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Satanyasuwan T, See-Ngam S, Kosathong W, Yippaditr W. Application of preputial tube-flap urethroplasty to establish a neourethra in a male dog with complications after preputial urethrostomy. J Small Anim Pract 2024; 65:214-217. [PMID: 38050707 DOI: 10.1111/jsap.13691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 10/09/2023] [Accepted: 11/05/2023] [Indexed: 12/06/2023]
Abstract
A 14-year-old male poodle weighing 7.5 kg presented due to complications after preputial urethrostomy for management of preprostatic urethral rupture. Revision surgery was performed with preputial tube-flap urethroplasty via preputiotomy. A longitudinal flap was raised from the prepuce and anastomosed to the end of the previously cut urethra to create a neourethra and reduce tension at the urethrostomy site. Follow-up retrograde positive contrast urethrography performed 10 days and 6 months postoperatively showed no contrast leakage from either the neourethra tube flap or new preputial urethrostomy. A follow-up email questionnaire, based on the American Urological Association Symptom Index, was completed by the owner 6 months after surgery. The dog had excellent symptom scores, and urinated from the prepuce without difficulty in a manner resembling physiological urination.
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Affiliation(s)
- T Satanyasuwan
- Kasetsart University Veterinary Teaching Hospital Hua Hin, Faculty of Veterinary Medicine, Kasetsart University, Phrachuap Khiri Khan, Thailand
| | - S See-Ngam
- Kasetsart University Veterinary Teaching Hospital Hua Hin, Faculty of Veterinary Medicine, Kasetsart University, Phrachuap Khiri Khan, Thailand
| | - W Kosathong
- Kasetsart University Veterinary Teaching Hospital Hua Hin, Faculty of Veterinary Medicine, Kasetsart University, Phrachuap Khiri Khan, Thailand
| | - W Yippaditr
- Kasetsart University Veterinary Teaching Hospital Hua Hin, Faculty of Veterinary Medicine, Kasetsart University, Phrachuap Khiri Khan, Thailand
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Fang Y, Sun N, Song H, Zhang W, Tang Y, Huang L, Yang Y, Chao M, Ma H, Zhang J, Zhang X, Li S, Li N, Chen C, He D, Wu W, Xie H, Guan Y. A multicenter study on surgical procedure selection and risk factor analysis of postoperative complications after TIP and Duckett hypospadias repair. BMC Urol 2022; 22:131. [PMID: 36008856 PMCID: PMC9413801 DOI: 10.1186/s12894-022-01051-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypospadias is a common congenital malformation in pediatric urology with surgery being the only curative treatment. Although there are hundreds of surgical methods for hypospadias, no single method can treat all types, and there are still high rates of postoperative complications. We performed this study to investigate surgical procedure selection and perform risk factor analysis of postoperative complications in hypospadias repair. METHODS Retrospective analysis was performed of complete clinical and follow-up data of children with hypospadias who were treated and followed up at 15 children's clinical centers in Mainland China from December 2018 to December 2019. Children were divided into groups according to Barcat classification and surgical methods in order to analyze the surgical choice for different types of hypospadias and the influencing factors of different surgical methods for complications. RESULTS In total, 1011 patients were followed up for 26 months. According to Barcat classification, there were 248 cases of distal type hypospadias, 214 of intermediate, and 549 of proximal type. Transverse preputial island flap urethroplasty (Duckett) and tubularized incised plate urethroplasty (TIP) were performed in 375 (37.1%) and 336 cases (33.2%), respectively. The postoperative complication rate of distal hypospadias was 23.4% (15.8-57.1%), mid shaft 29.0% (22.7-40.0%), and proximal 43.7% (30.2-52.9%). Among the 375 patients in Duckett group, 192 had complications. Multivariate logistic analysis showed that the length of prepuce island flap (OR = 3.506, 95% CI: 2.258-5.442) was an independent risk factor for complications after Duckett operation (P < 0.001). In TIP group, there were 336 cases with 84 complications. Multivariate logistic analysis showed that the width of urethral plate after longitudinal resection (OR = 0.836, 95% CI: 0.742-0.942) and glans width (OR = 0.851, 95% CI: 0.749-0.965) were independent risk factors for postoperative complications after TIP (P = 0.003, P = 0.012). CONCLUSION Several anatomical features play a role during the selection process among the different surgical approaches, including glans size, urethral plate width, and the meatal position. The width of the urethral plate and glans width were risk factors for postoperative complications after TIP. The length of prepuce island flap was a risk factor for complications after Duckett operation.
