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Shukla AR, Kolon TF. Douglas Arthur Canning: A Tribute. J Pediatr Urol 2022; 18:S1477-5131(22)00530-7. [PMID: 36464566 DOI: 10.1016/j.jpurol.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Aseem R Shukla
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Thomas F Kolon
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Wang C, Zhang ZC, Zhang DY, Hua Y, Liu F, He DW, Wei GH, Liu X. A new modified Duckett urethroplasty for repair of proximal hypospadias with severe chordee: outcomes of 133 patients. BMC Urol 2022; 22:47. [PMID: 35346153 PMCID: PMC8962008 DOI: 10.1186/s12894-022-00993-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Despite the continuous development and evolution of surgical methods and techniques, proximal hypospadias remains one of the most challenging issues for pediatric urologists. This study aims to evaluate the indications and postoperative complications of our new modified Duckett urethroplasty. Methods A total of 133 patients with proximal hypospadias who underwent repair of the modified Duckett urethroplasty from February 2016 to February 2021 were reviewed. The median age of patients was 3 years (range 1–16). All patients had severe chordee. One senior experienced pediatric urologist performed all the surgeries. Catheter was removed 14 days after the surgery. Results The location of the urethral meatus was proximal penile in 26 patients (19.5%), penoscrotal in 60 (45.1%), scrotal in 31 (23.3%), and perineal in 16 (12.0%). The mean length of the urethral defect was 4.5 cm (range 2.5–10). The median duration of follow-up was 46 months (range 8–67). Complications occurred in 31 patients (23.3%), including urethra-cutaneous fistula in 22 (16.5%), urethral stenosis in 7 (5.3%), and urethral diverticulum in 2 (1.5%). No recurrent chordee were found in all cases. All patients who developed complications were treated successfully at our hospital. Conclusions Our modified Duckett urethroplasty showed functionally and cosmetically favorable outcomes, with a lower incidence of postoperative complications. To the best of our knowledge, the novel Duckett technique is a feasible and suitable option for patients who suffer from proximal hypospadias with severe chordee and dysplasia of the urethral plate.
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Li J, Liu P, Yang Z, Wang X, Fan S, Li Z, Song H, Zhang W. Reoperation frequency after transverse preputial Island flap urethroplasty "Duckett's technique" in treatment of severe hypospadias: A single center study. Front Pediatr 2022; 10:1030649. [PMID: 36699300 PMCID: PMC9869034 DOI: 10.3389/fped.2022.1030649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/09/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Transverse Preputial Island Flap Urethroplasty (TPIFU) is one of the most common techniques for treating severe hypospadias. Studies on the reoperation frequency after TPIFU is lacking. In the present study, we reported our clinical outcomes of severe hypospadias treated with one-staged TPIFU and analyzed the operation frequency. METHODS We retrospectively analyzed the clinical data of severe hypospadias patients who underwent one-stage TPIFU from December 2018 to December 2019 in the department of Urology at Beijing Children's Hospital. A stepwise approach was used to manage the curvature. Severe hypospadias was defined as those residual curvature was higher than 30° after degloving. Urethroplasty complications included fistula, urethral stricture, and diverticulum. The short-term cure was identified as no complications occurring for 12 months after the date of last-time surgery. The reoperation rate and operation frequency of TPIFU were analyzed. RESULTS A total of 136 patients who underwent one-stage TPIFU were included in the study. The follow-up after primary urethroplasty ranged from 22 to 50 months. The median age at primary surgery was 22.5 months (range from 13 to 132 months). After primary TPIFU surgery, 53 (39%) patients underwent additional surgical interventions to treat postoperative complications. Among them, 24 patients (17.6%) developed fistula, 17 patients (12.5%) developed urethral stricture and 11 patients (8.1%) developed diverticulum. After the second surgery, five patients remained fistula, five patients remained urethral stricture, and seven patients remained diverticulum. Overall, 61% (85 patients) met the cured standard after the primary operation, and the two operations cure rate was 87.5% (119 patients). 91.2% (124 patients) were cured in three operations. CONCLUSIONS Although the complication rates after primary TPIFU were relatively high, more than half of patients achieved short-term cured through a single operation, and the cure rate after two or three operations was acceptable.
