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Siregar S, Steven S, Mustafa A. The benefit of tissue sealant on urethroplasty in hypospadias patients - A systematic review and meta-analysis. F1000Res 2024; 11:184. [PMID: 38974407 PMCID: PMC11226945 DOI: 10.12688/f1000research.108503.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 07/09/2024] Open
Abstract
Background Hypospadias was ranked second after undescended testis as the most prevalent congenital abnormality in newborn males. Hypospadias can be successfully repaired through multiple surgeries in the majority of children. Postoperative complications were not rarely seen after surgeries, such as urethrocutaneous fistula (UCF), meatal stenosis, and glans breakdown. Tissue sealant application in hypospadias repair serves as additional suture line coverage and reduces the post surgery complications. However, the effects of sealants usage during urethroplasty are still uncertain. This review aimed to know the effects of tissue sealant usage on patients with hypospadias who undergo urethroplasty. Methods The study was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Literature was searched on PubMed, Embase, and Scopus following PRISMA guidelines. The search was conducted on October 12th, 2021, using the search term ("glue" OR "sealants" OR "tissue glue" OR "tissue sealant" OR "tissue adhesive") AND ("hypospadias" OR "urethrocutaneous fistula" OR "urethral repair" OR "urethroplasty" OR "hypospadiology"). Result Systematic searching from all databases resulted in 160 potential articles. After a full-text review, eight articles were included in this study. Urethrocytaneous fistula complication was reported in all studies. The occurrence of complication reported by all studies was urethrocutaneous fistula. Several studies also reported tissue edema and flap-related complications. Tissue sealant had no significant effect in reducing meatal stenosis. Conclusions This systematic review revealed additional benefits from several types of tissue sealant in hypospadias repair surgery. Fibrin sealant application over the urethroplasty suture line in hypospadias repair offers a water-proof coverage and may enhance the outcome from the surgery.
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Affiliation(s)
- Safendra Siregar
- Urology department, Hasan Sadikin Academic Medical Center, Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
| | - Steven Steven
- Urology department, Hasan Sadikin Academic Medical Center, Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
| | - Akhmad Mustafa
- Urology department, Hasan Sadikin Academic Medical Center, Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
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Daboos M, Abdelmaboud M, Azab A, Abdelaziz M, Eldamanhory H. Evaluation of Tubularized Incised Plate Urethroplasty with Spongioplasty-Dartosoraphy Reinforcement in Pediatric Hypospadias: A Randomized Controlled Study. Eur J Pediatr Surg 2024. [PMID: 38262438 DOI: 10.1055/s-0044-1779277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
INTRODUCTION The original description of tubularized incised plate urethroplasty (TIPU) was provided by Snodgrass in 1994. The results were significantly improved by several modifications. To decrease the incidence of complications, interposing a vascularized flap after tubularization of the neourethra is recommended. The extent to which the type of interposed tissue has a direct effect on the rate of complications and cosmetic outcomes after TIPU repair is considered the answer to the main hypothesis of this study. MATERIALS AND METHODS This prospective controlled randomized trial was conducted in the Department of Pediatric Surgery, Al-Azhar University, Cairo, Egypt, between May 2019 and May 2023. A total of 220 patients were included in this study. Patients were randomly assigned to either group A or group B. Group A included 110 patients who underwent TIPU with spongioplasty-dartosoraphy reinforcement. The other 110 patients (group B) underwent TIPU with dorsal dartos flap interposition, without spongioplasty. RESULTS Complications developed in 34 of 220 patients (15.4%). In group A, complications developed in 11 of 110 patients (10.0%). In group B, complications occurred in 23 of 110 patients (20.9%). Although the fistula rate, glanular dehiscence, disruption, and meatal stenosis were not significantly different between the study groups, the skin necrosis rate was significantly lower in group A than in group B. The overall complication rate was significantly lower in group A than in group B. Also, the difference in the mean Hypospadias Objective Scoring Evaluation between the two groups was statistically significant. CONCLUSION TIPU with spongioplasty-dartosoraphy reinforcement is an effective modification of conventional TIPU. This modification appears to reduce the rate of complications and yield better cosmetic outcomes.
