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Maheshwari M, Gite VA, Agrawal M, Sankapal P, Shaw V, Sharma S, Dias S. Outcome of spongioplasty alone as second layer of tubularised incised plate urethroplasty in patients with hypospadias. AFRICAN JOURNAL OF UROLOGY 2022. [DOI: 10.1186/s12301-022-00305-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Abstract
Background
Spongioplasty alone or in combination with local tissue flaps can be used as a second layer for the prevention of complications of tubularised incised plate urethroplasty (TIPU) of hypospadias repair. It can be used when wide urethral plate and well-developed robust spongiosum are present. This study aims to review the success rate and complications of TIPU performed utilising spongioplasty alone as a second layer in Type 3 well-developed robust spongiosum.
Methods
This is a retrospective observational study conducted between January 2015 and December 2019 at a tertiary care centre. A total of 21 patients aged 4–15.4 years with primary hypospadias having a Type 3 well-developed robust spongiosum, Glans score ≤ 2, Meatal score ≤ 4, and Shaft score ≤ 3 underwent TIPU using spongioplasty alone as a second layer. The hospital stay ranged from 10 to 14 days and follow-up from 12 to 36 months.
Results
Hypospadias was distal in 12 (57.1%), mid in 5 (23.8%), and proximal penile in 4 (19.1%) patients. The mean Glans Meatus Shaft score was 6.1 (G = 1.25, M = 2.95, S = 1.9) with a range of 3–9. An early post-operative complication of preputial oedema and bladder spasm developed in 1 (4.7%) patient each. Meatal stenosis developed in 1 (4.7%) patient. None developed urethrocutaneous fistula. At 3 months all patients had good urinary flow (> 15 ml/s) and good cosmesis. All the patients/parents (in case of minors) were satisfied with the result.
Conclusion
Spongioplasty alone as the second layer after TIPU for primary penile hypospadias in patients with well-developed robust spongiosal tissue is associated with minimal, easily manageable complications.
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2
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Chatterjee US, Basak D. Extended Ulaanbaatar Procedure with Preputial Skin Graft for Proximal Hypospadias. J Indian Assoc Pediatr Surg 2022; 27:684-688. [PMID: 36714468 PMCID: PMC9878509 DOI: 10.4103/jiaps.jiaps_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/15/2022] [Accepted: 06/18/2022] [Indexed: 11/12/2022] Open
Abstract
Background Two stage urethroplasty for proximal penile hypospadias is time consuming, expensive and; traumatic both for parents and phallus. On the other hand, single stage procedure technically demanding. We would like to describe Extended Ulaanbaatar Procedure (EUP) which is not a two stage procedure. Rather, might be called as 'extended single stage' procedure. In EUP we have done orthoplasty along with urethroplasty with preputial skin graft at same sitting as primary procedure keeping urination diverted through proximal hypospadiac meatus as "controlled fistula" which was closed after six months as secondary procedure. Methods We operated on 35 patients of proximal penile hypospadias with moderate to severe chordee. Chordee was excised till correction of curvature. Two distracted cut ends of native plate was bridged with preputial skin graft (PSG) in between. Following that, silastic tube was placed over glandular plate as scaffold, on both cut ends of native plate and PSG. All the urethral plates and PSG were buried with tunica vaginalis flap before glanuloplasty. After six months, proximal "controlled fistula" was closed with scrotal dartos fascia and skin to join distal to proximal urethra. Results Vertical meatus in glans was found in 32 patients. One patient had glans dehiscence, two patients had medium sized fistula, another two patients had stenosis in neourethra and six had suture track fistula. Twenty-nine patients had satisfactory curve with good flow in uroflowmetry as per nomogram at sixth month of follow up. Conclusion In classic Ulaanbaatar procedure authors do distal urethroplasty and glanuloplsaty in 1st stage following orthoplasty to avoid repeat trauma in glans in repeat procedures. Left over urethroplasty in classic Ulaanbaatar was done in 2nd stage. However, in EUP; we did urethroplasty for full length following orthoplasty as primary procedure. This procedure is less invasive than two staged as we avoided repeat degloving and repeat dissection on operated tissues. Urethroplasty done as primary procedure shunned the need of repeat degloving, decreased the period of morbidity, stay, and cost of surgery. We also avoided problems of urination through not matured, long, neo-urethra. Similarly complications i.e disruption, stenosis in neo-urethra can be managed utilizing the advantages of urinary diversion.
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Affiliation(s)
- Uday Sankar Chatterjee
- Visiting Paediatric Surgeon, Park Medical Research and Welfare Society, Kolkata, West Bengal, India
| | - Dhananjay Basak
- Visiting Paediatric Surgeon, Park Medical Research and Welfare Society, Kolkata, West Bengal, India
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3
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Woldeselassie HG, Temesgen F, Taddese A, Negussie T, Kiflu W, Dejene B, Derbew M, Workineh ST. Outcomes of Tubularized Incised Plate Urethroplasty (TIPU) for Hypospadias at Tikur Anbesa Specialized and Menelik II referral Hospitals: One-year Prospective study". Urology 2022; 168:189-194. [PMID: 35809699 DOI: 10.1016/j.urology.2022.06.022] [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: 01/23/2022] [Revised: 06/05/2022] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the results and related factors of tubularized incised plate (TIP) urethroplasty at two institutions. METHODES This was a prospective cohort analytical study conducted over a period of 12 months. All patients who underwent TIP urethroplasty in the specified period were studied. Quantitative and qualitative data of the intrinsic parameters of the penis were obtained and patients were followed up for an average period of 14.72±3.67 months (range 9-21months) after surgery. RESULTS One hundred twenty-nine patients (N = 129) were included in the study. The mean age at surgery was 50.93 months. The mean glans size and pre-incised urethral plate width were 14.34 mm and 8.38mm respectively. The post-operative results were satisfactory with the meatus in a glanular position in 122(94.6%) patients. Overall, 49 patients (38%) developed complications. Eighteen patients (14%) developed early complications whereas forty-two (32.6%) patients had late complications. UCF and Meatal stenosis occurred in 27 (20.9%) & 14 (10.9%) patients respectively. Seven patients developed recurrent hypospadias and dehiscence of glans occurred in eight patients (6.2%). CONCLUSIONS TIP can be used to repair for all types of hypospadias in the absence of severe penile curvature. It has more complications rate in proximal than distal hypospadias. Distal hypospadias was the most common type of hypospadias corrected with TIP. UCF and meatal stenosis were the most common complication followed by glans dehiscence and recurrent hypospadias. Glans size, age at surgery, plate width, location of meatus and stretched penile length were the most determinant factors for the outcome.
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Affiliation(s)
| | - Fisseha Temesgen
- Department of Surgery, Pediatrics Surgery unit, AAUCMH, Addis, Ababa, Ethiopia
| | - Amezene Taddese
- Department of Surgery, Pediatrics Surgery unit, AAUCMH, Addis, Ababa, Ethiopia
| | - Tihitena Negussie
- Department of Surgery, Pediatrics Surgery unit, AAUCMH, Addis, Ababa, Ethiopia
| | - Woubedel Kiflu
- Department of Surgery, Pediatrics Surgery unit, AAUCMH, Addis, Ababa, Ethiopia
| | - Belachew Dejene
- Department of Surgery, Pediatrics Surgery unit, AAUCMH, Addis, Ababa, Ethiopia
| | - Miliard Derbew
- Department of Surgery, Pediatrics Surgery unit, AAUCMH, Addis, Ababa, Ethiopia
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4
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Okumuş M, Tireli GA. Tubularized incised plate repair in 473 primary distal hypospadias cases: An evaluation of outcomes according to coverages and stent types. Actas Urol Esp 2022; 46:361-366. [PMID: 35256325 DOI: 10.1016/j.acuroe.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/16/2021] [Accepted: 01/24/2021] [Indexed: 06/14/2023]
Abstract
AIM We have previously employed the tubularized incised plate (TIP) repair technique in distal hypospadias cases with a few modifications because of its excellent cosmetic results. In this study, we aimed to evaluate the effects of spongioplasty and dorsal dartos flaps, in addition to short urethral stents on the outcomes of TIP repair. MATERIALS AND METHODS Only distal hypospadias cases were involved in this study. Eligible patients were divided into two groups: group A included patients repaired with both spongioplasty and dorsal dartos flap placement, while group B included patients repaired with dorsal dartos flap placement alone. Group A was further divided into two subgroups according to the type of catheter used (bladder catheter or short urethral stent). RESULTS A total of 473 patients were included in this study. There was no statistically significant difference observed in the complication rates between the two groups. In Group A, a bladder catheter was used in 107 patients and a short urethral stent was used in 135 patients. When the results of the two groups were compared, there was no statistically significant difference. CONCLUSIONS Spongioplasty could be combined with dorsal dartos flap placement to reduce the need for dorsal plication rather than to reduce the fistula rate. Short urethral stents can be used safely with no postoperative effects in children who have completed toilet training.
