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Oshiba A, Kotb M. Is cystourethroscopy a crucial preoperative step in severe and complex types of hypospadias? Front Surg 2023; 10:1202539. [PMID: 37425347 PMCID: PMC10327474 DOI: 10.3389/fsurg.2023.1202539] [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: 04/08/2023] [Accepted: 06/09/2023] [Indexed: 07/11/2023] Open
Abstract
Background and objectives Proximal hypospadias is considered the most severe subtype of the hypospadias spectrum and represents approximately one-fifth of the total cases. It is well-evidenced by many studies that the rate of postoperative complications following the repair of this complex subtype is significantly higher when compared to the distal variants. Few reports described the proximal hypospadias from the other perspective which is the preoperative one. Most pediatric surgeons notice an unexplained incidence of lower urinary tract infection and occasional difficulty of urinary catheterization in those children. This sometimes requires the use of additional measures such as the use of urethral sounds, filiforms and followers, and even catheterization under anesthesia. The aim of the work is to evaluate the role of preoperative cystourethroscopy in detecting associated anomalies in cases of proximal and severe hypospadias. Materials and methods This prospective study was conducted in the pediatric surgery unit at Alexandria Faculty of Medicine between July 2020 and December 2021 and included all children with severe grades of hypospadias. After thorough evaluation, all children underwent cystourethroscopy just before the procedure. Any abnormalities in the urethra, urinary bladder, or ureteric openings were recorded if present. Finally, the definitive operation was performed as per schedule. Results Fifty-two patients (41 fresh and 11 redo patients) with a median (range) age at presentation of 5 (1-16) years were enrolled in this study. The intraoperative cystourethroscopy was done in all of the patients. Significant abnormal findings were recorded in 32 patients (61.5%), while the other 20 patients (38.5%) were revealed to be normal. The most common abnormal findings were dilated prostatic utricle opening and hypertrophied verumontanum (in 23 and 16 cases, respectively). Conclusion Although most of the associated anomalies with proximal hypospadias are asymptomatic, cystourethroscopy is better used owing to a high incidence of these anomalies. This can facilitate an early diagnosis as well as early detection and intervention at the time of repair.
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Affiliation(s)
- Ahmed Oshiba
- Department of Pediatric Surgery, Alexandria Faculty of Medicine, Alexandria, Egypt
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Sturm R. Response to letter to the Editor re: Variability in surgical practices and instrumentation for hypospadias repair. J Pediatr Urol 2023:S1477-5131(23)00056-6. [PMID: 36934032 DOI: 10.1016/j.jpurol.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 02/27/2023]
Affiliation(s)
- Renea Sturm
- Division of Pediatric Urology, Department of Urology, University of California, Los Angeles.
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- Division of Pediatric Urology, Department of Urology, University of California, Los Angeles
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Ali MM, El-Hawy MM, Galal EM, Tawfiek ER, Anwar AZ. Results of two-stage transverse preputial island flap urethroplasty for proximal hypospadias with chordee that mandate division of the urethral plate. Cent European J Urol 2021; 74:89-94. [PMID: 33976922 PMCID: PMC8097640 DOI: 10.5173/ceju.2021.0245.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/12/2020] [Accepted: 12/27/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction Reconstruction of proximal hypospadias with chordee remains a difficult task. Our work aims to evaluate the role of two-stage transverse preputial island flap urethroplasty for repair of proximal hypospadias with chordee. Material and methods This is a retrospective study including 57 children who underwent two-stage transverse preputial island flap urethroplasty. Glans meatus shaft (GMS) score was applied to 24 cases. Patient’s characteristics, operative details and complications were assessed. Hypospadias objective scoring evaluation was used for postoperative assessment. Results The mean age at the first stage operation was 23.6 months (9–84); the mean time interval between the first and second stage operations was 8.1 months (6–12) and the mean follow-up duration was 52.1 months (24–96). Urethral meatus was proximal penile in 18 patients, penoscrotal in 24 and scrotal in 15. The mean degree of ventral curvature (VC) was 51.5° (30–90). After the second stage operation, postoperative complications occurred in 16 (28.1%) patients with urethrocutaneous fistula in 6 (10.5%) cases, diverticulum in 3 (5.3%), glans dehiscence in 5 (8.8%) and meatal stenosis in 2 (3.5%). All cases of glans dehiscence occurred in severe hypospadias and small glans. Moderate GMS score was present in 10 (41.7%) cases and severe GMS in 14 (58.3%). Complications occurred in 7 (29.1%) patients with 5 (20.8%) with a severe GMS score and 2 (8.3%) with a moderate GMS score. The hypospadias objective scoring evaluation showed satisfactory results, with 39 (68.4%) patients achieving a score of 16 points. Conclusions Two-stage transverse preputial flap is a good choice for repair of proximal hypospadias with an acceptable complication rate of 28.1%.