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Affiliation(s)
- Mohammad Daboos
- Department of Pediatric Surgery, Al-Azhar University Faculty of Medicine, Nasr City, Cairo, Egypt
| | - Mohamed Abdelmaboud
- Department of Pediatric Surgery, Al-Azhar University Faculty of Medicine, Nasr City, Cairo, Egypt
| | - Ahmed Azab
- Department of Pediatric Surgery, Al-Azhar University Faculty of Medicine, Nasr City, Cairo, Egypt
| | - Mohamed Abdelaziz
- Department of Plastic Surgery, Al-Azhar University, Nasr City, Cairo, Egypt
| | - Hany Eldamanhory
- Department of Urology, Al-Azhar University Faculty of Medicine, Cairo, Egypt
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Yamashiro JR, Austin JC, Braga LH, Chuang KW, Davis-Dao CA, Hecht S, Holzman SA, Khoury AE, Kurzrock EA, Lerman SE, McGrath M, Merguerian PA, Saltzman AF, Schaeffer AJ, Seideman C, Singer JS, Wang P, Wehbi EJ, Wu HY, Sturm RM. Identifying variability in surgical practices and instrumentation for hypospadias repair across the Western Pediatric Urology Consortium (WPUC) network. J Pediatr Urol 2023; 19:277-283. [PMID: 36775718 PMCID: PMC10686787 DOI: 10.1016/j.jpurol.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 09/12/2022] [Accepted: 12/04/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Although hypospadias outcomes studies typically report a level or type of repair performed, these studies often lack applicability to each surgical practice due to technical variability that is not fully delineated. An example is the tubularized incised plate (TIP) urethroplasty procedure, for which modifications have been associated with significantly decreased complication rates in single center series. However, many studies fail to report specificity in techniques utilized, thereby limiting comparison between series. OBJECTIVE With the goal of developing a surgical atlas of hypospadias repair techniques, this study examined 1) current techniques used by surgeons in our network for recording operative notes and 2) operative technical details by surgeon for two common procedures, tubularized incised plate (TIP) distal and proximal hypospadias repairs across a multi-institutional surgical network. STUDY DESIGN A two-part study was completed. First, a survey was distributed to the network to assess surgeon volume and methods of recording hypospadias repair operative notes. Subsequently, an operative template or a representative de-identified operative note describing a TIP and/or proximal repair with urethroplasty was obtained from participating surgeons. Each was analyzed by at least two individuals for natural language that signified specified portions of the procedure. Procedural details from each note were tabulated and confirmed with each surgeon, clarifying that the recorded findings reflected their current practice techniques and instrumentation. RESULTS Twenty-five surgeons from 12 institutions completed the survey. The number of primary distal hypospadias repairs performed per surgeon in the past year ranged from 1-10 to >50, with 40% performing 1-20. Primary proximal hypospadias repairs performed in the past year ranged from 1-30, with 60% performing 1-10. 96% of surgeons maintain operative notes within an electronic health record. Of these, 66.7% edited a template as their primary method of note entry; 76.5% of these surgeons reported that the template captures their operative techniques very or moderately well. Operative notes or templates from 16 surgeons at 10 institutions were analyzed. In 7 proximal and 14 distal repairs, parameters for chordee correction, urethroplasty suture selection and technique, tissue utilized, and catheter selection varied widely across surgeons. CONCLUSION Wide variability in technical surgical details of categorically similar hypospadias repairs was demonstrated across a large surgical network. Surgeon-specific modifications of commonly described procedures are common, and further evaluation of short- and long-term outcomes accounting for these technical variations is needed to determine their relative influence.
