. Associated abnormalities are commonly found with proximal hypospadias and encompass a large spectrum, including ventral curvature (VC) up to 50 degrees or more, ventral skin deficiency, a flattened glans, penile torsion and penoscrotal transposition. Our contemporary understanding of hypospadiology is comprised of a foundation built by experts who have described a number of techniques and their outcomes, combined with survey data detailing practice patterns. The two largest components of hypospadias repair include repair of VC and urethroplasty. VC greater than 20 degrees is considered clinically relevant to warrant surgical correction. To repair VC, the penis is first degloved-a procedure that may reduce or remove curvature by itself in some cases. Residual curvature is then repaired with dorsal plication techniques, transection of the urethral plate, and/or ventral lengthening techniques. Urethroplasty takes the form of 1- or 2-stage repairs. One-stage options include the tubularized incised urethroplasty (TIP) or various graft or flap-based techniques. Two-stage options also include grafts or flaps, including oral mucosal and preputial skin grafting. One stage repairs are an attractive option in that they may reduce cost, hospital stay, anesthetic risks, and time to the final result. The downside is that these repairs require mastery of multiple techniques may be more complex, and-depending on technique-have higher complication rates. Two-stage repairs are preferred by the majority of surveyed hypospadiologists. The 2-stage repair is versatile and has satisfactory outcomes, but necessitates a second procedure. Given the lack of clear high-quality evidence supporting the superiority of one approach over the others, hypospadiologists should develop their own algorithm, which gives them the best outcomes.
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Affiliation(s)
- Shawn Dason
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Nathan Wong
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Luis H Braga
- Division of Urology, McMaster University, Hamilton, ON, Canada
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Acimi S. Re. 'Urethral strictures following urethral plate and proximal urethral elevation during proximal TIP hypospadias repair'. J Pediatr Urol 2014; 10:575-6. [PMID: 24411689 DOI: 10.1016/j.jpurol.2013.12.003] [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: 11/18/2013] [Accepted: 12/09/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Smail Acimi
- Children's Hospital of Canastel, University of Oran, Department of Pediatric Surgery, Canastel, Oran 31000, Algeria.
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Hadidi AT. Perineal hypospadias: the Bilateral Based (BILAB) skin flap technique. J Pediatr Surg 2014; 49:218-23. [PMID: 24439613 DOI: 10.1016/j.jpedsurg.2013.09.067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 09/29/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to present the "bilateral based skin flap (BILAB) technique" for patients with perineal hypospadias associated with severe deep chordee and report the follow up. OPERATIVE PRINCIPLE The short urethral plate is incised, the hypoplastic corpus spongiosum excised, the glans split in the midline, and a healthy urethral plate is reconstructed from the lateral penile skin and foreskin to the tip of the glans. PATIENTS AND METHODS Between January 2005 and December 2011, the BILAB technique was performed in 68 patients with perineal hypospadias associated with severe chordee as a one or two stage repair. The records of 63 patients who maintained regular follow up were reviewed. The new urethra was reconstructed from the new urethral plate during the same setting in 26 patients. The remaining 37 patients had the urethroplasty performed 3-6 months later as a two stage repair. Patient age ranged from 8 months and 2 years (mean 10 months). Follow-up period ranged from 18 months to 8 years (mean 43 months). RESULTS Satisfactory results were obtained in 54 patients (85%). Two children developed diverticula, two patients developed glans dehiscence, one child developed fistula, and one child had complete wound dehiscence, and urethroplasty was successfully reconstructed 6 months later. Three patients developed scar contraction 6-12 months after surgery. This was corrected by excision of the scarred intermediate layer. CONCLUSIONS The BILAB technique is a reliable technique for patients with perineal hypospadias. It produces slit like meatus at the tip of the glans. The surgeon may decide intra-operatively whether to complete the urethroplasty in one or two stages. Long term follow up until puberty is being carried out.
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Affiliation(s)
- Ahmed T Hadidi
- Hypospadias Clinic, Department of Pediatric Surgery, Emma and Sana Offenbach Hospitals, Germany.