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Affiliation(s)
- Mostafa M Ali
- University Hospital, School of Medicine, Department of Urology, Minia, Egypt
| | - Mamdouh M El-Hawy
- University Hospital, School of Medicine, Department of Urology, Minia, Egypt
| | - Ehab M Galal
- University Hospital, School of Medicine, Department of Urology, Minia, Egypt
| | - Ehab R Tawfiek
- University Hospital, School of Medicine, Department of Urology, Minia, Egypt
| | - Ahmed Z Anwar
- University Hospital, School of Medicine, Department of Urology, Minia, Egypt
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Ullah S, Karimi S, Sabir Khan H, Farooque U, Cheema O, Kumari P, Girdhari K, Kumar N, Sheikh FN, Basham MA, Yasmin F, Farooque R. The Success Level of Hypospadias Repair in Adults. Cureus 2020; 12:e9108. [PMID: 32789053 PMCID: PMC7417118 DOI: 10.7759/cureus.9108] [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] [Indexed: 11/05/2022] Open
Abstract
Introduction Hypospadias is the abnormal opening of the urethra at the undersurface of the penis. Hypospadias repair is performed in such patients to treat the condition. The success level of hypospadias repair in adults still needs to be established on a larger scale. Therefore, we conducted this study to document the success level of hypospadias repair in adults in our setting to add to the literature. Materials and methods This prospective study was conducted at a major metropolitan hospital in Karachi over a period of six months. A total of 75 male patients aged between 20-50 years and diagnosed with hypospadias of any level with or without mild to moderate chordee were included. Demographic features such as age and the duration of hypospadias were noted. Hypospadias repair using a tubularized incised plate (TIP) urethroplasty technique was performed, and the patients were observed for three days in the ward and for three months in the outpatient department for any complications. The procedure was considered a success if there were no complications and no need for a second surgery; we also took into account patient satisfaction with the procedure to determine the success level. The mean and standard deviation were calculated for patient age and the duration of hypospadias. Frequency and percentages were calculated for distribution of patient age, distribution of the duration of hypospadias, and the success of hypospadias repair. The correlation of patient age and the duration of hypospadias with the success of hypospadias repair was also determined by applying the Chi-square test, and a p-value of ≤0.05 was considered to be statistically significant. Results The mean age and the duration of hypospadias for the study population were the same at 31.43 ± 8.47 years. Distribution of patient age and the duration of hypospadias was also the same with 51 (68%) patients of ≤35 years of age and 24 (32%) patients of >35 years of age. Hypospadias repair was successful in 52 (69.33%) patients but unsuccessful in 23 (30.66%). The stratification of patient age and the duration of hypospadias with the success of hypospadias repair showed a significant inverse relationship (p = 0.017). The data relating to patient age and the duration of hypospadias showed the same values as hypospadias is a birth defect. Conclusion Adult patients undergoing primary hypospadias repair generally show good outcomes. However, the chances of favorable outcomes gradually decrease with age. Hence, patients should be encouraged to undergo the procedure as early in their lives as possible. Patients who are middle-to-old aged should especially be counseled about the relatively higher risk of unsuccessful procedures. Further analysis is needed to confirm the validity of these findings.