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Affiliation(s)
- Jiayi Li
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Pei Liu
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhenzhen Yang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xinyu Wang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Songqiao Fan
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zonghan Li
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Hongcheng Song
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Weiping Zhang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Huang Y, Xie H, Lv Y, Yu L, Sun L, Li X, Chen Y, Sun H, Chen F. One-stage repair of proximal hypospadias with severe chordee by in situ tubularization of the transverse preputial island flap. J Pediatr Urol 2017; 13:296-299. [PMID: 28359778 DOI: 10.1016/j.jpurol.2017.02.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 02/15/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To investigate a modified transverse preputial island flap repair which is performed in an attempt to reduce the complications following one-stage repair of proximal hypospadias with chordee. METHODS Briefly, the two ends of the flap were trimmed into V shape and anastomosed with the spatulated urethra proximally and urethral plate distally before tubularization. Then the in situ tubularization of the flap was performed. The procedure was performed in our hospital on 32 patients (mean age = 11 months). They were followed for 12-38 months. RESULTS The length of the urethral defect ranged from 4.0-6.0 cm after chordee correction. Urethrocutaneous fistulae occurred in 6 (18.7%) cases. No urethral strictures or meatal stenoses were observed. 29/32 families were satisfied with the cosmetic results. CONCLUSION This procedure seems straightforward and reliable, leading to good result after a short-term follow-up.
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Affiliation(s)
- Yichen Huang
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiaotong University, China
| | - Hua Xie
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiaotong University, China
| | - Yiqing Lv
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiaotong University, China
| | - Ling Yu
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiaotong University, China
| | - Li Sun
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiaotong University, China
| | - Xiaoxi Li
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiaotong University, China
| | - Yan Chen
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiaotong University, China
| | - Huizhen Sun
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiaotong University, China
| | - Fang Chen
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiaotong University, China.
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Li HB, Xu YM, Fu Q, Sa YL, Zhang J, Xie H. One-stage dorsal lingual mucosal graft urethroplasty for the treatment of failed hypospadias repair. Asian J Androl 2017; 18:467-70. [PMID: 26228042 PMCID: PMC4854106 DOI: 10.4103/1008-682x.157545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to retrospectively investigate the outcomes of patients who underwent one-stage onlay or inlay urethroplasty using a lingual mucosal graft (LMG) after failed hypospadias repairs. Inclusion criteria included a history of failed hypospadias repair, insufficiency of the local skin that made a reoperation with skin flaps difficult, and necessity of an oral mucosal graft urethroplasty. Patients were excluded if they had undergone a failed hypospadias repair using the foreskin or a multistage repair urethroplasty. Between January 2008 and December 2012, 110 patients with failed hypospadias repairs were treated in our center. Of these patients, 56 underwent a one-stage onlay or inlay urethroplasty using LMG. The median age was 21.8 years (range: 4–45 years). Of the 56 patients, one-stage onlay LMG urethroplasty was performed in 42 patients (group 1), and a modified Snodgrass technique using one-stage inlay LMG urethroplasty was performed in 14 (group 2). The median LMG urethroplasty length was 5.6 ± 1.6 cm (range: 4–13 cm). The mean follow-up was 34.7 months (range: 10–58 months), and complications developed in 12 of 56 patients (21.4%), including urethrocutaneous fistulas in 7 (6 in group 1, 1 in group 2) and neourethral strictures in 5 (4 in group 1, 1 in group 2). The total success rate was 78.6%. Our survey suggests that one-stage onlay or inlay urethroplasty with LMG may be an effective option to treat the patients with less available skin after failed hypospadias repairs; LMG harvesting is easy and safe, irrespective of the patient's age.