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Vepakomma D, Alladi A, Ramareddy RS, Akhtar T. Modified koyanagi repair for severe hypospadias. J Indian Assoc Pediatr Surg 2013; 18:96-9. [PMID: 24019639 PMCID: PMC3760317 DOI: 10.4103/0971-9261.116041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aim: To report the results of an early series of patients who underwent modified Koyanagi repair for severe hypospadias. Materials and Methods: A total of 24 boys (age: 9 months to 11 years) with proximal hypospadias, chordee, and poor urethral plate underwent modified Koyanagi repair between September 2008 and January 2012. Nine boys had associated penoscrotal transposition that was corrected simultaneously. Vascularized parameatal based foreskin flap was used to correct the hypospadias in a single stage. The follow-up ranged from 6 months to 3.5 years. Results: A total of 13 of the 24 children had a good outcome and were voiding normally, while 11 boys developed complications, 3 of which were major and 8 minor. The major complications were complete breakdown (n = 1), meatal and distal neourethral stenosis requiring laying open of distal urethra (n = 1), and glans breakdown (n = 1). The minor complications included fistulae (n = 5), meatal stenosis amenable to dilatation (n = 1), and lateral chordee (n = 1). Majority of the complications were in the initial patients, with successful outcomes in the last 1 year. Most of these complications were successfully managed by minor second procedures. Conclusion: Modified Koyanagi repair not only corrects severe hypospadias with chordee but also corrects the associated penoscrotal transposition in a single stage. The results are good once the learning curve is crossed.
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Affiliation(s)
- Deepti Vepakomma
- Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India ; Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
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Hadidi AT. Proximal hypospadias with small flat glans: the lateral-based onlay flap technique. J Pediatr Surg 2012; 47:2151-7. [PMID: 23164016 DOI: 10.1016/j.jpedsurg.2012.06.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 06/20/2012] [Accepted: 06/23/2012] [Indexed: 12/20/2022]
Abstract
PURPOSE The lateral-based onlay (LABO) technique for patients with proximal hypospadias associated with flat glans and report of the follow-up. MATERIALS AND METHODS Between January 2004 and December 2010, the LABO technique was performed in 107 patients. The principle is to use the lateral foreskin adjacent to the glans as the onlay flap. Patient age ranged between 8 months and 2 years (mean, 11 months). The records of 98 patients who maintained regular follow-up were reviewed. All the patients had proximal hypospadias with flat or incomplete cleft glans and did not have a deep chordee. Follow-up period ranged from 12 months to 8 years (mean, 32 months). A transurethral silastic catheter was used for 7 days. RESULTS AND COMPLICATIONS Satisfactory results were obtained in 93 patients (95%). Two children developed fistula, 2 developed glans dehiscence, and 1 child had skin prolapsing from the meatus that required excision. CONCLUSIONS The LABO technique is a reliable technique for patients with proximal hypospadias in the absence of a deep chordee. It has particular value in patients with small or flat glans. With multiple layer closure and careful attention to technical details, a low complication rate (5%) was achieved in correcting this type of proximal hypospadias.
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Affiliation(s)
- Ahmed T Hadidi
- Hypospadias Clinic, Department of Pediatric Surgery, Emma and Offenbach Hospitals, Offenbach, Germany.
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Proximal Hypospadias: Effect of Urethral Plate Mobilization on Release of Chordee. Urology 2012; 80:894-8. [DOI: 10.1016/j.urology.2012.06.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 06/26/2012] [Accepted: 06/28/2012] [Indexed: 11/17/2022]
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Jayanthi VR. The modified Koyanagi hypospadias repair for the one-stage repair of proximal hypospadias. Indian J Urol 2011; 24:206-9. [PMID: 19468399 PMCID: PMC2684275 DOI: 10.4103/0970-1591.40617] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Perineal and penoscrotal hypospadias were often managed by two-stage urethroplasty with variable results and significant number of these may need third surgery. Though modified Koyanagi one-stage repair has a learning curve, it has all the advantages of two-stage repair. The aim was to review the results of modified Koyonagi repair from the literature and our own centre experience.