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Affiliation(s)
- YiWei Fang
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital of Capital Medical University, Beijing, 100045, China
| | - Ning Sun
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital of Capital Medical University, Beijing, 100045, China.
| | - HongCheng Song
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital of Capital Medical University, Beijing, 100045, China.
| | - WeiPing Zhang
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital of Capital Medical University, Beijing, 100045, China
| | - YunMan Tang
- Department of Pediatric Surgery, Department of Pediatric Surgery, Sichuan Academy of Medical Sciences - Sichuan Provincial People's Hospital (SAMSPH), Chengdu, 610072, China
| | - LuGang Huang
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610044, China
| | - Yi Yang
- Department of Pediatric Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Min Chao
- Department of Pediatric Urology, Anhui Children's Hospital, Hefei, 230022, China
| | - Hong Ma
- Department of Pediatric Urology and General Thoracic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, China
| | - JingTi Zhang
- Department of Urology, Xi'an Children's Hospital, Xi'an, 710002, China
| | - XuHui Zhang
- Department of Urology, Shanxi Children's Hospital, Taiyuan, 030006, China
| | - ShouLin Li
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, 518034, China
| | - Ning Li
- Department of Pediatric Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 230022, China
| | - Chao Chen
- Department of Pediatric Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - DaWei He
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400015, China
| | - WenBo Wu
- Department of Urology, Children's Hospital of Jiangxi Province, Nanchang, 330006, China
| | - Hua Xie
- Department of Urology, Shanghai Children's Hospital, Shanghai, 200062, China
| | - Yong Guan
- Department of Urology, Tianjin Children's Hospital, Tianjin, 300134, China
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Castagnetti M, El-Ghoneimi A. Surgical management of primary severe hypospadias in children: an update focusing on penile curvature. Nat Rev Urol 2022; 19:147-160. [PMID: 35039660 DOI: 10.1038/s41585-021-00555-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 11/09/2022]
Abstract
Over the past two decades, assessment and treatment of associated curvature has emerged as a major issue in treating patients with proximal hypospadias. However, the cut-off for defining a curvature as clinically significant is still unclear, as not all patients are bothered by the same degree of curvature and, although the need for a method to assess the curvature objectively has been emphasized, no standard method yet exists. Curvature is multifactorial. The same degree of curvature can be due to any possible combination of skin and/or subcutaneous dartos tethering, a short urethral plate and an intrinsic corpora disproportion. Different strategies can be used to treat curvature, depending on the underlying cause, surgeon preferences, and the goals of the repair. In the past 10 years, use of urethral plate transection and ventral lengthening procedures has increased, although the lack of long-term follow-up data on ventral lengthening procedures suggests that the use of such procedures should be selective. Furthermore, straightening manoeuvres are influenced by the technique used for subsequent urethroplasty and, in turn, may influence the success rate of the urethroplasty. This Review provides a comprehensive overview of the major developments from the past 10 years in the management of severe proximal hypospadias in children.
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Affiliation(s)
- Marco Castagnetti
- Paediatric Urology Unit, Department of Surgery, Bambino Gesù Children Hospital and Research Institute, Rome, Italy. .,Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padua, Italy.
| | - Alaa El-Ghoneimi
- Department of Paediatric Surgery and Urology, Reference Centre for Rare Urinary Tract Malformations (MARVU), Hôpital Robert Debré, APHP, Université de Paris, Paris, France
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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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Lin H, Wang YY, Li SB, Chen ZT, Su LJ. Staged transverse preputial island flap urethroplasty for some proximal hypospadias with moderate-to-severe chordee. BMC Urol 2021; 21:182. [PMID: 34949173 PMCID: PMC8697458 DOI: 10.1186/s12894-021-00948-8] [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: 05/04/2021] [Accepted: 12/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to assess the outcome of staged transverse preputial island flap (TPIF) urethroplasty for repairing certain cases of primary proximal hypospadias with moderate-to-severe chordee in children. METHODS Nighty-two consecutive boys who underwent either one-stage or staged TPIF urethroplasty for the repair of proximal hypospadias with moderate-to-severe chordee between August 2015 and December 2019 were evaluated retrospectively. Patients were divided into two groups: one-stage TPIF urethroplasty group (n = 44) and staged TPIF urethroplasty group (n = 48). We noted and compared the postoperative complications, including urethrocutaneous fistula, urethral diverticula, residual penile curvature, and urethral stricture in both groups. RESULTS Both groups were followed up for 1-5 years, with an average of 3 years. No cases of residual or recurrence of penile chordee were reported in either group. In Group A, 9 patients (9/44, 20.4%) had postoperative urethrocutaneous fistula, and all patients underwent urinary fistula repair or urethroplasty. In Group B, postoperative urethrocutaneous fistula occurred in 2 cases (2/48, 4.1%), and one patient developed a urethrocutaneous fistula after the first operation, which was successfully repaired during the second operation. A urethrocutaneous fistula occurred in 1 case after completion of the second-stage operation; urethral fistula repair was performed successfully 6 months later. There were 2 cases of urethral stricture in Group A (2/44, 4.5%) and none in Group B. There were 6 cases of urethral diverticulum in Group A (6/44, 13.6%) and no cases of urethral diverticulum in Group B. The operative success rates were 61.3% and 95.8% in Group A and Group B, respectively (P < 0.001). CONCLUSIONS Compared with one-stage TPIF urethroplasty, staged TPIF urethroplasty in the treatment of certain cases of primary proximal hypospadias with moderate-to-severe chordee resulted in fewer postoperative fistulas, urethral strictures and urethral diverticula. The staged TPIF urethroplasty procedure was effective in reducing the operation difficulty and complication rate of hypospadias, improving the curative effect of complex hypospadias and having good clinical application value.