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Affiliation(s)
- M Okumuş
- Department of Pediatric Surgery, Yeniyüzyıl University, Medical Faculty, Gaziosmanpaşa Hospital, İstanbul, Turkey.
| | - G A Tireli
- Department of Pediatric Urology, Türkiye Health Science University, Bakırköy Research and Teaching Hospital, İstanbul, Turkey
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5
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Ahmed F, Nikbakht HA, Al-Naggar K, Al-Wageeh S, Alyhari Q, Ghabisha S, Al-Shami E, Dajenah M, Aljbri W, Mohammed F, Al-Hajri A. Role of tunica vaginalis flap and dartos flap in tubularized incisional plate for primary hypospadias repair: A retrospective monocentric study. Arch Ital Urol Androl 2022; 94:206-210. [PMID: 35775348 DOI: 10.4081/aiua.2022.2.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/23/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In the tubularized incised plate (TIP) procedure, flap interposition between the skin and neourethra is highly recommended to decrease the postoperative fistula rate. However, there is no consensus regarding the ideal flap for this procedure. This study aimed to report our experiences in the one-stage TIP hypospadias surgery utilizing dartos flap (DF) (penile skin subcutaneous tissue) and tunica vaginalis flap (TVF) (parietal layer of the testis) as a tissue coverage of neourethra. METHODS In a retrospective study from Sep 2018 to May 2021, 16 cases of hypospadias with different types, ranging from midpenile to penoscrotal types, were managed with TIP urethroplasty using DF or TVF as a tissue coverage of neourethra were enrolled. The demographic characteristics of the participants, type of hypospadias, outcome, and complications were analyzed and compared. RESULTS We used TVF and DF as soft tissue coverage in 11 (68.8%) and 5 (31.3%) patients, respectively. The mean age was 56.38 ± 47.83 months. Mid-penile, proximal, and penoscrotal hypospadias were presented in 3 (18.8%), 8 (50.0%), and 5(31.2%) patients, respectively. The total success rate was 14 (87.5%), while 2 (12.5%) patients developed a urethrocutaneous fistula, which required delayed closure later. In comparison between TVF and DF groups: the TVF was applied in all patients with moderate and severe chordee and all patients with penoscrotal hypospadias, and six patients with proximal hypospadias, while only three patients with mild chordee and two patients with proximal hypospadias used the DF and showed statistical significance between groups (p < 0.001 and 0.012) respectively. The success rate was 90.9% vs. 80.0% in TVF and DF groups, respectively, with no statistical significance between groups (p = 1.000). CONCLUSIONS In the primary TIP repair, the TVF is a practical option as a DF for the interposition cover of a neourethra, especially in penoscrotal and proximal hypospadias with severe chordee.
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Affiliation(s)
- Faisal Ahmed
- Urology Research Center, Al-Thora General Hospital, Department of Urology, School of Medicine, Ibb University of Medical Science, Ibb.
| | - Hossein-Ali Nikbakht
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol.
| | - Khalil Al-Naggar
- Urology Research Center, Al-Thora General Hospital, Department of Urology, School of Medicine, Ibb University of Medical Science, Ibb.
| | - Saleh Al-Wageeh
- Department of General Surgery, School of Medicine, Ibb University of Medical Science, Ibb.
| | - Qasem Alyhari
- Department of General Surgery, School of Medicine, Ibb University of Medical Science, Ibb.
| | - Saif Ghabisha
- Department of General Surgery, School of Medicine, Ibb University of Medical Science, Ibb.
| | - Ebrahim Al-Shami
- Urology Research Center, Al-Thora General Hospital, Department of Urology, School of Medicine, Ibb University of Medical Science, Ibb.
| | - Menawar Dajenah
- Department of General Surgery, School of Medicine, Ibb University of Medical Science, Ibb.
| | - Waleed Aljbri
- Department of Urology, School of Medicine, 21 September University, Sana'a.
| | - Fawaz Mohammed
- Department of Orthopedy, School of Medicine, Ibb University of Medical Science, Ibb.
| | - Abdu Al-Hajri
- Department of General Surgery, School of Medicine, Ibb University of Medical Science, Ibb.
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Wu S, Ye C, Yang H, Chen B, Nie H, Li S. Application of Allogeneic Human Acellular Dermal Matrix Reduces the Incidence of Fistula in Hypospadias Repair. Front Pediatr 2022; 10:774973. [PMID: 35356442 PMCID: PMC8959589 DOI: 10.3389/fped.2022.774973] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/03/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Urethrocutaneous fistula is one of the most common complications arising from hypospadias surgery. The purpose of our study was to investigate the effectiveness and safety of allogeneic human acellular dermal matrix (HADM) application as a means of preventing the occurrence of urethrocutaneous fistula following hypospadias surgery. METHODS This is a non-randomized study of 219 cases (out of 270 patients with hypospadias) which satisfied inclusion and exclusion criteria. These patients were divided into two groups: 101 HADM patients, and 118 control patients (who did not receive HADM). In the control group, 77 boys were treated by single-stage urethroplasty (TIP) and 41 underwent staged urethroplasty (Thiersch-Duplay). In the HADM group, 59 boys underwent the TIP and 42 underwent the Thiersch-Duplay. In the postoperative period, we recorded the incidence of infection, urethrocutaneous fistula, and urethral stricture complications in these two groups of patients. The effectiveness and safety of HADM in preventing urethrocutaneous fistula following hypospadias surgery were evaluated according to these indicators. RESULTS In the control group, following the operation there were 16 cases of infection, 38 cases of urethrocutaneous fistula after extubating, and 5 cases of urethral stricture. In the HADM group, there were 19 cases of postoperative infection, 12 cases of urethrocutaneous fistula after extubating, and 5 children with urethral stricture. In comparing the two groups, it was found that the postoperative infection rate (13.6 vs. 18.8%) and the incidence of urethral stricture (4.2 vs. 5.0%) were not statistically significant (P > 0.05), while the postoperative urethrocutaneous fistula rate (32.2 vs. 11.9%) was statistically significant (P < 0.001). CONCLUSION It is found that HADM application can significantly reduce the incidence of urethrocutaneous fistula complications, without increasing the risk of infection and urethral stricture.
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Affiliation(s)
- Shijian Wu
- Department of Urology, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Chenglong Ye
- Department of Urology, General Hospital of Southern Theatre Command, Guangzhou, China.,Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huai Yang
- Department of Urology, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Bote Chen
- Department of Urology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Haibo Nie
- Department of Urology, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Shaowei Li
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
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Okumuş M, Tireli G. Tubularización e incisión de la placa uretral para reparación de hipospadias distal primario en 473 casos: evaluación de los resultados según la cobertura y el tipo de sonda. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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8
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Chatterjee US, Basu AK, Bhaumik K. Needling for Suture Track Fistula. J Indian Assoc Pediatr Surg 2021; 26:203-205. [PMID: 34321797 PMCID: PMC8286017 DOI: 10.4103/jiaps.jiaps_73_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/20/2020] [Accepted: 05/16/2020] [Indexed: 11/04/2022] Open
Abstract
A day care procedure for ablation of epithelium of suture track fistula (STF) is described with a tip of hypodermic needle under surface anesthesia. STF is a minor but annoying and frustrating complication following hypospadias surgery. Parents and patients are worried of soiling of dress from dribbling of urine through STF during urination. It is embarrassing particularly in the presence of peers. Nevertheless, no specific treatment is found in literature for its remedy other than the conventional procedures for repair of fistula. Here, we describe a simple day care procedure under surface anesthesia with prilocaine ointment. Thirty-five out of 42 STFs healed in single or repeat attempts with this 'needling' procedure.
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Affiliation(s)
- Uday Sankar Chatterjee
- Depatrment of Pediatric Surgery, Park Medical Research and Welfare Society, Kolkata, West Bengal, India
| | - Ashoke Kumar Basu
- Depatrment of Pediatric Surgery, Park Medical Research and Welfare Society, Kolkata, West Bengal, India
| | - Kuntal Bhaumik
- Depatrment of Pediatric Surgery, Park Medical Research and Welfare Society, Kolkata, West Bengal, India
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9
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Tiwari C, Borkar N. Evaluation of tunica vaginalis free graft as a better alternative to tunica vaginalis pedicled flap for providing waterproof cover in Stage II hypospadias repair. Afr J Paediatr Surg 2021; 18:90-93. [PMID: 33642405 PMCID: PMC8232358 DOI: 10.4103/ajps.ajps_93_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/10/2020] [Accepted: 09/29/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Tunica vaginalis (TV) flap has been used by many surgeons as a waterproof layer to cover neourethra. We present our experience in using free TV graft as an alternative to TV flap for providing waterproof cover in second-stage hypospadias repair. MATERIALS AND METHODS A retrospective review of ten patients with severe hypospadias who underwent Stage II hypospadias repair over a period of 15 months was carried out. Free TV graft was used to cover neourethra in all the patients. RESULTS The median age of patients was 3.5 years. Six patients had proximal hypospadias with severe chordee and four patients had peno-scrotal hypospadias. Eight patients had undergone Byars procedure and two patients had undergone Bracka's procedure during the first stage repair in the same institute. The mean operative time for Stage II repair using free TV graft was 150 min (standard deviation ± 15 min). All patients passed urine in good stream following stent/feeding tube removal. The average duration of hospital stay was 11 days. None of our patients developed urethrocutaneous fistula. Only one patient had superficial surgical site infection. All patients are well on follow-up after 6 months. CONCLUSION Free TV graft could be used in place of TV flap as an intermediate waterproof cover to reduce the incidence of urethrocutaneous fistula in staged II hypospadias repair; however, studies involving a larger number of patients would be required to draw conclusions.