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Affiliation(s)
- Justine R Yamashiro
- University of California Los Angeles, 200 Medical Plaza, Suite 170, Los Angeles, CA, 90095, USA.
| | - J Christopher Austin
- Oregon Health & Science University, 700 S.W. Campus Drive, Portland, Oregon, USA 97239, 875 Oak Street S.E., Salem, OR, 97301, USA.
| | - Luis H Braga
- McMaster University, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada.
| | - Kai-Wen Chuang
- Children's Hospital of Orange County and University of California Irvine, 101 the City Dr S Pavilion 3, Orange, CA, 92686, USA.
| | - Carol A Davis-Dao
- Children's Hospital of Orange County and University of California Irvine, 101 the City Dr S Pavilion 3, Orange, CA, 92686, USA.
| | - Sarah Hecht
- Oregon Health & Science University, 700 S.W. Campus Drive, Portland, Oregon, USA 97239, 875 Oak Street S.E., Salem, OR, 97301, USA.
| | - Sarah A Holzman
- Children's Hospital of Orange County and University of California Irvine, 101 the City Dr S Pavilion 3, Orange, CA, 92686, USA.
| | - Antoine E Khoury
- Children's Hospital of Orange County and University of California Irvine, 101 the City Dr S Pavilion 3, Orange, CA, 92686, USA.
| | - Eric A Kurzrock
- University of California Davis, 4860 Y Street, Suite 2200, Sacramento, CA, 95817, USA.
| | - Steven E Lerman
- University of California Los Angeles, 200 Medical Plaza, Suite 170, Los Angeles, CA, 90095, USA.
| | - Melissa McGrath
- McMaster University, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada.
| | - Paul A Merguerian
- University of Washington, 4800 Sand Point Way NE, OA.9.220, Seattle, WA, 98105, USA.
| | - Amanda F Saltzman
- University of Kentucky, 800 Rose Street, MS 237, Lexington, KY, 40536, USA.
| | - Anthony J Schaeffer
- University of Utah, 100 N Mario Capecchi Drive, Suite 3550, Salt Lake City, UT, 84113, USA.
| | - Casey Seideman
- Oregon Health & Science University, 700 S.W. Campus Drive, Portland, Oregon, USA 97239, 875 Oak Street S.E., Salem, OR, 97301, USA.
| | - Jennifer S Singer
- University of California Los Angeles, 200 Medical Plaza, Suite 170, Los Angeles, CA, 90095, USA.
| | - Peter Wang
- LHSC-Victoria Hospital, 800 Commissioners Road East, London, Ontario, N6A 5A5, Canada.
| | - Elias J Wehbi
- Children's Hospital of Orange County and University of California Irvine, 101 the City Dr S Pavilion 3, Orange, CA, 92686, USA.
| | - Hsi-Yang Wu
- Brown University, 593 Eddy Street, Suites 185 & 190, Providence, RI, 02903, USA.
| | - Renea M Sturm
- University of California Los Angeles, 200 Medical Plaza, Suite 170, Los Angeles, CA, 90095, USA.
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Sholklapper T, Crigger C, Morrill C, Harris TGW, Haney N, Lue K, Young E, Gearhart JP. Application of Tunica Vaginalis Flap for Epispadias Repair in the Epispadias-Exstrophy Complex. Urology 2023; 171:190-195. [PMID: 36336142 DOI: 10.1016/j.urology.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/13/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe long-term outcomes and experience with the tunica vaginalis flap (TVF) as a tissue augment for complex epispadias repair. METHODS A prospectively maintained institutional database was reviewed for patients who underwent epispadias repair with TVF from 2010 to 2021. Evaluation of patient characteristics between those who developed dehiscence or UCF and those who did not was performed via Mann-Whitney U, Kruskal-Wallis, or Fisher's exact test, as appropriate. RESULTS A total of 47 male patients were identified, of whom, 1 (2.1%) had cloacal exstrophy, 38 (80.9%) had classic bladder exstrophy or a variant, and 8 (17.0%) had epispadias as their primary exstrophy-epispadias complex diagnosis. The median age at epispadias repair was 13 months (IQR 11 - 19). The overall rate of fistula or dehiscence development was 19.1% (9 patients), of whom, 7 developed urethrocutaneous fistulae, 1 dehiscence, and 1 both. Notably, 0 of the 5 patients who had undergone prior epispadias repair and 0 of the 8 patients with a diagnosis of isolated epispadias developed a UCF or dehiscence after repair with TVF. Differences in age at repair, primary EEC diagnosis, prior epispadias repair, pre-repair testosterone, fibrin sealant utilization, closure layers, stent removal time, and bladder capacity at repair were not statistically significant (P>.05) CONCLUSION: Our expanded evaluation indicates that utilization of the tunica vaginalis as an adjunct to epispadias repair may provide durable protection against fistula development in EEC patients who have undergone prior epispadias repair and in primary repair of patients with isolated epispadias.