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Affiliation(s)
| | - Yue-Min Xu
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital and Shanghai Eastern Institute for Urologic Repair and Reconstruction, Shanghai, China
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Surgical Repair of Mid-shaft Hypospadias Using a Transverse Preputial Island Flap and Pedicled Dartos Flap Around Urethral Orifice. Aesthetic Plast Surg 2016; 40:535-9. [PMID: 27286850 DOI: 10.1007/s00266-016-0659-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Abstract
OBJECT To evaluate the effects, particularly the incidence of anastomotic fistula, of a pedicled dartos flap around the urethral orifice in the treatment of urethroplasty of mid-shaft hypospadias. METHODS A total of 46 cases of congenital mid-shaft hypospadias were included in this study. The patients ranged in age from 0.7 to 25.4 years and the average was 5.8 years. The patients received penis chordee correction. A transverse preputial island flap was developed for urethral reconstruction. The proximal dartos of the urethral orifice was used to develop a pedicled dartos flap, which was transposed to cover and strengthen neourethral anastomosis. The ventral penile skin defect was repaired by another flap. RESULTS The 46 patients were examined during follow-up visits for 6 months to 3 years. An anastomotic fistula was observed in one case (2.2 %). Scar healing without fistula was observed in another patient due to poor blood supply to part of the ventral penile skin. No other incidences of fistula, urethral rupture, flap necrosis, wound infections, urinary tract (meatal) stenosis, or urethral diverticulum were observed in the patients. CONCLUSION A pedicled dartos flap around the urethral orifice can take advantage of well-vascularized local tissue to add a protective layer to the proximal aspect of the neourethral anastomosis for reducing the incidence of anastomotic fistula in mid-shaft hypospadias repair using a transverse preputial island flap. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Herbst KW, Ferrer FA, Makari JH. The Need for Additional Procedures in Patients Undergoing Proximal Hypospadias Repairs as Reported in the Pediatric Health Information System Database. J Urol 2013; 190:1550-5. [DOI: 10.1016/j.juro.2013.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2013] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - John H. Makari
- Connecticut Children's Medical Center, Hartford, Connecticut
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Chandrasekharam VVS. Single-stage repair of hypospadias using longitudinal dorsal island flap: Single-surgeon experience with 102 cases. Indian J Urol 2013; 29:48-52. [PMID: 23671365 PMCID: PMC3649600 DOI: 10.4103/0970-1591.109984] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: There are many techniques of harvesting vascularized skin flaps from penile skin for hypospadias repairs. Here, we review our experience with the use of longitudinal dorsal island flap (LDIF) for mid- and proximal hypospadias repairs and to assess the results and complications of onlay and tubularized repairs. Materials and Methods: We retrospectively reviewed the data of all children with hypospadias operated by a single surgeon using the LDIF technique. The severity of hypospadias, technique, complications, and follow-up were assessed. Results: Over a 9.4-year period, 102 children (mean age 4.2 years, range 6 months to 11 years) were operated for primary hypospadias using the LDIF technique. All children had poorly formed urethral plates and hence were considered unsuitable for tubularized incised plate repair. The hypospadias was classified as midpenile, proximal penile/penoscrotal or perineal in 29, 64, and 9 children respectively. Onlay LDIF repair was done in 85 children, while in 17 children, tubularized LDIF repair was performed. At a mean follow-up of 1.8 years, complications occurred in 12 (12%) children. Complications were more common after tubularized repairs than onlay repairs (24% vs. 9.5%). All glans dehiscences occurred after onlay repairs, while meatal stenosis and diverticulum occurred after tubularized repairs. No child had urethral stenosis after onlay repair, and uroflow studies in 16 children demonstrated normal curves and flow rates. Conclusions: We report the use of LDIF for single-stage mid and proximal hypospadias repair with good success and an acceptable complication rate. Onlay repairs had fewer complications than tubularized repairs. Our results indicate that the specific advantages and versatility of LDIF make it a good option to consider in cases of hypospadias with poorly developed urethral plates where onlay or substitution urethroplasty is indicated.