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Affiliation(s)
- Charu Tiwari
- Department of Paediatric Surgery, AIIMS, Raipur, Chhattisgarh, India
| | - Nitinkumar Borkar
- Department of Paediatric Surgery, AIIMS, Raipur, Chhattisgarh, India
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10
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Yang H, Xuan XX, Hu DL, Zhang H, Shu Q, Guo XD, Fu JF. Comparison of effect between dartos fascia and tunica vaginalis fascia in TIP urethroplasty: a meta-analysis of comparative studies. BMC Urol 2020; 20:161. [PMID: 33059661 PMCID: PMC7559339 DOI: 10.1186/s12894-020-00737-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 10/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background Tubularized incised plate (TIP) urethroplasty is the most commonly performed procedure for hypospadias. Several flap procedures have been recommended to decrease the postoperative complication rate in TIP repair, but no single flap procedure is ideal. This study aimed to compare the outcomes of dartos fascia (DF) and tunica vaginalis fascia (TVF) as intermediate layers in TIP urethroplasty. Methods We searched PubMed, EMBASE, the Cochrane Library, Web of Science, clinicaltrials.gov, and other sources for comparative studies up to April 16, 2020. Studies were selected by the predesigned inclusion criteria. The primary outcomes were postoperative complications. The secondary outcomes were functional and cosmetic outcomes. Results The pooled RR with 95% CI were calculated. We extracted the relevant information from the included studies. Only 6 comparative studies were included. No secondary outcomes were reported. The RR of the total complications rate for DF was 2.41 (95% CI 1.42–4.07, P = 0.0001) compared with TVF in TIP repair. For each postoperative complication, the RRs were 6.48 (2.20–19.12, P = 0.0007), 5.95 (1.13–31.30, P = 0.04), 0.62 (0.25–1.52, P = 0.29), and 0.75 (0.23–2.46, P = 0.64) for urethrocutaneous fistula, prepuce-related complications, meatal/urethral stenosis, and wound-related complications, respectively. Conclusions This meta-analysis reveals that compared to DF, TVF is a better option in TIP repair in terms of decreasing the incidence of the total postoperative complications, urethrocutaneous fistula, and prepuce-related complications. However there is limited evidence for functional and cosmetic outcomes. Overall, larger prospective studies and long-term follow-up data are required to further demonstrate the superiority of TVF over DF. Trial registration PROSPERO CRD42019148554.
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Affiliation(s)
- Hao Yang
- Zhejiang University School of Medicine, Hangzhou, China.,Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiao-Xiao Xuan
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,National Clinical Research Center for Child Health, Hangzhou, China
| | - Dong-Lai Hu
- Department of Pediatric Surgery, Zhejiang University Jinhua Hospital, Jinhua, China
| | - Hang Zhang
- Zhejiang University School of Medicine, Hangzhou, China.,Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,National Clinical Research Center for Child Health, Hangzhou, China
| | - Qiang Shu
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiao-Dong Guo
- Department of Pediatric Surgery, Zhejiang University Jinhua Hospital, Jinhua, China.
| | - Jun-Fen Fu
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China. .,National Clinical Research Center for Child Health, Hangzhou, China.
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11
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Han JH, Song SH, Lee JS, Park S, Kim SJ, Kim KS. Efficacy of additional tunica vaginalis flap coverage for protecting against urethrocutaneous fistulas in tubularized incised plate urethroplasty: A prospective, randomized controlled trial. Investig Clin Urol 2020; 61:514-520. [PMID: 32734722 PMCID: PMC7458875 DOI: 10.4111/icu.20200024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/24/2020] [Accepted: 03/10/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We compared the protective effect of additional tunica vaginalis flap coverage combined with a dartos flap against urethrocutaneous fistulas in tubularized incised plate (TIP) urethroplasty in a randomized controlled trial. MATERIALS AND METHODS This prospective, randomized controlled trial in a single tertiary center enrolled 50 patients in whom it was feasible to perform single TIP urethroplasty between 2016 and 2017. Consecutive children were randomly allocated to study group A (additional tunica vaginalis flap coverage, n=25) or control group B (dartos-only coverage, n=25). All patients were examined in the outpatient clinic at 1, 3, 12, and 24 months. Postoperative cosmetic outcomes were evaluated by surgeons and parents using the Pediatric Penile Perception Scale questionnaire. RESULTS In group B, 1 of 25 patients (4.0%) developed an urethrocutaneous fistula within 12 months. An additional two cases of fistula were found in all proximal-type hypospadias patients at 24 months in the same group without statistical significance (p=0.07). The penile cosmetic satisfaction rate was not significantly different between the groups according to scores on the Pediatric Penile Perception Scale. CONCLUSIONS Our randomized controlled trial did not show a significant decrease in the incidence of or a significant slowing of the progression of postoperative fistulas after TIP urethroplasty by the use of additional tunica vaginalis coverage. A tunica vaginalis flap is not routinely recommended but could have a selective role in proximal-type TIP urethroplasty with deficient dartos and subcutaneous tissue to cover the neourethra.
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Affiliation(s)
- Jae Hyeon Han
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Hoon Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Je Seong Lee
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Sungchan Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sung Jin Kim
- Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Kun Suk Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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12
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Razzaghi M, Rahavian A, Fallah Karkan M, Allameh F, Ghiasy S, Javanmard B. Use of human amniotic membrane repair of anterior urethral defect: First clinical report. Int J Urol 2020; 27:605-609. [PMID: 32430969 DOI: 10.1111/iju.14257] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/02/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the use of human amniotic membrane allograft to prevent urethrocutaneous fistula after tubularized incised plate repair for redo-hypospadias and anterior urethral defects. METHODS This pilot study included 28 patients (mean age 25.3 ± 11 years) with a history of previous failed hypospadia repair, who underwent tubularized incised plate urethroplasty in one session by the same surgical team from April 2016 to April 2019. After the reconstruction of a neourethra and proper hemostasis, a human amniotic membrane allograft - Grafting Scaffold - was used to cover the suture lines. RESULTS The mean follow-up time was 13.3 ± 4.5 months. Two urethrocutaneous fistulas occurred within the first 2 weeks after the surgery, one of which was caused by the infection of the surgical site. No penile torsion, urethral diverticula, meatal stenosis or glans dehiscence was reported. CONCLUSIONS Amniotic membrane graft provides an applicable, low-cost, feasible, biodegradable and safe second cover in redo-hypospadias repairs by tubularized incised plate technique. Its use is technically easy; it has satisfactory cosmetic outcomes and might decrease urethrocutaneous fistula formation.
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Affiliation(s)
- Mohammadreza Razzaghi
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhossein Rahavian
- Clinical Research Development Unit, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Fallah Karkan
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Allameh
- Center of Excellence for Training Laser Applications in Medicine, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saleh Ghiasy
- Clinical Research Development Unit, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Javanmard
- Clinical Research Development Unit, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Duan S, Jiang X, Zhang X, Ou W, Fu M, Chen K, Li J, Ma S. Megameatus intact prepuce treated with urethral plate-preserving surgery: a retrospective study of an unusual hypospadias variant. Transl Androl Urol 2019; 8:583-590. [PMID: 32038954 PMCID: PMC6987599 DOI: 10.21037/tau.2019.10.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/29/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Megameatus intact prepuce (MIP) is a unique variant of hypospadias and is a clinically rare condition. Due to the anatomical characteristics of the MIP hypospadias variant presenting a unique challenge to surgeons, no single urethroplasty method provides a universal solution for all patients. The purpose of this study was to evaluate the outcomes of hypospadias after MIP repair by urethral plate-preserving urethroplasty. METHODS A retrospective study was performed on 25 coronal or distal MIP patients, with a median age of 8, with most deficiencies being discovered during their first hospital visit for phimosis. Correction with urethroplasty was performed for all patients; 5 underwent the Mathieu procedure, 13 underwent the tubularized incised plate (TIP) procedure, and 7 underwent the Duplay procedure. The 25 patients were followed up for 6 to 36 months to evaluate the surgical outcomes. RESULTS There were no significant differences in intraoperative bleeding, hospital stays, postoperative analgesia rate, and cure rate among the three surgical procedures. The operative time for the Mathieu procedure was longer than that for the TIP and Duplay procedures, which did not differ. Complications occurred in 4 of the 25 patients (16.0%), and the overall complication-free survival rate at 1 year after surgery was 80.5%. The age at the time of surgery, urethral plate width, urethroplasty length, surgical procedures, or meatal location (coronal or distal penis) were not independently predictive of complications. CONCLUSIONS The clinical manifestations of MIP are often concealed and then accidentally discovered during hospital visits for phimosis; thus, the actual incidence of MIP might be higher. The urethral plate should be preserved during MIP-correcting treatment, especially for coronal or distal MIP. The same satisfactory outcomes can be obtained with Mathieu, TIP, or Duplay urethroplasty.