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Affiliation(s)
- Sami Ullah
- Urology, Pakistan Navy Ship (PNS) Shifa Hospital, Karachi, PAK
| | - Sundas Karimi
- General Surgery, Combined Military Hospital, Karachi, PAK
| | | | - Umar Farooque
- Neurology, Dow University of Health Sciences, Karachi, PAK
| | - Omer Cheema
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | | | - Naresh Kumar
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | | | - Farah Yasmin
- Cardiology, Dow University of Health Sciences, Karachi, PAK
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Zhou Y, Peng J, Cao X, Yan C, Huang F, Shen L, Long C, Liu X, Wei G. Retardation of Preputial Wound Healing in Rats with Hypospadias Induced by Flutamide. J INVEST SURG 2018; 33:164-171. [PMID: 30380353 DOI: 10.1080/08941939.2018.1483448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Yue Zhou
- Department of Pediatric Urology Surgery, Children′s Hospital of Chongqing Medical University, Chongqing, China,
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China,
- China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China,
- Chongqing Key Laboratory of Pediatrics, Chongqing, China,
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Jinpu Peng
- Department of Pediatric Urology Surgery, Children′s Hospital of Chongqing Medical University, Chongqing, China,
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China,
- China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China,
- Chongqing Key Laboratory of Pediatrics, Chongqing, China,
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Xining Cao
- Department of Pediatric Urology Surgery, Children′s Hospital of Chongqing Medical University, Chongqing, China,
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China,
- China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China,
- Chongqing Key Laboratory of Pediatrics, Chongqing, China,
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Chao Yan
- Department of Pediatric Urology Surgery, Children′s Hospital of Chongqing Medical University, Chongqing, China,
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China,
- China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China,
- Chongqing Key Laboratory of Pediatrics, Chongqing, China,
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Fangyuan Huang
- Department of Pediatric Urology Surgery, Children′s Hospital of Chongqing Medical University, Chongqing, China,
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China,
- China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China,
- Chongqing Key Laboratory of Pediatrics, Chongqing, China,
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Lianju Shen
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China,
- China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China,
- Chongqing Key Laboratory of Pediatrics, Chongqing, China,
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Chunlan Long
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China,
- China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China,
- Chongqing Key Laboratory of Pediatrics, Chongqing, China,
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Xing Liu
- Department of Pediatric Urology Surgery, Children′s Hospital of Chongqing Medical University, Chongqing, China,
| | - Guanghui Wei
- Department of Pediatric Urology Surgery, Children′s Hospital of Chongqing Medical University, Chongqing, China,
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Rynja SP, de Jong TPVM, Bosch JLHR, de Kort LMO. Proximal hypospadias treated with a transverse preputial island tube: long-term functional, sexual, and cosmetic outcomes. BJU Int 2018; 122:463-471. [PMID: 29624839 DOI: 10.1111/bju.14234] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study long-term urinary and sexual function, and cosmetic outcomes in adult patients who underwent single-stage transverse preputial island tube (TPIT) for proximal hypospadias repair in childhood. Long-term data on outcomes of patients with proximal hypospadias with severe coexisting curvature and insufficient urethral plate are scarce, but are necessary to decide which repair technique is most beneficial. PATIENTS, SUBJECTS AND METHODS Patients with proximal hypospadias operated with TPIT (TPIT Group) were compared to patients with distal hypospadias repair (Distal Group) and to a control group of male medical students (Control Group). Participants completed the International Prostate Symptom Score, the International Index of Erectile Function (IIEF-15), additional non-validated questions, and performed uroflowmetry. Cosmesis was assessed in the patients with hypospadias using the Pediatric Penile Perception Score (PPPS); stretched penile length was also measured. RESULTS Of the 121 eligible patients with hypospadias, 54 with either TPIT or distal hypospadias repairs participated. The TPIT Group comprised 12 patients (median age of 20.0 years) and the Distal Group comprised 42 patients (median age of 19.6 years). The complication rates were similar, at 8 of the 12 patients in the TPIT Group vs 26/42 (62%) in the Distal Group (P = 0.76). Urinary outcomes were similar in the TPIT, Distal, and the Control (comprised of 148 medical students with a median age of 21.0 years) groups. The TPIT Group had a lower maximum urinary flow rate compared to the Control Group, at 24.1 vs 28.6 mL/s (P < 0.05). IIEF-15 scores were similar in the TPIT, Distal and Control groups, except for 'Orgasmic Function' (7.5 vs 10.0 vs 10.0, respectively; P < 0.01). Although the TPIT Group had a smaller penile length compared to the Distal Group (10.1 vs 12.9 cm, P < 0.01), PPPS outcomes were similar. CONCLUSION In these TPIT patients, long-term urinary, sexual and cosmetic outcomes were similar to those in patients with distal hypospadias repairs and controls.
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Affiliation(s)
- Sybren P Rynja
- University Medical Center (UMC), Utrecht, The Netherlands
| | - Tom P V M de Jong
- University Children's Hospital UMC Utrecht, Utrecht, The Netherlands
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