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Affiliation(s)
- V V S Chandrasekharam
- Department of Pediatric Surgery and Pediatric Urology, Rainbow Children's Hospitals, Hyderabad, Andhra Pradesh, India
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Rigamonti W, Castagnetti M. Onlay on Albuginea: Modified Onlay Preputial Island Flap Urethroplasty for Single-stage Repair of Primary Severe Hypospadias Requiring Urethral Plate Division. Urology 2011; 77:1498-502. [DOI: 10.1016/j.urology.2010.09.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 09/27/2010] [Accepted: 09/27/2010] [Indexed: 11/26/2022]
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Singh BP, Solanki FS, Kapoor R, Dassi V, Kaswan HK, Agrawal V, Swain SK, Andankar MG, Pathak HR. Factors predicting success in hypospadias repair using preputial flap with limited pedicle mobilization (Asopa procedure). Urology 2010; 76:92-6. [PMID: 20381843 DOI: 10.1016/j.urology.2010.01.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 12/20/2009] [Accepted: 01/11/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To analyze the objective factors determining success in hypospadias repair by the Asopa technique of limited preputial pedicle mobilization. METHODS This was a prospective study involving a cohort of 48 patients (age range 1-19 years) who underwent hypospadias repair in a tertiary care teaching institution, with a follow-up of 20-58 months. Patient inclusion criteria were absence of past history of any local surgery with urethral plate less than 6 mm and hooded prepuce. RESULTS At a median follow-up of 33.5 months, the overall complication and fistula rates were 22.9% and 16.7%. Complication and fistula rates were 40% and 30% with tube repairs vs. 18.4% and 13.2% with onlay repairs. CONCLUSIONS In patients unsuitable for Snodgrass repair, the Asopa technique of transverse preputial flap repair provides reasonably good results. Patients with proximal hypospadias, conical glans configuration, tube repairs, and more advanced age had higher complication rates with transverse preputial flap repair.
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Affiliation(s)
- Bhupendra P Singh
- Department of Urology, BYL Nair Charitable Hospital and Topiwala National Medical College, Mumbai Central, Mumbai, India.
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Kocvara R. Commentary to "One-stage repair of severe hypospadias using modified tubularized transverse preputial island flap with V-incision suture by K. Aoki, K. Fujimoto, K. Yoshida, Y. Hirao, K. Ueoka, J Pediatr Urol 2008;4:438-441". J Pediatr Urol 2009; 5:426-7; author reply 428. [PMID: 19443273 DOI: 10.1016/j.jpurol.2009.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 03/19/2009] [Indexed: 11/26/2022]
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An alternative flap choice in penis skin defects: preputial mucosal flap. Urology 2009; 74:1344-6. [PMID: 19643464 DOI: 10.1016/j.urology.2009.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 05/04/2009] [Accepted: 05/13/2009] [Indexed: 11/24/2022]
Abstract
In this study, the authors present their experience with preputial mucosal flap usage for reconstruction of full-thickness skin loss of the penis in a patient with scald injury and discuss the possible treatment modalities in penile skin defects. During the 2-year follow-up period, no complication was encountered, and the patient healed uneventfully.
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Hadidi AT. Lateral-based flap: a single stage urethral reconstruction for proximal hypospadias. J Pediatr Surg 2009; 44:797-801. [PMID: 19361643 DOI: 10.1016/j.jpedsurg.2008.08.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Revised: 08/03/2008] [Accepted: 08/08/2008] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study is to describe and report the outcome of a single stage repair-the lateral-based (LB) flap--for proximal hypospadias with chordee. MATERIALS AND METHODS Between January 1995 and January 2007, 107 boys with proximal hypospadias underwent repair using the LB flap technique. The boys' age ranged from 1 to 5 years. The technique employs the use of lateral penile skin and extends into the outer preputial skin. The LB flap enjoys double blood supply from the base of the meatus as well as the preputial vessels. The Y-shaped incision in the glans gives a terminal slit-like meatus, and the technique allows for correction of the chordee. Follow-up period ranged from 1 year to 13 years (mean, 72 months). RESULTS AND COMPLICATIONS Satisfactory results were obtained in 98 (91%) patients. Three patients developed fistulae. Two patients had proximal stenosis that required temporary urethrotomy for 3 months. Four patients developed urethral diverticulum. CONCLUSIONS The LB flap is a robust flap with a reliable dual blood supply, which produces good results (91%) and is suitable for proximal forms of hypospadias with chordee.
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Affiliation(s)
- Ahmed T Hadidi
- Pediatric Surgery Department, Mannheim-Heidelberg University, Mannheim, Germany.