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Affiliation(s)
- Shouxing Duan
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
- epartment of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
| | - Xuewu Jiang
- Department of Pediatric Surgery, Woman’s and Children’s Hospital, Shenzhen University and Pingshan District, Shenzhen 518122, China
| | - Xuan Zhang
- Department of Pediatric Surgery, Woman’s and Children’s Hospital, Shenzhen University and Pingshan District, Shenzhen 518122, China
| | - Wenhui Ou
- epartment of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
| | - Maxian Fu
- epartment of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
| | - Kaihong Chen
- epartment of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
| | - Jianhong Li
- epartment of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
| | - Shuhua Ma
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
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Gite VA, Kandi AJ, Bote SM, Nikose JV, Patil SR. Outcome of Snodgrass Repair for Various Types of Hypospadias: Our Experience. Indian J Surg 2019. [DOI: 10.1007/s12262-018-1768-6] [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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Mahmoud AY, Gouda S, Gamaan I, Baky Fahmy MA. Autologous platelet-rich plasma covering urethroplasty versus dartos flap in distal hypospadias repair: A prospective randomized study. Int J Urol 2019; 26:475-480. [PMID: 30719774 DOI: 10.1111/iju.13912] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/18/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the outcome and complication rate of the platelet-rich plasma applied as a coverage layer and dartos flap layer during primary repair of distal hypospadias. METHODS A prospective randomized study was carried out comprising 180 boys (age range 12-65 months) from October 2011 to December 2016 at Al-Azhar University Hospitals, Cairo, Egypt. A single surgeon carried out all urethroplasty. Patients were randomly divided into two groups: group A (tubularized incised plate urethroplasty with platelet-rich plasma coverage layer) and group B (ventral dartos flap). Complication rates were compared between two groups. RESULTS There was a significant difference in the occurrence of complications between the two groups. A total of 36 (20%) complications were recorded in 26 patients, just 12 (13.3%) reported in group A, but 24 (26.7%) complications were reported in group B. Urethrocutaneous fistula was observed in nine patients (10%) in group A, and 12 (13.3%) in group B. Partial glans dehiscence occurred in one patient in group A, and four patients in group B. No patient in group A had a superficial wound infection, compared with six patients in group B. One case of meatal stenosis and urethral stricture was recorded in each group, all of which were managed conservatively. The resultant urinary stream was single and good in 154 patients of both groups. CONCLUSIONS Platelet-rich plasma sheet might be considered as an alternative coverage layer for distal hypospadias repair, especially in the absence of a healthy layer.
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Affiliation(s)
| | - Samir Gouda
- Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt
| | - Ibrahim Gamaan
- Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt
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Kurbet SB, Koujalagi RS, Geethika V, Nagathan V. A 1-year randomized controlled trial to compare the outcome of primary repair of hypospadias with vascular cover using tunica vaginalis flap with those using preputial dartos fascia. Afr J Paediatr Surg 2018; 15:42-47. [PMID: 30829308 PMCID: PMC6419552 DOI: 10.4103/ajps.ajps_104_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND : Tubularized incised plate (TIP) urethroplasty is the most common technique noted to correct hypospadias. However, urethrocutaneous fistula (UCF) is still one of the most common complications of this technique. Several techniques of providing vascularized flaps to the neourethra have been recommended to decrease this complication rate. The aim of the study was to assess the outcome of primary repair of hypospadias using tunica vaginalis (TV) flap with those using preputial dartos (PD) fascia. PATIENTS AND METHODS : Children diagnosed with hypospadias between the age group of 9 months to 18 years, who fulfilled the criteria were randomly divided into two groups by computerized randomization technique. Initially, TIP urethroplasty was done. Children with PD vascular cover were included in Group A and those with TV vascular cover were included in Group B. All the patients were followed up for a minimum of 6 months after surgery. RESULTS : Two (10%) patients in Group A developed UCF and one (5%) patient developed stricture urethra in the follow-up period. None of the patients developed UCF in the Group B. One (5%) patient had stricture urethra in Group B. Two (10%) patient developed meatal stenosis in Group A. Two (10%) patient in Group B developed meatal stenosis. CONCLUSIONS TV flap could be an alternative to PD flap as a vascular cover of neourethra in patients undergoing primary hypospadias repair by TIP urethroplasty.
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Affiliation(s)
- Santosh B. Kurbet
- Department of Paediatric Surgery, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Ramesh S. Koujalagi
- Department of Paediatric Surgery, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - V. Geethika
- Department of Paediatric Surgery, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Vikram Nagathan
- Department of Paediatric Surgery, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
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Comparison of interrupted- and continuous-suture urethroplasty in tubularised incised-plate hypospadias repair: A prospective study. Arab J Urol 2017; 15:312-318. [PMID: 29234534 PMCID: PMC5717464 DOI: 10.1016/j.aju.2017.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/14/2017] [Accepted: 10/18/2017] [Indexed: 12/02/2022] Open
Abstract
Objective To compare the effect of interrupted- and continuous-suture urethroplasty on complication rates in Snodgrass tubularised incised-plate (TIP) hypospadias repair. Patients and methods This was a prospective randomised study comprising 100 boys (age range 1–5 years) with primary subcoronal, distal- and mid-penile hypospadias who underwent repair from October 2010 to March 2015 in a tertiary care hospital. Boys with glanular, recurrent, and proximal hypospadias were excluded from the study. The boys were prospectively randomised into two groups: Group A, comprised 50 boys who underwent interrupted subcuticular suture Snodgrass TIP urethroplasty; and Group B, comprised 50 boys who underwent continuous subcuticular suture Snodgrass TIP urethroplasty. Outcomes were assessed in terms of complication rates and aesthetic appearance during follow-up. Results There was no significant difference in the occurrence of complications between the groups. There were 21 complications, with 10 occurring in Group A and 11 in Group-B. Urethrocutaneous fistula was the most common complication in both groups (six in Group A and seven in Group B), the fistulae were <2 mm in nine patients and 3–5 mm in the remaining four. Partial glans dehiscence occurred in one patient in each group. One patient from each group also had superficial wound infection, meatal stenosis and urethral stricture respectively, all of which were managed conservatively. The resultant urinary stream was single and good in all patients of both groups. Conclusions The type of suture technique had no significant effect on complication rates after Snodgrass hypospadias repair and thus the choice of technique depends on surgeon preference.
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Basavaraju M, Balaji DK. Choosing an ideal vascular cover for Snodgrass repair. Urol Ann 2017; 9:348-352. [PMID: 29118537 PMCID: PMC5656960 DOI: 10.4103/ua.ua_90_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/14/2017] [Indexed: 11/11/2022] Open
Abstract
AIM The aim of this study is to compare tunica vaginalis (TV), dorsal dartos, and ventral dartos flap as a second layer vascular cover during Snodgrass repair. MATERIALS AND METHODS Data of 83 patients who underwent primary hypospadias repair with Snodgrass technique (age range: 1.6-12 years) were retrospectively collected and compared. They were divided into three groups. Group A (26 patients) included cases using TV flap, Group B (36 patients) included those where dorsal dartos from prepuce was used as second cover, and Group C (21 patients) included those with ventral dartos as cover. RESULTS In Group A, no complications recorded. Mild scrotal edema was present in 5 patients which was conservatively managed. In Group B, there were 8 fistulas, 2 glans breakdown, and 1 meatal stenosis. In Group C, there were 3 fistulas and 1 glans breakdown. CONCLUSION TV flap is better than dorsal dartos and ventral dartos as vascular cover for primary hypospadias repair with Snodgrass technique.
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Affiliation(s)
- Mamatha Basavaraju
- Department of Pediatric Surgery, Vydehi Institute of Medical Science, Bengaluru, Karnataka, India
| | - Dhiraj K. Balaji
- Department of Pediatric Surgery, Vydehi Institute of Medical Science, Bengaluru, Karnataka, India
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Tam YH, Pang KKY, Wong YS, Tsui SY, Wong HY, Mou JWC, Chan KW, Lee KH. Improved outcomes after technical modifications in tubularized incised plate urethroplasty for mid-shaft and proximal hypospadias. Pediatr Surg Int 2016; 32:1087-1092. [PMID: 27473011 DOI: 10.1007/s00383-016-3954-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate and compare the outcomes after tubularized incised plate (TIP) urethroplasty in mid-shaft and proximal hypospadias using a standard and a modified technique. METHODS We conducted a retrospective study in 104 consecutive children who underwent mid-shaft or proximal TIP repairs from Jan 2007 to Sept 2015. Patients in Cohort One had dorsal dartos (DD) neourethral coverage while patients in Cohort Two had either de-epithelialized split preputial (DESP) or tunica vaginalis (TV) flap coverage. TV flap was used only when DESP flap was not sufficient to cover the neourethra. RESULTS There were 52 patients each in Cohort One (DD, n = 52) and Cohort Two (DESP, n = 38; TV, n = 14) with no difference in ratio of mid-shaft/proximal between the two cohorts. At a median follow-up of 28 months, 36 patients (34.6 %) developed 47 complications including fistula (n = 19; 18.3 %) and neourethral dehiscence (n = 4; 3.8 %). Cohort One patients had significantly more fistula (28.8 vs 7.7 %; p = 0.005) and neourethral dehiscence (7.7 vs 0 %; p = 0.04) than Cohort Two. There was no difference between the two cohorts in the complication rates of meatal stenosis, recurrent ventral curvature and neourethral stricture. CONCLUSIONS Both DESP and TV flap appear to be superior to DD in preventing fistula and neourethral dehiscence in non-distal TIP repairs.