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Affiliation(s)
- Hai Lin
- Department of Pediatric Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Xiuying District, Haikou, 570311, Hainan, People's Republic of China.
| | - Yu-Yun Wang
- Department of Pediatric Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Xiuying District, Haikou, 570311, Hainan, People's Republic of China
| | - Shi-Bing Li
- Department of Pediatric Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Xiuying District, Haikou, 570311, Hainan, People's Republic of China
| | - Ze-Ting Chen
- Department of Pediatric Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Xiuying District, Haikou, 570311, Hainan, People's Republic of China
| | - Liang-Ju Su
- Department of Pediatric Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Xiuying District, Haikou, 570311, Hainan, People's Republic of China
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Babu R, Chandrasekharam VVS. Meta-analysis comparing the outcomes of single stage (foreskin pedicled tube) versus two stage (foreskin free graft & foreskin pedicled flap) repair for proximal hypospadias in the last decade. J Pediatr Urol 2021; 17:681-689. [PMID: 34099397 DOI: 10.1016/j.jpurol.2021.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/08/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite many technical advances the debate continues on single versus staged procedures for proximal hypospadias. In this systematic review and meta-analysis we have compared the contemporary outcomes of proximal hypospadias repair: single stage foreskin pedicle tube (FPT) versus two stage foreskin free graft (FFG) and two-stage foreskin pedicled flap (FPF) over the last decade. METHODS A systematic literature review of publications in English of the following electronic databases was conducted: Cochrane Database, PUBMED, MEDLINE and EMBASE. The following keywords were used: (proximal) AND (hypospadias) AND (repair OR urethroplasty) AND (outcomes OR complications). The publication date range for studies was from January 2010 to December 2020. Outcomes analyzed were complications like urethro-cutaneous fistula (UCF), glans dehiscence (GD), meatal stenosis (MS), urethral stricture (US), urethral diverticulum (UD), recurrent curvature or residual chordee (RC), buried penis (BP) and poor cosmesis (PC) as per objective assessment scores, or poor graft uptake (PGF) during first stage. We also divided the papers based on case load into two groups: < 5 cases or >5 cases operated per year and compared the post-operative outcomes. RESULTS The I 2 statistics for prevalence of total complications showed high heterogeneity with I 2 of 88% for one stage repair and 92% & 98% for two stage repairs. The pooled data from 26 articles covered a total of 2664 patients; mean follow-up of 4.5 years (1.8-14 years). One stage repair (FPT) was used in 680 (25%) patients while two stage repair was used in 1984 (75%) patients. Complications were encountered in 285/680 (42%) of those who underwent single stage repair (FPT) and this was significantly higher (Fishers; p = 0.001) than 414/1984 (21%) complication rate seen in two stage repair. Among the two different techniques of two stage operations over-all complication rate was not significantly different (Fisher's; p = 0.1) between FFG (155/674; 23%) and FPF (259/1310; 20%). FFG was superior to FPF in terms of individual complications UCF, MS, GD and UD. For two-stage FPT and FPF repairs the complication rate significantly reduced (p = 0.01) with increasing case load. For single stage repairs the complication rate remained high despite the increasing case load. CONCLUSIONS Two-stage repair of proximal hypospadias had significantly less complications compared to single stage repair. Among two-stage repairs specific complications were significantly less for FFG, although total complications were not significantly different from that seen with FPF. The results of two-stage repairs improved with higher case load supporting the concept of dedicated hypospadias centres.
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Affiliation(s)
- Ramesh Babu
- Pediatric Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
| | - V V S Chandrasekharam
- Pediatric Surgery, Pediatric Urology and MAS, Ankura Hospitals for Women and Children, Hyderabad, Telangana, India
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