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Aoki K, Fujimoto K, Yoshida K, Hirao Y, Ueoka K. One-stage repair of severe hypospadias using modified tubularized transverse preputial island flap with V-incision suture. J Pediatr Urol 2008; 4:438-41. [PMID: 19013413 DOI: 10.1016/j.jpurol.2008.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Accepted: 05/20/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE Although hypospadias repair for preserving the urethral plate is popular among pediatric urologists, applying this procedure to severe hypospadias is controversial. We report the outcome of applying additional modifications to the modified tubularized transverse preputial island flap (TPIF) procedure reported previously [Patel RP, Shukla AR, Austin JC and Canning DA. Modified tubularized transverse preputial island flap repair for severe proximal hypospadias. BJU Int 2005;95:901-4] for repairing severe hypospadias. MATERIALS AND METHODS We retrospectively evaluated our series of 22 patients (mean age 17.5 months) who underwent the modified TPIF with an additional simple modification of meatoplasty with V-incision suture. Patients were followed for a mean period of 18 months. RESULTS After releasing the chordee, the hypospadiac orifice was retracted to become penile in five patients (22.7%), penoscrotal in six (27.3%), scrotal in nine (40.9%), and perineal in two (9.1%). The median length of the neourethra was 46 mm. One-stage repair was successful in 19 patients (86.4%) without any complications. CONCLUSION Our modified TPIF procedure yielded favorable outcomes functionally and cosmetically with a low postoperative morbidity rate. Such a procedure can be considered useful for repairing severe hypospadias when the urethral plate cannot be preserved.
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Affiliation(s)
- Katsuya Aoki
- Department of Urology, Nara Medical University, Nara, Japan.
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Abstract
Anatomical anomalies in hypospadias are an abnormal ventral opening of the urethral meatus, abnormal ventral curvature of the penis and abnormal distribution of the foreskin around the glans with a ventrally deficient hooded foreskin. The techniques of hypospadias surgery continue to evolve. The current standard of care for hypospadias repair includes not only a functional penis adequate for sexual intercourse and urethral reconstruction offering the ability to stand to urinate, but also a satisfactory cosmetic result. Tubularized incised plate repair has been the mainstay for distal hypospadias. In cases of proximal hypospadias, one-stage repairs such as the Duckett repair or the Koyanagi repair have been well established, while two-stage repairs remain important alternatives. Whether dorsal plication or ventral lengthening should be used to correct penile curvature is still controversial, and long-term results are required. Efforts have been made in this decade to improve cosmetic appearance, constructing a slit-like meatus or performing foreskin reconstruction, and to prevent onerous complications.
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Affiliation(s)
- Yutaro Hayashi
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
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Johal NS, Nitkunan T, O'Malley K, Cuckow PM. The two-stage repair for severe primary hypospadias. Eur Urol 2008; 50:366-71. [PMID: 16464530 DOI: 10.1016/j.eururo.2006.01.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2005] [Accepted: 01/03/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The repair of severe primary hypospadias represents a major surgical challenge. After initial enthusiasm for single-stage procedures, many paediatric urologists have turned to the alternative two-stage approach after experiencing disappointing results. A single surgeon's experience of the two-stage procedure is reported. METHODS Between 1998 and 2003, 62 boys underwent a two-stage reconstruction for primary hypospadias. Indications for staged repair included proximal meatus (mid-shaft [18 patients], peno-scrotal [23] or perineal [two]), moderate or severe chordee (38 patients), poor glans groove, and lichen sclerosis. Inner prepuce was the graft of choice. Median age was 27.6 months at completion of surgery and median follow-up was 26 months. RESULTS All grafts took well and none of the 62 patients needed revision. One patient developed a haematoma. Maturation of the graft for at least six months ensured the best conditions for the second-stage closure. Overall the cosmetic and functional results after the second stage were excellent. The outcomes were determined by the parents' and surgeon's assessment of function and the cosmetic appearance. Complications included partial glans dehiscense (three patients), residual mild curvature (three) and meatal stenosis (three). CONCLUSION The two-stage repair has proved to be a reliable and reproducible technique with a low complication rate in a difficult cohort of hypospadias patients. Inner preputial skin grafts take very successfully on the ventral surface of the penis, and splitting the glans enables a slit-like meatus to be achieved. Excellent cosmetic results can be anticipated.
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Affiliation(s)
- Navroop S Johal
- Department of Paediatric Urology, Great Ormond Street Hospital, London, UK.
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Bibliography. Current world literature. Female urology. Curr Opin Urol 2006; 16:310-3. [PMID: 16770134 DOI: 10.1097/01.mou.0000232056.97213.e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [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.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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