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Affiliation(s)
- Yuk Him Tam
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China.
| | - Kristine Kit Yi Pang
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China
| | - Yuen Shan Wong
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China
| | - Siu Yan Tsui
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China
| | - Hei Yi Wong
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China
| | - Jennifer Wai Cheung Mou
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China
| | - Kin Wai Chan
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China
| | - Kim Hung Lee
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China
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20
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Is the double cross flap technique the panacea for avoiding fistula formation in hypospadias surgery? ANNALS OF PEDIATRIC SURGERY 2016. [DOI: 10.1097/01.xps.0000489164.33691.5f] [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] Open
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21
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Which Way for Waterproofing? Eur Urol 2016; 70:299-300. [DOI: 10.1016/j.eururo.2016.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/17/2016] [Indexed: 11/22/2022]
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22
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Fahmy O, Khairul-Asri MG, Schwentner C, Schubert T, Stenzl A, Zahran MH, Gakis G. Algorithm for Optimal Urethral Coverage in Hypospadias and Fistula Repair: A Systematic Review. Eur Urol 2016; 70:293-8. [DOI: 10.1016/j.eururo.2015.12.047] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/29/2015] [Indexed: 11/30/2022]
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Jia W, Liu GC, Zhang LY, Wen YQ, Fu W, Hu JH, Wang Z, He QM, Xia HM. Comparison of tubularized incised plate urethroplasty combined with a meatus-based ventral dartos flap or dorsal dartos flap in hypospadias. Pediatr Surg Int 2016; 32:411-5. [PMID: 26783086 DOI: 10.1007/s00383-016-3860-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Tubularized incised plate urethroplasty (TIPU) is the preferred surgical option for distal and mid-shaft hypospadias repair. Neourethra dartos flap coverage is routinely used as a protective layer with good results. We modified meatus-based ventral dartos flap (MBVDF) to TIPU by dissecting the proximal mid-ventral dartos attached urethra and leaving the subcutaneous fascia connecting the meatus, and retrospectively compared the outcomes of using MBVDF with single dorsal dartos flap (DDF) on the complication rates of TIPU. METHODS We present 2 surgeons' experiences with 356 patients with distal and mid-shaft hypospadias between January 2010 and December 2014. Patients were divided into two groups. Group DDF included 185 patients (mean age 29 months) underwent TIPU with DDF rotated laterally covering the suture lines of the neourethra. Group MBVDF included 171 patients (mean age 26 months) underwent TIPU with MBVDF covering the suture lines of the neourethra. Statistical analysis of patient basic information and complications was performed by two independent sample t test and Chi square test or Fisher's exact test. RESULTS There were no statistical differences in age, type of hypospadias, and follow-up time between the two groups. The mean operative time in the group MBVDF (68.93 ± 8.32 min) was significantly shorter than in the group DDF (73.60 ± 9.06 min). Ventral skin necrosis (2.7%) and penile rotation (3.8%) in group DDF was significantly higher than group MBVDF which did not occur. The differences in other complication rates including fistula rate (2.7 vs 2.9%) between the groups were not statistically significant. CONCLUSION DDF and MBVDF with TIPU are similarly effective methods for decreasing fistula in hypospadias repair. MBVDF with TIPU may be an easier method and can avoid ventral skin necrosis and penile rotation.
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Affiliation(s)
- Wei Jia
- Southern Medical University, Guangzhou, 510515, People's Republic of China
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, People's Republic of China
| | - Guo-chang Liu
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, People's Republic of China
| | - Li-yu Zhang
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, People's Republic of China
| | - Ying-quan Wen
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, People's Republic of China
| | - Wen Fu
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, People's Republic of China
| | - Jin-hua Hu
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, People's Republic of China
| | - Zhe Wang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, People's Republic of China
| | - Qiu-ming He
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, People's Republic of China
| | - Hui-min Xia
- Southern Medical University, Guangzhou, 510515, People's Republic of China.
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, People's Republic of China.
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Hamid R, Baba AA, Shera A, Ahmad S. Tunica vaginalis flap following 'Tubularised Incised Plate' urethroplasty to prevent urethrocutaneous fistulaa. Indian J Plast Surg 2015; 48:187-91. [PMID: 26424985 PMCID: PMC4564505 DOI: 10.4103/0970-0358.163059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Surgery for hypospadias has been continuously evolving, implying thereby that no single technique is perfect and suitable for all types of hypospadias. Snodgrass technique is presently the most common surgical procedure performed for hypospadias. MATERIALS AND METHODS We analysed the results of tunica vaginalis flap (TVF) as an additional cover to the tubularised incised plate (TIP) repair. RESULTS A total of 35 patients of hypospadias were repaired using TIP urethroplasty and TVF as a second layer. Mean age at the time of presentation was 6.63 ± 3.4 years. Post-operative complications namely wound infection, flap necrosis, scrotal haematoma, scrotal abscess, urethral fistula, meatal stenosis were recorded and analysed during follow-up period. Need for re-do surgery was considered as failure of the operative procedure. Out of 35 patients, 8 (22.85%) patients had proximal penile hypospadias and 27 (77.14%) patients had distal penile hypospadias. Mean post-operative follow-up was 24.53 months. During the follow-up complications noticed included wound infection (n = 2), urethrocutaneous fistula (n = 1) and meatal stenosis (n = 1). Wound infection was managed with appropriate antibiotics as per hospital policy/culture and sensitivity reports. Meatal stenosis responded to bougie dilatation/calibration during follow-up. CONCLUSION To conclude, TVF as an additional cover is associated with an acceptable complication rate and good cosmetic results if performed with meticulous tissue handling.
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Affiliation(s)
- Raashid Hamid
- Department of Paediatric Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Aejaz A. Baba
- Department of Paediatric Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Altaf Shera
- Department of Paediatric Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Sarfaraz Ahmad
- Department of Paediatric Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
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The use of dermal graft in severe chordee hypospadias repair: experience from Vietnam. Pediatr Surg Int 2015; 31:291-5. [PMID: 25573387 DOI: 10.1007/s00383-015-3656-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE Severe chordee with hypospadias may require repair by ventral corporoplasty with a free graft before urethroplasty. We report an 11 year experience with one-stage and two-stage hypospadias repair using dermal grafts. MATERIALS AND METHODS From 12/1997 to 12/2008, 47 hypospadias with severe chordee were repaired using a ventral dermal graft to correct the chordee. Forty cases were repaired in two stages; the remaining seven patients had adequate preputial skin and were repaired in one stage. In 28 cases the neourethra was covered with both tunica vaginalis and penile dartos flap while 12 were covered only with penile dartos flap. Patients ranged from 12 to 152 months of age. Follow-up ranged from 6 months to 4 years. RESULTS 28 patients with both tunica vaginalis and dartos flap had 7 urethral fistulas and 2 developed meatal stenosis. 12 patients with only penile dartos flap had 3 fistulas and 2 had meatal regression. The seven patients who underwent a one-stage repair had good results with a straight penis and no evidence of urethral fistula or urethral stenosis. CONCLUSIONS Dermal graft can be performed in one or two stage hypospadias repair. Complication rates are similar to other standard repairs for proximal hypospadias.