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Affiliation(s)
- Venkata R Jayanthi
- Section of Urology, Columbus Children's Hospital, Columbus, OH 43205, USA
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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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21
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Lambert SM, Snyder HM, Canning DA. The History of Hypospadias and Hypospadias Repairs. Urology 2011; 77:1277-83. [DOI: 10.1016/j.urology.2010.10.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 09/18/2010] [Accepted: 09/18/2011] [Indexed: 11/30/2022]
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Nerli R, Santhoshi P, Guntaka A, Patil S, Hiremath M. Modified Koyanagi's procedure for proximal hypospadias: our experience. Int J Urol 2010; 17:294-6. [PMID: 20409225 DOI: 10.1111/j.1442-2042.2010.02475.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Koyanagi described an elegant technique for one-stage proximal hypospadias repair. It is particularly suited for the most severe forms of hypospadias. A modified Koyanagi technique was used to repair the hypospadias in 14 children, aged 3-9 years. One child developed breakdown of the suture line, three other children developed small urethrocutaneous fistula needing closure and one child had post-operative meatal stenosis. Despite the high rate of complications, modified Koyanagi's procedure is a good procedure of choice for severe/proximal hypospadias.
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Affiliation(s)
- Rajendra Nerli
- KLES Kidney Foundation, Urology, KLES Dr Prabhakar Kore Hospital & MRC, Belgaum, India.
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23
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Abstract
PURPOSE To review the evolution of the technique of hypospadias repair. METHODS A search of Pubmed, Medline and the Journal of Pediatric Urology was performed, and papers dealing with surgical techniques for hypospadias repair were critally reviewed. Special emphasis was given to papers on the effects in the long term of hypospadias repair on voiding and sexual dysfunction. RESULTS The techniques for hypospadias repair have evolved over the years. The most popular technique now is tubularized incised plate urethroplasty. Long-term results with the use of the new techniques of the hypospadias repair in terms of voiding and sexual problems should be addressed. CONCLUSION There is a need for valid studies on the outcomes of hypospadias repair in adults that were performed in childhood in terms of cosmetic appearance, voiding and sexual performance.
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Affiliation(s)
- Boris Chertin
- Division of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
| | - Dan Prat
- Division of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
| | - Ofer Z Shenfeld
- Department of Urology, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
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de Mattos e Silva E, Gorduza DB, Catti M, Valmalle AF, Demède D, Hameury F, Pierre-Yves M, Mouriquand P. Outcome of severe hypospadias repair using three different techniques. J Pediatr Urol 2009; 5:205-11; discussion 212-4. [PMID: 19201261 DOI: 10.1016/j.jpurol.2008.12.010] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 12/17/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the outcomes of three different urethroplasty techniques (onlay, buccal mucosa, Koyanagi type I) used in the reconstruction of severe hypospadias. PATIENTS AND METHODS Over 10 years (1997-2007), 300 severe hypospadias cases were treated with a mean follow up of 2 years (1-105 months); 203 were operated by the same surgeon of whom 184 completed follow up. Three main techniques were used according to the quality of the urethral plate: onlay urethroplasty (133), buccal graft urethroplasty (25) and Koyanagi type I (26). The mean age at surgery was 36 months (8-298); 76 required preoperative androgen stimulation (onlay 37, buccal 11, Koyanagi 26); 18 required a corporoplasty to straighten the penis (onlay 13, buccal 3, Koyanagi 2). RESULTS Thirty-eight onlay (28.5%); 14 buccal (56%); 16 Koyanagi (61.5%) urethroplasties had a complication. The fistula rate was 15% for the onlay group; 32% for the buccal mucosa group; 19.2% for the Koyanagi cases. The dehiscence rate was, respectively, 11.3%, 20% and 42.3%. The stricture rate was, respectively, 1.5%, 20% and 34.6%. Urethrocele was found in seven Koyanagi patients. Final functional and cosmetic results were satisfactory in 126/133 (94.7%) onlay, 20/25 (80%) buccal and 14/26 Koyanagi (53.8%) urethroplasties. Primary cases had better results (89%) than redo cases (75.9%). Patients submitted to preoperative androgen therapy developed more complications (onlay: 40.5% vs 23.9%; buccal: 70% vs 43.7%). CONCLUSION Two striking results are the low number of severe hypospadias cases requiring an additional corporoplasty, and the increased complication rate found in androgen-stimulated patients. The excellent results of the onlay procedure could be related to the use of dorsal preputial tissue, which in hypospadias is characterized by a well-balanced protein platform compared to the ventral tissues.