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Affiliation(s)
- Tamir Sholklapper
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chad Crigger
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christian Morrill
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thomas G W Harris
- Division of Plastic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nora Haney
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kathy Lue
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ezekiel Young
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - John P Gearhart
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD.
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Storm DW, Lockwood GM, Bonnett MA, Cooper BJ, Harris LM, Cooper CS. The Impact of Perioperative and Operative Variables on Early Postoperative Complications Following Primary Hypospadias Repair. Urology 2022; 170:184-188. [PMID: 35970358 DOI: 10.1016/j.urology.2022.08.002] [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: 04/21/2022] [Revised: 07/20/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate possible risk factors for complications following primary hypospadias repair relative to factors associated with timing of hypospadias repair in terms of case order, morning or afternoon scheduling, perioperative delays, and surgeon's daily work schedule as well as individual operative techniques. METHODS We retrospectively reviewed charts of 422 boys undergoing primary hypospadias repair with a sutured urethroplasty by one of three surgeons over a 10-year period and the surgeon's daily schedule. RESULTS The median age and IQR of the patients at time of operation was 0.79 (0.57) years, and median follow-up was 259 (664) days. A significant increase in the rate of any complication was noted with morning versus afternoon cases for the group overall with morning cases having a hazard 2.3 times higher than afternoon cases (p=0.012). Additionally, there was a significant increase in hazard of complication with increasing difference in time between actual procedure duration versus scheduled duration, with hazard of complication increasing 5% for each increase of 15 minutes of surgical time (p=.043). CONCLUSIONS A variety of previously identified potential risk factors for hypospadias complications were identified. Our analysis also demonstrated variability in level of risk of different factors between surgeons, reinforcing the utility of surgeons monitoring their own results in response to changes in technique. Novel potential risk factors for some surgeons identified in our study included an increased risk of complications when the hypospadias was done in the morning rather than the afternoon and when the procedure lasted longer than scheduled.
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Affiliation(s)
- Douglas W Storm
- Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Gina M Lockwood
- Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Megan A Bonnett
- Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Benjamin J Cooper
- Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Logan M Harris
- Department of Biostatistics, University of Iowa, Iowa City, IA
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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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Singh A, Anand S, Goel P, Yadav DK, Bajpai M. Can sealing promote healing?: A systematic review and meta-analysis highlighting the adjunctive role of tissue sealant application during urethroplasty for hypospadias. J Pediatr Urol 2021; 17:805-812. [PMID: 34417129 DOI: 10.1016/j.jpurol.2021.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/15/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND A significant proportion of children require multiple surgeries for successful repair of hypospadias. This is not only a source of a financial burden to the family but also causes long-term social and psychosexual issues. Tissue sealant application can provide additional coverage to the suture line and subsequently prevents operative failure. However, a consensus statement regarding its usage during urethroplasty is lacking. This systematic review and meta-analysis aims to compare the outcomes of hypospadias surgery, in terms of its complications, in children with and without tissue sealant application. METHOD The authors systematically searched the databases PubMed, EMBASE, Web of Science and Scopus through September 2020. The occurrence of overall complications, and specific complications (including urethrocutaneous fistula, wound-related complications, flap-related complications, complications involving the neo-urethral tube and meatal stenosis) were the primary and secondary outcomes, respectively. Statistical analysis was performed using a random-effects model, and pooled risk ratio (RR) and heterogeneity (I2) were calculated. The methodological quality of the studies was assessed utilizing the Downs and Black scale. RESULT Four comparative studies were included in the meta-analysis. The different types of tissue sealants such as fibrin glue, cyanoacrylate glue, BioGlue and cryocalcium glue were used in these studies. As compared to without sealant application, hypospadias repair performed with sealant application showed no significant difference in the incidence of overall postoperative complications (RR 0.63; 95% CI 0.34-1.14, p = 0.13). However, a significant reduction in some specific complications including urethrocutaneous fistula (RR 0.37; 95% CI 0.19-0.72, p = 0.003), wound-related complications (RR 0.57; 95% CI 0.38-0.86, p = 0.008) and complications involving the neo-urethra (RR 0.15; 95% CI 0.04-0.54, p = 0.004) was observed with sealant usage. The average Downs and Black scale scores ranged from 16 to 18, with all studies having a moderate risk of bias. Kappa statistics showed a value of 0.962 (p < 0.001), highlighting an almost perfect agreement among the two observers. CONCLUSION The present meta-analysis revealed no additional benefit of the repair of hypospadias performed with tissue sealants as compared to without sealants in terms of reducing the overall postoperative complications. However, a significant reduction in the occurrence of some specific complications, including UCF, wound-related complications and complications involving the neourethra was observed with sealant application. The level of evidence of the published comparative studies is limited. Therefore, further studies need to be conducted for optimal comparison between the sealant and no sealant (or placebo), and different types of sealants.
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Affiliation(s)
- Apoorv Singh
- Department of Pediatric Surgery, AIIMS, New Delhi, 110029, India
| | - Sachit Anand
- Department of Pediatric Surgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai, 400053, India.
| | - Prabudh Goel
- Department of Pediatric Surgery, AIIMS, New Delhi, 110029, India
| | | | - Minu Bajpai
- Department of Pediatric Surgery, AIIMS, New Delhi, 110029, India
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9
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Ji F, Tang H, Wu C, Chen L, Wang H, Yan B. Predictive Value of C-Reactive Protein for Early Postoperative Complications in Children After Hypospadias Surgery. Front Pediatr 2021; 9:690863. [PMID: 34589449 PMCID: PMC8474872 DOI: 10.3389/fped.2021.690863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study explored the predictive value of postoperative C-reactive protein in children with hypospadias for postoperative complications and the risk factors. Methods: The clinical and follow-up data of 106 children with hypospadias who were treated with operations at Kunming Children's Hospital in 2020 were, respectively, analyzed. According to the occurrence of postoperative complications, the patients were divided into two groups: 25 patients with postoperative complications were the complications group, and 81 without postoperative complications were the control group. The baseline data, clinical characteristics, laboratory test indexes, and outcome of the two groups were collected. Receiver operating characteristic (ROC) was used to calculate the optimal cutoff value of C-reaction protein (CRP). Logistic regression was used to analyze the risk factors of hypospadias after surgery. A probability value (P) < 0.05 was considered statistically significant. Results: According to the result of the ROC curve, the optimal cutoff value of CRP was 11.7 mg/L. Logistic regression showed that the length of urethral defect, the urethral material, the operative produce, and the postoperative CRP level were related to the occurrence of postoperative complications of patients with DCC. The length of the urethral defect and the CRP level were the independent risk factors of the prognosis of hypospadias patients. The CRP level was related to the occurrence of postoperative complications and fistula. Conclusions: Postoperative CRP level can be used as a reliable marker for predicting the prognosis of hypospadias patients.