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Bhat A, Sabharwal K, Bhat M, Saran R, Singla M, Kumar V. Outcome of tubularized incised plate urethroplasty with spongioplasty alone as additional tissue cover: A prospective study. Indian J Urol 2014; 30:392-7. [PMID: 25378820 PMCID: PMC4220378 DOI: 10.4103/0970-1591.134234] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Additional cover after neourethra formation to decrease the fistula rate, has been described using the dartos, tunica, denuded skin and corpus spongiosum. The use of corpus spongiosum alone to cover the neourethra is infrequent. The objective of this study was to evaluate the efficacy of spongioplasty alone as an intervening layer in the prevention of urethral fistula following tubularized incised plate urethroplasty (TIPU). MATERIALS AND METHODS A prospective study was performed including 113 primary hypospadias cases undergoing TIPU with spongioplasty from June 2010 to March 2012. Correction of chordee was carried out by penile degloving alone in 5, mobilization of urethral plate with spongiosum in 22 and combination of both in 45 cases. Intra-operatively, spongiosum was taken to be poorly developed if it was thin and fibrous, moderate if good spongiosal tissue with good vascularization and well-developed if healthy robust spongiosum, which became bulkier than native spongiosum after tubularisation. Spongioplasty was done in a single layer after mobilization of spongiosum, starting just proximal to the native meatus and into the glans distally. RESULTS The mean age of the patients was 11.53 years. The type of hypospadias was distal, mid and proximal in 81, 12 and 20 cases respectively. Spongiosum was poorly developed in 13, moderate in 53 and well-developed in 47 cases. The mean hospital stay was 8-10 days and follow-up ranged from 6 months to 2 years. Urethral fistula was seen in six patients (11.3%) with moderate spongiosum (distal 1, mid 1 and proximal 4), and three (23.03%) with poorly developed spongiosum (one each in distal, mid and proximal) with an overall 7.96% fistula rate. None of the patients with well-developed spongiosum developed a fistula. Poorer spongiosum correlated with a greater number of complications (P = 0.011). Five out of thirteen cases with poor spongiosum (38.46%) had proximal hypospadias, i.e. more proximal was the hypospadias, poorer was the development of the spongiosum (P = 0.05). Meatal stenosis was seen in two patients (1.76%) with proximal hypospadias, one with moderate and the other with poorly developed spongiosum. More proximal was the hypospadias, greater were the number of complications (P = 0.0019). CONCLUSION TIPU with spongioplasty reconstructs a near normal urethra with low complications. Better developed and thicker spongiosum results in lower incidence of fistula and meatal stenosis. More proximal hypospadias is associated with poorer spongiosum. We recommend spongioplasty to be incorporated as an essential step in all patients undergoing tubularized incised-plate repair for hypospadias.
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Affiliation(s)
- Amilal Bhat
- Department of Urology, S.P. Medical College, Bikaner, Rajasthan, India
| | | | - Mahakshit Bhat
- Department of Preventive and Social Medicine, S.P. Medical College, Bikaner, Rajasthan, India
| | - Ramakishan Saran
- Department of Urology, S.P. Medical College, Bikaner, Rajasthan, India
| | - Manish Singla
- Department of Urology, S.P. Medical College, Bikaner, Rajasthan, India
| | - Vinay Kumar
- Department of Urology, S.P. Medical College, Bikaner, Rajasthan, India
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Comparative Study of Snodgrass and Mathieu's Procedure for Primary Hypospadias Repair. ISRN UROLOGY 2014; 2014:249765. [PMID: 24944834 PMCID: PMC4040194 DOI: 10.1155/2014/249765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 03/30/2014] [Indexed: 11/24/2022]
Abstract
Objective. Present study was undertaken to compare the results of two single stage hypospadias repairs, namely, Tubularized Incised Plate (TIP) repair and Mathieu's repair. Methods. The study included 100 patients of distal penile hypospadias, from January, 2008 to January, 2013. After a detailed history, local examination was performed with reference to the site of meatus, shape of glans, and presence of chordee. TIP repair was performed in 52 patients and Mathieu's repair in 48 patients. On follow-up, the patients were examined for the position of meatus, shape of meatus, urinary stream, urethrocutaneous fistula, and stricture formation. Results. The mean age of presentation was 6.2 ± 3.2 years (range 1.5–15years). The mean operative time was 63.7 ± 14.3 (45–90) minutes and 95.0 ± 19.1 (70–125) minutes in TIP and Mathieu's repair, respectively.Complications after surgery were urethero cutaneous fistula in 3(5.76%) and 7 (14.5%), meatal stenosis in 3(5.33%) and 4(8.33%), wound infection in 19.2% and 8.3% cases in TIP repair and Mathieu repair, respectively. The shape of meatus was slit-like and vertically oriented in 48(92.3%) patients who had undergone TIP repair. Conclusion. The Snodgrass repair is significantly faster, with more natural cosmetic appearance of the meatus than the Mathieu's repair.
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Bhat A, Singla M, Bhat M, Sabharwal K, Kumar V, Upadhayay R, Saran RK. Comparison of Results of TIPU Repair for Hypospadias with “Spongioplasty Alone” and “Spongioplasty with Dorsal Dartos Flap”. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/oju.2014.45008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Babu R, Hariharasudhan S. Tunica vaginalis flap is superior to inner preputial dartos flap as a waterproofing layer for primary TIP repair in midshaft hypospadias. J Pediatr Urol 2013. [PMID: 23186594 DOI: 10.1016/j.jpurol.2012.10.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS The aims of this study are 1. to compare outcome of standard tubularised incised plate urethroplasty (TIP) repair using dartos flap in distal vs. midshaft hypospadias and 2. to determine whether tunica vaginalis flap (TVF) is superior to dartos flap in midshaft hypospadias in reducing early complications. METHODS All patients who underwent TIP repair between 2004 and 2011 by the same surgeon were divided into three groups based on type of hypospadias and choice of waterproofing layer: Group A: Distal hypospadias; inner prepucial dartos flap (n = 36); Group B: Midshaft hypospadias; inner prepucial dartos flap (n = 26); Group C: Midshaft hypospadias; TVF (n = 21). Early outcomes were compared between the groups using Fisher's exact test. RESULTS There was no significant difference in the age distribution or duration of follow up between the groups. There was no significant difference in terms of, glans dehiscence or meatal stenosis between the groups. In Group A, 0/36 had ventral skin necrosis and 3/36 (8.3%) developed urethrocutaneous fistula. In Group B, there was significantly higher ventral skin necrosis (6/26; 23%) and urethrocutaneous fistula (8/26; 30.7%) compared to Group A (p = 0.04). In Group C, there was significantly less ventral skin necrosis (0/21) and urethrocutaneous fistula (1/21; 4.7%) compared to group B (p = 0.03). There was no significant difference in outcomes between Group A and Group C. CONCLUSION 1. TIP repair using inner prepucial dartos flap has significantly higher complications when used for midshaft hypospadias compared to distal hypospadias. 2. Tunica vaginalis flap reduces the fistula rate and is superior to inner prepucial dartos flap as a waterproofing layer for primary TIP repair in midshaft hypospadias.
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Affiliation(s)
- Ramesh Babu
- Pediatric Urology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai 600116, India.
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Inclusion and Exclusion Criteria to Overcome Bias and Reach a Valid Conclusion for Interpositional Flap Coverage in Primary Hypospadias Repair With Tubularized Incised Plate Urethroplasty. Ann Plast Surg 2013; 71:581-5. [DOI: 10.1097/sap.0b013e31825516a0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Yaqubi AA, Yuan WW, Mei SH, Xiong JT. Tunica Vaginalis Pedicle Flap for Reconstruction of Anterior Urethral Stricture. Low Urin Tract Symptoms 2013; 6:15-9. [PMID: 26663495 DOI: 10.1111/luts.12012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 12/11/2012] [Accepted: 12/30/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the intermediate-term clinical efficacy and success rate of tunica vaginalis (TV) pedicle flap for reconstruction of bulbo-penile urethral stricture. METHODS We assessed the medical records of 15 male patients who had undergone TV pedicle flap urethroplasty for reconstruction of anterior urethral stricture between January 2006 and December 2011. The surgical outcome was assessed by comparison of four parameters including the maximum flow rate (Qmax ), international prostate symptom score (IPSS), residual urine (RU) and quality of life (QOL) in all patients pre- and postoperatively. Moreover, pre- and postoperative retrograde urethrography films were compared in all patients. t-test was used for data analysis. RESULTS The mean patient age was 38.1 ± 9.3 years (range: 25-55), mean stricture length was 4.2 ± 1.1 cm (range: 3-6.1 cm), and the mean follow up time was 14.6 ± 1.9 months (range: 12-18) months. There was a statistically significant difference between Q(max) , IPSS, RU and QOL pre- and postoperatively (P < 0.01). The clinical success rate in this study was 86.6% (13/15). The early complication was one case of wound infection and subsequent wound dehiscence, one case of hematoma formation in another patient, which did not have any influence in the long-term clinical outcome. CONCLUSION At intermediate-term follow up, TV pedicle flap urethroplasty has a high clinical success rate with low complication. However, a large clinical trial with long-term follow up is needed to confirm the result.
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Affiliation(s)
| | - Wu Wen Yuan
- Department of Urology, Yan Bian University, Yanji, China
| | - Shen Hong Mei
- Department of Radiology, Yan Bian University, Yanji, China
| | - Jin Tie Xiong
- Department of Urology, Yan Bian University, Yanji, China
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Cimador M, Pensabene M, Sergio M, Catalano P, de Grazia E. Coverage of urethroplasty in pediatric hypospadias: randomized comparison between different flaps. Int J Urol 2013; 20:1000-5. [PMID: 23421595 DOI: 10.1111/iju.12092] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 12/26/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The use of covering urethroplasty with flaps in hypospadias surgery has been well recommended. Various techniques have been described for flap harvesting. The aim of the present study was to compare the outcome and complication rate of dorsal preputial flaps and ventral dartos flaps. METHODS A total of 130 patients were prospectively evaluated from January 2008 to December 2011. Using the tubularized incised plate urethroplasty procedure, urethroplasty was carried out by a single surgeon. Patients were randomly divided in two groups: group A (57 patients), in which a preputial flap was carried out using three different techniques; and group B (73 patients), in which a single or a double ventral dartos flap was used. RESULTS A total of 41 complications occurred in 24 patients. Urethrocutaneous fistulas were observed in 14.9%, quite equally distributed between groups A and B. There was only one urethrocutaneous fistula in a patient treated with the double ventral dartos flaps. Five cases (3.8%) of glans dehiscence were observed: four after single ventral dartos flap and one after dorsal preputial flap. Six patients in group A and seven in group B experienced meatal stenosis. In three cases of iatrogenic torsion of the penis, a dorsal preputial flap was laterally transposed. Finally, a lower complication rate was observed for double ventral dartos flap versus the other techniques. CONCLUSIONS The use of a double ventral dartos flap should represent the first-line technique for coverage of distal urethroplasty.