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Affiliation(s)
- Elisângela de Mattos e Silva
- Department of Pediatric Urology, Hôpital Mère-Enfants - GHE, Groupe Hospitalier Est, Université Claude-Bernard, 59, Boulevard Pinel, Lyon I, 69677 Bron Cedex, France
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25
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Jorgensen B, Jorgensen TM, Olsen LH. Outcome of new surgical techniques in hypospadia repair. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 2004; 37:134-8. [PMID: 12745722 DOI: 10.1080/00365590310008875] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Retrospectively we evaluated the outcome of all primary hypospadia operations done at Skejby Sygehus, Aarhus University Hospital, in the period May 1999 to March 2001. In that period the concept of treating hypospadias was changed from mainly the Mathiau operation and the preputial skin tube (Duckett) to the method of Barcat (and Koyanagi). MATERIAL AND METHODS During the study period 101 boys consecutively underwent treatment of hypospadias using mainly the techniques of Koyanagi, Barcat and the Glanular Approximation Procedure (GAP). RESULTS Cosmetic and functional outcome were excellent. Complications consisted of 12% urethrocutaneous fistula of which the majorities were seen in the first year after taken up the new techniques. There were 3% meatal stenosis and no urethral diverticula. CONCLUSION The short-term results of the new techniques are superior in cosmetic and functional outcome. The fistula rate was a little high in the start of the period after introducing the new techniques but have fallen to a level comparable to other centres results. The level of fistula is comparable to other centres results.
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Affiliation(s)
- Bettina Jorgensen
- Department of Urology, Aarhus University Hospital, Skejby Sygehus, Brendstrupgaardsvej, DK 08200 Aarhus N, Denmark
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26
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Kurahashi N, Murakumo M, Kakizaki H, Nonomura K, Koyanagi T, Kasai S, Sata F, Kishi R. The Estimated Prevalence of Hypospadias in Hokkaido, Japan. J Epidemiol 2004; 14:73-7. [PMID: 15242062 PMCID: PMC8685173 DOI: 10.2188/jea.14.73] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND: Hypospadias is one of the most common congenital anomalies in the world. Recently, increases in the prevalence of hypospadias have been reported in various countries including Japan. In this study, we examined whether the prevalence of hypospadias in Hokkaido, Japan, increased or not, using standardized diagnostic criteria. We also investigated the degree of its severity. METHODS: We calculated prevalence of hypospadias using hospital records of hypospadias repair in Hokkaido. The prevalence from 1985 through 1997 by dividing the number of patients obtained from hospital records by the number of births. RESULTS: The average prevalence of hypospadias in Hokkaido was 3.9 per 10,000 births, and did not significantly changed (p=0.7). The average proportions of distal, proximal and chordee alone were 56.7%, 39.6% and 3.7%, respectively. The decrease in the proportion of the proximal type was statistically significant (p=0.05) for the entire time period, whereas the proportion of the distal type did not have a significant upward trend for the observed 13 years (p=0.1). CONCLUSION: No significant changes in the prevalence of hypospadias existed in Hokkaido.
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Affiliation(s)
- Norie Kurahashi
- Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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27
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DeFoor W, Wacksman J. Results of single staged hypospadias surgery to repair penoscrotal hypospadias with bifid scrotum or penoscrotal transposition. J Urol 2003; 170:1585-8; discussion 1588. [PMID: 14501667 DOI: 10.1097/01.ju.0000084141.51617.1b] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE During the last 10 years there has been controversy in the approach to severe hypospadias. Many pediatric urologists have elected to perform a 2-staged procedure to minimize complication rates and improve cosmesis. We continued to perform a single staged repair using the Hodgson XX or Koyanagi technique for even the most severe hypospadias. We review our results during the last 5 years in severe cases of penoscrotal hypospadias with bifid scrotum or penoscrotal transposition. MATERIALS AND METHODS The medical records of 20 consecutive children presenting to a single surgeon from 1996 to 2000 with severe penoscrotal hypospadias were reviewed. Patients underwent a 1-stage repair using an operative microscope. Cases not requiring further surgery were grouped as successful while cases requiring subsequent procedures were considered as complications. RESULTS After an average followup of 23 months 16 patients have not required subsequent procedures. Two patients had urethrocutaneous fistulas and 2 had a urethral diverticulum for an overall complication rate of 20%. All 4 patients were successfully treated with 1 additional procedure and have not required further intervention. Another patient with a small urethral diverticulum is being treated conservatively. All patients had satisfactory cosmetic results. CONCLUSIONS We believe that a single staged repair can be safely and effectively performed even in patients with the most severe penoscrotal hypospadias. The Hodgson XX and Koyanagi repairs are excellent techniques with relatively low complication rates. Pediatric urologists should continue to use these techniques in their armamentarium and strive to perfect a 1-stage approach to severe hypospadias.