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Affiliation(s)
- Fengming Ji
- Yunnan Key Laboratory of Children's Major Disease Research, Urology Department, Kunming Children's Hospital, Kunming, China
| | - Haoyu Tang
- Yunnan Key Laboratory of Children's Major Disease Research, Urology Department, Kunming Children's Hospital, Kunming, China
| | - Chengchuang Wu
- Yunnan Key Laboratory of Children's Major Disease Research, Urology Department, Kunming Children's Hospital, Kunming, China
| | - Li Chen
- Yunnan Key Laboratory of Children's Major Disease Research, Department of General Surgery, Kunming Children's Hospital, Kunming, China
| | - Huake Wang
- Yunnan Key Laboratory of Children's Major Disease Research, Urology Department, Kunming Children's Hospital, Kunming, China
| | - Bing Yan
- Yunnan Key Laboratory of Children's Major Disease Research, Urology Department, Kunming Children's Hospital, Kunming, China
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Zhang Y, Chao M, Zhang WP, Tang YM, Chen HC, Zhang KP, Lu RG, Zhang XS, Lou DH. Using Buck's Fascia as an Integral Covering in Urethroplasty to Restore the Anatomical Structure of the Penis in One-Stage Hypospadias Repair: A Multicenter Chinese Study Comprising 1,386 Surgeries. Front Pediatr 2021; 9:695912. [PMID: 34434906 PMCID: PMC8380957 DOI: 10.3389/fped.2021.695912] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: The objective of the study is to investigate the feasibility and efficacy of urethroplasty with a Buck's fascia integral-covering technique (BFIC) to wrap and restore the normal anatomical structure of the penis in one-stage hypospadias surgery. Methods: One-stage surgeries for hypospadias management were performed using BFIC from January 2016 to September 2020 at four high-volume medical centers in China. The technique integrates Buck's fascia with glans wings to mobilize and wrap the urethra and restore penile anatomical relationships. The clinical data, postoperative follow-up data, and complications were recorded, and the results were analyzed. Results: A total of 1,386 patients were included in the study: 1,260 cases of primary hypospadias and 126 cases of re-operations; distal in 382 cases (27.6%), mid-shaft in 639 (46.1%), proximal in 365 (26.3%); tubularized incised plate (TIP) in 748 cases, inlay-graft in 124, onlay-graft in 49, Mathieu in 28, free-tube graft urethroplasty in 406, and 31 of hybrid procedures. One thousand one hundred forty-two patients (82.4%) were found to have penile curvature (>10°) after artificial erection and all corrected by dorsal plication/s or transection of the urethra plate (UP) simultaneously. The median followed-up time was 27 months (6-62). A total of 143 (10.3%) complications were recorded: 114 (9.0%) in the primary operations and 29 (23%) in the re-operations, 15 (3.9%) in distal hypospadias, 61 (9.5%) in mid-shaft, and 67 (18.4%) in proximal. The complication rate in UP preservation and transection was 10.1 and 10.8%, respectively. Of all case complications, there were 73 (5.2%) of fistula, 10 (0.6%) of dehiscence, 22 (1.6%) of meatal stenosis, 21 (1.5%) of stricture, 6 (0.7%) of diverticulum, and resident curvature in 11 cases (1.2%). The overall complication rate in TIP and free-tube procedure was 9.8 and 9.9%, respectively, and fistula occurred in primary TIP of 33 cases (4.9%). Conclusions: Buck's fascia with the glans can be used as an integral covering technique in one-stage distal to proximal hypospadias and primary or re-operative hypospadias repair. It is safe, feasible, and effective for the repair of hypospadias.
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Affiliation(s)
- Yin Zhang
- Department of Urology, Anhui Provincial Children's Hospital/Children's Hospital of Fudan University (Affiliated Anhui Branch), Hefei, China
| | - Min Chao
- Department of Urology, Anhui Provincial Children's Hospital/Children's Hospital of Fudan University (Affiliated Anhui Branch), Hefei, China
| | - Wei-Ping Zhang
- Department of Pediatric Urology, Beijing Children's Hospital, Affiliated to the Capital Medical University, Beijing, China
| | - Yun-Man Tang
- Department of Pediatric Surgery of Children's Medical Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Affiliated Hospital of the University of Electronic Science and Technology of China, Chengdu, China
| | - Hai-Chen Chen
- Department of Pediatric Surgery, Xiamen Maternal and Children's Health Hospital, Xiamen, China
| | - Kai-Ping Zhang
- Department of Urology, Anhui Provincial Children's Hospital/Children's Hospital of Fudan University (Affiliated Anhui Branch), Hefei, China
| | - Ru-Gang Lu
- Department of Urology, Nanjing Children's Hospital, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xian-Sheng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dong-Hua Lou
- Department of Biostatistics, Nanjing Medical University, Nanjing, China
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