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Affiliation(s)
- Marcello Cimador
- Section of Pediatric Urology, Pediatric Surgical Unit, Department of Mother and Child Care, University of Palermo, Palermo, Italy
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Chatterjee US, Chatterjee SK. Regenerative urethroplasty in reoperative hypospadias: Buried strip principle revisited. J Indian Assoc Pediatr Surg 2012; 17:63-7. [PMID: 22529550 PMCID: PMC3326824 DOI: 10.4103/0971-9261.93965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: Reporting the feasibility of the Denis Browne (buried strip) principle along with tunica vaginalis (TV) pedicled wrapping of the strip in reoperative urethroplasty in hypospadias. Materials and Methods: Over a period of 5 years, 32 patients presented with failure of previous urethroplasty and the range of failure was between 2 and 6 times; mean 2.5 times. Mean age was 12.9 (range 2 to 26 years) years. “Buried strip” urethroplasty (i.e., without tubularization of urethral plate) and wrapping with TV were done along with supra pubic cystostomy (SPC) for diversion of urine. Mean follow-up was 29.8 (range 12 to 56 months) months. Results: One patient had fistula and vertical slit meatus was possible in 26 patients. The flow of urine was satisfactory in 31 patients and one patient developed pouch in penile urethra. Conclusions: The buried strip along with the additional coverage with TV was found to be simple and effective in salvaging the failed urethroplasty.
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Affiliation(s)
- Uday S Chatterjee
- Department of Pediatric Surgery, Park Medical Research and Welfare Society, Kolkata, India
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Dhua AK, Aggarwal SK, Sinha S, Ratan SK. Soft tissue covers in hypospadias surgery: Is tunica vaginalis better than dartos flap? J Indian Assoc Pediatr Surg 2012; 17:16-9. [PMID: 22279358 PMCID: PMC3263032 DOI: 10.4103/0971-9261.91080] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIM To compare tunica vaginalis with dartos flap as soft tissue cover in primary hypospadias repair. MATERIALS AND METHODS 25 cases (age range: 12-132 months; all fresh cases) of primary hypospadias were prospectively repaired by tubularized incised plate (TIP)/TIP + graft urethroplasty using tunica vaginalis flap (TVF) as soft tissue cover to urethroplasty (group A). Their results were compared with another set (group B) of age- and anatomy-matched controls (25 patients operated during the previous 3 years) who had undergone TIP repair using dartos flap as soft tissue cover. Statistical analysis of results was done with Fischer's exact test. RESULTS GROUP A No fistula, skin necrosis, meatal stenosis, urethral stricture. One case had partial wound dehiscence that resolved on conservative treatment with no sequelae. One case required catheter removal on 3(rd) day because of severe bladder spasm. There was no testicular atrophy/ascent. Group B: 3 fistulae - all required surgery. There were three cases of superficial skin necrosis that healed spontaneously without sequel. There was no meatal stenosis/urethral stricture. The difference in fistula rate between both the groups, however, was not statistically significant (P = 0.4). CONCLUSION TVF may have an edge over dartos fascia for soft tissue coverage of the neourethra.
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Affiliation(s)
- Anjan Kumar Dhua
- Department of Pediatric Surgery, Maulana Azad Medical College, Delhi, India
| | | | - Shandip Sinha
- Department of Pediatric Surgery, Maulana Azad Medical College, Delhi, India
| | - Simmi K. Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College, Delhi, India
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Bertozzi M, Yıldız A, Kamal B, Mustafa M, Prestipino M, Yiğiter M, Al-Darawany H, Oral A, Nardi N, Appignani A. Multicentric experience on double dartos flap protection in tubularized incised plate urethroplasty for distal and midpenile hypospadias. Pediatr Surg Int 2011; 27:1331-6. [PMID: 21935592 DOI: 10.1007/s00383-011-2978-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE We report a multicenter experience using double dartos flap to protect the neourethra in TIP urethroplasty for distal and midpenile hypospadias. METHODS A total of 394 patients underwent tubularized incised plate urethroplasty for primary distal and midpenile hypospadias using double dartos flap protection by ten pediatric surgeons and urologists at five different institutions. RESULTS Tubularized incised plate urethroplasty protected by a double dartos flap was simple to perform and flaps were easy to obtain. Complications occurred in 23 patients (5.83%): fistulas 1.01% (4 cases), stenosis 0.25% (1 case), mild stenosis 2.53% (10 cases), dehiscence of ventral cutis 0.50% (2 cases) and penile torsion 1.26% (5 cases). All fistulae had a spontaneous resolution. CONCLUSION Double dartos flap to protect tubularized incised plate urethroplasty is safe with a low complication rate. The neourethra is covered entirely with a double layer of vascularized tissue and the double coverage appears a good choice for preventing urethrocutaneous fistula formation.
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Affiliation(s)
- M Bertozzi
- S. C. di Clinica Chirurgica Pediatrica, Ospedale S. Maria della Misericordia, Università degli Studi di Perugia, 06100 S. Andrea delle Fratte, Perugia, Italy.
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Rosito TE, Pires JA, Delcelo R, Ortiz V, Macedo Jr A. Macroscopic and histological evaluation of tunica vaginalis dorsal grafting in the first stage of Bracka’s urethroplasty: an experimental study in rabbits. BJU Int 2010; 108:E17-22. [DOI: 10.1111/j.1464-410x.2010.09708.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Snodgrass WT, Bush N, Cost N. Tubularized incised plate hypospadias repair for distal hypospadias. J Pediatr Urol 2010; 6:408-13. [PMID: 19837000 DOI: 10.1016/j.jpurol.2009.09.010] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 09/21/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE We report surgical technique and outcomes in consecutive patients with primary distal hypospadias. MATERIALS AND METHODS A prospectively maintained database of all patients operated by WS in 2000-2008 was reviewed for pertinent data in consecutive patients. RESULTS A total of 551 consecutive patients of mean age 17 months underwent distal tubularized incised plate hypospadias repair by urethral plate tubularization with (459) or without (92) midline incision. Follow up occurred for 426 (77%) at a mean of 8.2 months. Calibration and/or uroflowmetry were obtained in 279 (65%). Complications developed in 19 (4%), including nine fistulas, nine glans dehiscences and one delayed meatal stenosis from balanitis xerotica obliterans. These complications could not be attributed to meatal location, urethral plate configuration or incision, suture materials or methods for urethroplasty and glansplasty, or to use or not of a dartos flap barrier layer. CONCLUSIONS No contraindication to urethral plate tubularization with or without incision was found in 551 consecutive patients operated for distal hypospadias. Reliability of the procedure was confirmed by the low complication rate and success using varied suture materials and methods.
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Affiliation(s)
- Warren T Snodgrass
- Pediatric Urology Section, Children's Medical Center and The University of Texas Southwestern Medical Center, Dallas, Texas 75207, USA.
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Yiğiter M, Yildiz A, Oral A, Salman AB. A comparative study to evaluate the effect of double dartos flaps in primary hypospadias repair: no fistula anymore. Int Urol Nephrol 2010; 42:985-90. [PMID: 20411329 DOI: 10.1007/s11255-010-9735-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Accepted: 03/30/2010] [Indexed: 11/26/2022]
Affiliation(s)
- Murat Yiğiter
- Faculty of Medicine, Department of Pediatric Surgery, Ataturk University, 25240, Erzurum, Turkey.
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Routh JC, Wolpert JJ, Reinberg Y. Tunneled tunica vaginalis flap for recurrent urethrocutaneous fistulae. Adv Urol 2008; 2008:615928. [PMID: 19009031 PMCID: PMC2581732 DOI: 10.1155/2008/615928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2008] [Accepted: 08/11/2008] [Indexed: 11/21/2022] Open
Abstract
The tubularized incised plate (TIP) hypospadias repair is currently the most widely used urethroplasty technique. The most significant post-TIP complication is urethrocutaneous fistula (UCF) development. Tunneled tunica vaginalis flap (TVF) is a well-described technique for the repair of UCF. We retrospectively reviewed all patients undergoing repeat repair of UCF after TIP repair from 2001 to 2005. Twelve boys underwent TVF repair at our institution for recurrent UCF. Fistulae ranged from distal penile to penoscrotal in location. Median surgical time was 45 minutes and no postoperative complications occurred. After a median follow-up of 32 months (range 16-48 months), no patient has yet had a recurrence of UCF. In conclusion, TVF repair is a successful technique for the treatment of UCF after previous failed repair. TVF is technically simple to perform and should be considered for treating UCF following TIP urethroplasty, particularly in a repeat surgical setting.