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Affiliation(s)
- William DeFoor
- Division of Pediatric Urology, Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA
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Gershbaum MD, Stock JA, Hanna MK. A Case For 2-stage Repair of Perineoscrotal Hypospadias With Severe Chordee. J Urol 2002. [DOI: 10.1016/s0022-5347(05)64399-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Meyer D. Gershbaum
- From the Departments of Urology, Schneider Children’s Hospital, Long Island Jewish Medical Center, New Hyde Park, New York, and the Children’s Hospital of New Jersey, St. Barnabas Health Care System, Livingston, New Jersey
| | - Jeffrey A. Stock
- From the Departments of Urology, Schneider Children’s Hospital, Long Island Jewish Medical Center, New Hyde Park, New York, and the Children’s Hospital of New Jersey, St. Barnabas Health Care System, Livingston, New Jersey
| | - Moneer K. Hanna
- From the Departments of Urology, Schneider Children’s Hospital, Long Island Jewish Medical Center, New Hyde Park, New York, and the Children’s Hospital of New Jersey, St. Barnabas Health Care System, Livingston, New Jersey
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30
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A Novel Solution for the Short Neourethra in Mitchell Epispadias Repair. J Urol 2002. [DOI: 10.1097/00005392-200205000-00064] [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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31
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Emír L, Germiyanoğlu C, Erol D. A novel solution for the short neourethra in Mitchell epispadias repair. J Urol 2002; 167:2168-70. [PMID: 11956473 DOI: 10.1016/s0022-5347(05)65121-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- L Emír
- Clinic of Urology, Ankara Teaching and Research Hospital, Ministry of Health, Ankara, Turkey
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32
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Abstract
Approximately 20% of hypospadiac urethras are located proximally, anywhere from the penoscrotal to the perineal region. Repair of proximal defects is still one of the most challenging surgical procedures facing the hypospadiologist. Modifications of current techniques for the correction of proximal hypospadias as well as new innovative techniques continue to be proposed.
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Affiliation(s)
- Bartley G Cilento
- Department of Urology, Children's Hospital, Department of Surgery, Harvard Medical School, Boston, MA, USA.
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Emir H, Jayanthi VR, Nitahara K, Danismend N, Koff SA. Modification of the Koyanagi technique for the single stage repair of proximal hypospadias. J Urol 2000; 164:973-5; discussion 976. [PMID: 10958720 DOI: 10.1097/00005392-200009020-00013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We describe a modification of the Koyanagi technique for hypospadias. Use of opposing parameatal-based skin flaps that extend distally to incorporate the inner layer of the prepuce was modified to preserve blood supply to the flaps in an attempt to reduce complications and improve results. MATERIALS AND METHODS During the last 7 years 20 boys underwent treatment of proximal hypospadias using the modified hypospadias repair. RESULTS Cosmetic and functional, long-term (mean 34 months) results were excellent. Complications consisted of 4 urethrocutaneous fistulas (20%). There were no instances of meatal stenosis, diverticulum or urethral stricture. CONCLUSIONS The modified technique permits 1-stage repair of proximal hypospadias with a low complication rate.
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Affiliation(s)
- H Emir
- Section of Pediatric Urology, Children's Hospital and The Ohio State University Medical Center, Columbus, Ohio, USA
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EMIR H, JAYANTHI V, NITAHARA K, DANISMEND N, KOFF S. MODIFICATION OF THE KOYANAGI TECHNIQUE FOR THE SINGLE STAGE REPAIR OF PROXIMAL HYPOSPADIAS. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67229-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H. EMIR
- From the Section of Pediatric Urology, Children’s Hospital and The Ohio State University Medical Center, Columbus, Ohio, and Department of Pediatric Surgery, Cerrahpaba Medical Faculty, University of Istanbul, Istanbul, Turkey
| | - V.R. JAYANTHI
- From the Section of Pediatric Urology, Children’s Hospital and The Ohio State University Medical Center, Columbus, Ohio, and Department of Pediatric Surgery, Cerrahpaba Medical Faculty, University of Istanbul, Istanbul, Turkey
| | - K. NITAHARA
- From the Section of Pediatric Urology, Children’s Hospital and The Ohio State University Medical Center, Columbus, Ohio, and Department of Pediatric Surgery, Cerrahpaba Medical Faculty, University of Istanbul, Istanbul, Turkey
| | - N. DANISMEND
- From the Section of Pediatric Urology, Children’s Hospital and The Ohio State University Medical Center, Columbus, Ohio, and Department of Pediatric Surgery, Cerrahpaba Medical Faculty, University of Istanbul, Istanbul, Turkey
| | - S.A. KOFF
- From the Section of Pediatric Urology, Children’s Hospital and The Ohio State University Medical Center, Columbus, Ohio, and Department of Pediatric Surgery, Cerrahpaba Medical Faculty, University of Istanbul, Istanbul, Turkey
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Jospeh VT. Concepts in the surgical technique of one-stage hypospadias correction. BRITISH JOURNAL OF UROLOGY 1995; 76:504-9. [PMID: 7551894 DOI: 10.1111/j.1464-410x.1995.tb07758.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To report on a single-stage technique for hypospadias repair based on the combination of several features of established methods and to emphasize the importance of identifying and excising the chordee that is almost always present in the tissues proximal to the urethral opening to ensure the complete correction of this deformity. PATIENTS AND METHODS Over a 3-year period, 84 boys (age range from 8 months to 14 years) underwent a single-stage repair of proximal hypospadias. Chordee was corrected by excising fibrotic tissue representing the atretic corpus spongiosum proximal to the urethral opening. The neourethra was constructed using the epithelium distal to the urethral opening and part of the dorsal prepuce. RESULTS Satisfactory results were obtained in 79 patients with a single procedure. Only five patients had fistulae and of these, four were closed successfully during the same hospital stay. CONCLUSION Proximal hypospadias can be corrected using the single-stage technique described, with satisfactory results in most cases. Fistulae are uncommon and can be closed by a primary procedure performed in the post-operative period.
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Affiliation(s)
- V T Jospeh
- Department of Pediatric Surgery, Singapore General Hospital
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36
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Koyanagi T, Nonomura K, Yamashita T, Kanagawa K, Kakizaki H. One-stage repair of hypospadias: is there no simple method universally applicable to all types of hypospadias? J Urol 1994; 152:1232-7. [PMID: 8072111 DOI: 10.1016/s0022-5347(17)32556-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A simple method of hypospadias repair is described. The operative technique consists of 7 steps, including 1) outlining the skin incision and dartos mobilization; 2) artificial erection, harvesting parameatal foreskin flap and release of chordee as needed; 3) glans splitting and creation of glanular wings; 4) 1-stage urethroplasty with parameatal foreskin flap; 5) meatal glanuloplasty; 6) creation of Byars' flaps of the skin, and 7) skin closure. Central to the technique is the feasibility of the choice of 1-stage urethroplasty with meatal based manta-wing flap or with parameatal based and fully extended circumferential foreskin flap even after the skin incision is made, which enables its application to all types of hypospadias. Of 120 patients the 1-stage urethroplasty was performed with meatal based manta-wing flap in 50, and with parameatal based and fully extended circumferential foreskin flap in 70. Primary success was obtained in 82% of the cases with meatal based manta-wing flap, and in 53% with parameatal based and fully extended circumferential foreskin flap. Complications requiring secondary repair occurred in 42 cases (9 with meatal based manta-wing flap, and 33 with parameatal based and fully extended circumferential foreskin flap) but repair was successful in 32. Thus, the overall success rate was 91% (96% with meatal based manta-wing flap, and 87% with parameatal based and fully extended circumferential foreskin flap). Additional repair (10 secondary, 2 tertiary and 1 quaternary) is planned in 13 cases. The technique of 1-stage urethroplasty with parameatal foreskin flap is recommended as a simple and reliable treatment for hypospadias with a reasonable success rate.