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Affiliation(s)
| | - James J. Wolpert
- Division of Pediatric Urology, Pediatric Surgical Associates, Minneapolis, MN 55404, USA
| | - Yuri Reinberg
- Division of Pediatric Urology, Pediatric Surgical Associates, Minneapolis, MN 55404, USA
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Braga LHP, Lorenzo AJ, Salle JLP. Tubularized incised plate urethroplasty for distal hypospadias: A literature review. Indian J Urol 2008; 24:219-25. [PMID: 19468401 PMCID: PMC2684277 DOI: 10.4103/0970-1591.40619] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The tubularized incised plate (TIP) urethroplasty or Snodgrass procedure has gained worldwide acceptance for distal hypospadias repair due to its low complication rate, good cosmetic result, and technical simplicity. As a result, several articles have been published concerning various aspects and subtle variations of this procedure. The aim of this review is to critically and systematically analyze the published complication rates of TIP repair for distal hypospadias in children. We also reviewed the surgical modifications that have been introduced to the original technique and discussed the potential impact on the final outcome of the Snodgrass procedure.
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Affiliation(s)
- Luis Henrique P. Braga
- Division of Urology and University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Armando J. Lorenzo
- Division of Urology and University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joao L. Pippi Salle
- Division of Urology and University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
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El-Kassaby AW, Al-Kandari AM, Elzayat T, Shokeir AA. Modified Tubularized Incised Plate Urethroplasty for Hypospadias Repair: A Long-Term Results of 764 Patients. Urology 2008; 71:611-5. [DOI: 10.1016/j.urology.2007.11.121] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2007] [Revised: 11/18/2007] [Accepted: 11/20/2007] [Indexed: 10/22/2022]
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Savanelli A, Esposito C, Settimi A. A prospective randomized comparative study on the use of ventral subcutaneous flap to prevent fistulas in the Snodgrass repair for distal hypospadias. World J Urol 2007; 25:641-5. [PMID: 17912528 DOI: 10.1007/s00345-007-0215-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 09/07/2007] [Indexed: 10/22/2022] Open
Abstract
We evaluated the importance of urethral coverage using vascularized subcutaneous ventral flaps for the prevention of fistulas in patients undergoing distal hypospadias repair. Our prospective study included 130 patients, aged 9 months to 12 years, who underwent distal hypospadias repair using tubularized incised plate urethroplasty (TIPU), from January 2001 through January 2006. Patients were assigned to one of two groups by a computer-generated random selection: 65 patients underwent non-covered urethroplasty (NCU group); another group of 65 patients underwent covered urethroplasty (CU group) with a vascularized subcutaneous ventral flap. The results were evaluated by two pediatric surgeons unaware of the type of treatment each patient had undergone. Successful results were achieved in 99/130 patients (76.2%). We recorded 31 (23.8%) post-operative complications: 20 patients presented with a urethrocutaneous fistula (15 patients in the NCU group and 5 in the CU group); five with urethral stenosis (3 in the NCU and 2 in the CU group); and six with skin dehiscence of the preputioplasty (3 patients in each group). We analyzed the results using the chi2 test and the only statistically significant difference between the two groups (p < 0.05) was in terms of incidence of fistulas. Urethrocutaneous fistulas seem to be the most frequent complication of distal hypospadias after TIPU repair. Urethral coverage should be part of the Snodgrass procedure because it significantly reduces the formation of fistulas. A well-vascularized subcutaneous ventral flap represents, in our experience, a simple and optimal choice for the prevention of fistulas.
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Affiliation(s)
- Antonio Savanelli
- Department of Pediatric Surgery, Federico II University of Naples, Naples, Italy
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Bakan V, Yildiz A. Dorsal Double-Layer Dartos Flap for Preventing Fistulae Formation in the Snodgrass Technique. Urol Int 2007; 78:241-4. [PMID: 17406134 DOI: 10.1159/000099345] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 09/11/2006] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The Snodgrass technique and its modifications have become a preferred method for all varieties of hypospadias in the past decade. However, fistula is the most common complication of this technique. The aim of this study was to investigate the importance of the single and double flap to prevent fistula formation in the Snodgrass procedure. MATERIALS AND METHODS Tubularized incised plate urethroplasty, using a single or the double flap, was undertaken in 74 consecutive boys (median age 6.6 years old, range 1-15) within the last 4 years. In the first 29 patients (group 1), a dorsolateral flap was rotated laterally for covering the neourethra and in the remaining 45 patients (group 2) the neourethra was covered with dorsal double dartos flaps. RESULT In group 1, fistula in 4 patients and partial glanular dehiscence in 1 patient were detected. There was no fistula formation in group 2. CONCLUSION For preventing fistula formation, urethral covering by a well-vascularized dorsal double-layer dartos flap should be the basic part of the Snodgrass procedure.
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Affiliation(s)
- Vedat Bakan
- Department of Pediatric Surgery, Numune Training and Research Hospital, Erzurum, Turkey.
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Ambriz-González G, Velázquez-Ramírez GA, García-González JL, de León-Gómez JMG, Muciño-Hernández MI, González-Ojeda A, Basterra JV. Use of Fibrin Sealant in Hypospadias Surgical Repair Reduces the Frequency of Postoperative Complications. Urol Int 2007; 78:37-41. [PMID: 17192730 DOI: 10.1159/000096932] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Accepted: 04/26/2006] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Urethrocutaneous fistulas (UCF) and flap dehiscence (FD) are the most common postoperative complications after hypospadias (HS) surgical repair. The aim of this study was to evaluate whether the application of fibrin sealant over the site of surgery and suture lines reduces these complications. MATERIALS AND METHODS A prospective cohort of consecutive patients was treated over a 3-year period. 30 patients were submitted to HS surgical repair plus application of fibrin glue over the suture line and surgical site; for comparison, another 56 subjects made up the control group which was submitted to surgical repair only. Variables assessed included: age, type of HS, fibrin sealant used, complications and number of surgical procedures required to treat recurrences. RESULTS In general, the frequency of complications was 10 vs. 41% for UCF (p = 0.002), 13 vs. 50% for FD (p = 0.001), and for flap necrosis (FN) 6.7 vs. 28.6% (p = 0.01) for the treatment and control groups respectively. The number of surgical reinterventions to treat recurrences was higher in the control group than in the study group (p = 0.04). CONCLUSION The incidence of UCF after HS surgical repair can be reduced by applying fibrin sealant over the site of surgery and the suture lines.
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Routh JC, Wolpert JJ, Reinberg Y. Tunneled Tunica Vaginalis Flap is an Effective Technique for Recurrent Urethrocutaneous Fistulas Following Tubularized Incised Plate Urethroplasty. J Urol 2006; 176:1578-80; discussion 1581. [PMID: 16952688 DOI: 10.1016/j.juro.2006.06.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2006] [Indexed: 11/15/2022]
Abstract
PURPOSE In the last several years the use of the tubularized incised plate hypospadias repair has greatly increased. The most significant complication after this mode of urethroplasty is urethrocutaneous fistula development. Tunneled tunica vaginalis flap is a well described technique for repair of urethrocutaneous fistula. However, to our knowledge its use after tubularized incised plate repair has not yet been described. We present our results with this technique. MATERIALS AND METHODS We retrospectively reviewed all patients undergoing repair of urethrocutaneous fistula after initial tubularized incised plate repair between January 2001 and December 2005. We analyzed the initial number and location of fistulas, number of previous urethrocutaneous fistula repairs, duration of surgery, and intraoperative and postoperative complications. RESULTS A total of 16 boys (median age 2.2 years) underwent tunica vaginalis flap repair at our institution for urethrocutaneous fistula following initial failed tubularized incised plate repair. Of these patients 4 had not previously undergone urethrocutaneous fistula repair and 12 had undergone 1 to 4 failed repair attempts. All boys had a subcoronal fistula and 8 had additional fistulas along the penile shaft, 4 each with 3 and 4 fistulas, including 1 penoscrotal fistula. Mean surgical time was 45 minutes, and no intraoperative or postoperative complications occurred. After a mean followup of 18 months (range 4 to 36) no patient had recurrence of urethrocutaneous fistula. CONCLUSIONS Tunneled tunica vaginalis flap repair is a highly successful technique for the treatment of urethrocutaneous fistula after initial failed tubularized incised plate repair. The technique is technically simple to perform, and we encountered no complications. Tunneled tunica vaginalis flap repair should be considered for treating urethrocutaneous fistula following initial failed tubularized incised plate hypospadias surgery, particularly in a repeat surgical setting.
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Current World Literature. Curr Opin Urol 2005. [DOI: 10.1097/01.mou.0000188972.91538.be] [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]
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Current World Literature. Curr Opin Urol 2005. [DOI: 10.1097/01.mou.0000172405.15632.cb] [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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Chandrasekharam VVSS. Comparative study of dartos fascia and tunica vaginalis pedicle wrap for the tubularized incised plate in primary hypospadias repair. BJU Int 2005; 95:909-10. [PMID: 15794812 DOI: 10.1111/j.1464-410x.2005.05494_6.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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