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Affiliation(s)
- T Koyanagi
- Department of Urology, Hokkaido University School of Medicine, Sapporo, Japan
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37
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Perović S, Vukadinović V. Onlay island flap urethroplasty for severe hypospadias: a variant of the technique. J Urol 1994; 151:711-4. [PMID: 8308994 DOI: 10.1016/s0022-5347(17)35067-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A variant of the onlay island flap urethroplasty in severe hypospadias repair is described. The principles of the technique include mobilization of the urethral plate without dividing it, release of chordee, creation of a pedicle island flap on the dorsal penile skin with redundant vascularized tissue that is transposed to the ventral side of the penis by a buttonhole maneuver, and onlay of the flap to the mobilized urethral plate, covering all suture lines with a wide pedicle of flap. During the last 3 years this operation was performed in 92 patients 12 months to 19 years old with severe hypospadias. The complication rate was 5%.
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Affiliation(s)
- S Perović
- Department of Pediatric Surgery and Urology, University Children's Hospital, Belgrade, Yugoslavia
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Mollard P, Mouriquand P, Felfela T. Application of the onlay island flap urethroplasty to penile hypospadias with severe chordee. BRITISH JOURNAL OF UROLOGY 1991; 68:317-9. [PMID: 1913075 DOI: 10.1111/j.1464-410x.1991.tb15331.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The onlay island flap urethroplasty was originally used to repair anterior hypospadias without chordee and was later used to repair penile hypospadias with a well developed urethral plate exhibiting little or no chordee after release of skin tethering. It is possible to treat all cases of penile hypospadias even with severe chordee by releasing the chordee without dividing the urethral plate and by reconstructing the urethra with an onlay island flap.
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Affiliation(s)
- P Mollard
- Division of Urology, Debrousse Children's Hospital, Lyon, France
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Koyanagi T, Imanaka K, Nonomura K, Togashi M, Asano Y, Tanda K. Further experience with one-stage repair of severe hypospadias and scrotal transposition. Modifications in the technique and its result in eight cases. Int Urol Nephrol 1988; 20:167-77. [PMID: 3384611 DOI: 10.1007/bf02550668] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Further experience with one-stage repair of severe hypospadias and scrotal transposition performed in eight patients is reported. Primary success was obtained in six, while one patient was cured by secondary repair. While describing the operative technique with some modifications it was reassured that our parameatal preputial flap is a well vascularized one which can safely and easily be constructed into a neourethra. Advantages of improved "glanulomeatoplasty" and scrotoplasty are also discussed. The method is recommended as highly successful to attain excellent functional and cosmetic results in one stage for severe hypospadias.
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Affiliation(s)
- T Koyanagi
- Department of Urology, Hokkaido University School of Medicine, Sapporo, Japan
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Nonomura K, Koyanagi T, Imanaka K, Togashi M, Asano Y, Tanda K. One-stage total repair of severe hypospadias with scrotal transposition: experience in 18 cases. J Pediatr Surg 1988; 23:177-80. [PMID: 3343654 DOI: 10.1016/s0022-3468(88)80152-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This is a report detailing further experience with our one-stage repair of severe hypospadias and scrotal transposition performed on 18 patients. Initial success was obtained in 12 cases, while two more were improved by secondary repair. The operative technique, as modified, assures a parameatal preputial flap, which is well vascularized and easily constructed into a neourethra. The advantages of this improved "glanulomeatoplasty" and scrotoplasty are discussed. The method is recommended as an excellent functional and cosmetic procedure for one-stage correction of severe hypospadias.
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Affiliation(s)
- K Nonomura
- Department of Urology, Hokkaido University School of Medicine, Sapporo, Japan
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