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Anttila A, Lahdes-Vasama T, Pakkasjärvi N, Taskinen S. Cumulative re-operation rates during follow-up after hypospadias repair. BJU Int 2024. [PMID: 39224939 DOI: 10.1111/bju.16519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To assess the cumulative rates of re-operations after hypospadias repair and evaluate long-term surgical outcomes at a tertiary paediatric urology centre. PATIENTS AND METHODS Retrospective analysis of 293 boys born between 1991 and 2003 undergoing hypospadias surgery was conducted. The study included 274 patients: 165 with distal, 34 with midshaft, and 75 with proximal hypospadias. Kaplan-Meier methods were used to evaluate the re-operation data. RESULTS The median age at primary surgery was 1.3 years, with a median follow-up of 14.4 years. The overall re-operation rate was 48.2%, with approximately half of the problems detected within the first 3 months after surgery. The risk of re-operation was correlated with hypospadias severity, with 5- and 15-year re-operation risks at 39.3% and 51.8%, respectively. Limitations of the study include its retrospective nature and variations in surgical techniques from current standards. CONCLUSION There is a significant risk of unplanned re-operations following hypospadias repair, increasing with the severity of the original condition. This underscores the need for extended follow-up and effective communication with patients and their families about the likelihood of requiring multiple surgeries for optimal outcomes.
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Affiliation(s)
- Annaleena Anttila
- Department of Pediatric Surgery, Section of Pediatric Urology, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
- Department of Pediatric Surgery, Tampere University Hospital, Tampere, Finland
| | - Tuija Lahdes-Vasama
- Department of Pediatric Surgery, Tampere University Hospital, Tampere, Finland
| | - Niklas Pakkasjärvi
- Department of Pediatric Surgery, Section of Pediatric Urology, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Seppo Taskinen
- Department of Pediatric Surgery, Section of Pediatric Urology, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
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Wood D, Wilcox D. Hypospadias: lessons learned. An overview of incidence, epidemiology, surgery, research, complications, and outcomes. Int J Impot Res 2023; 35:61-66. [PMID: 35352016 DOI: 10.1038/s41443-022-00563-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022]
Abstract
Hypospadias is a common condition and familiar, though sometimes challenging territory for the pediatric urologist. This review is a summary of hypospadias incidence, epidemiology, surgery, research, and complications intended for the non-specialist. It outlines the history, the principles of surgery for hypospadias, and the long-term outcomes.
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Affiliation(s)
- Dan Wood
- University of Colorado, Aurora, CO, USA. .,Center for Childrens' Surgery Children's Hospital Colorado, Aurora, CO, USA.
| | - Duncan Wilcox
- Center for Childrens' Surgery Children's Hospital Colorado, Aurora, CO, USA
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Daboos M, Hefney K, Abdelhafez Mahmoud M, Salama A, Mohammed Y, Hussein M, Abdelmaboud M, Hussein T, Ashour Y, Gouda S. Evaluation of double faced transverse preputial (onlay) island flap for hypospadias repair in pediatrics: a randomized controlled study. Int Urol Nephrol 2022; 54:1471-1477. [PMID: 35462581 PMCID: PMC9035285 DOI: 10.1007/s11255-022-03217-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
Abstract
Background The preputial onlay island flap technique has been popularized for hypospadias repair as a result of offering a consistent combination of acceptable functional and cosmetic results. Like other techniques, urethrocutaneous fistulae and stricture continues to be the most common complications, in addition to other complications, which could be attributed to the compromise in flaps vascularity. Some authors describe a technique that resolves some of these problems by combining the unique benefits of the double faced preputial flaps. The aim of this study:- to evaluate double faced preputial onlay island flap technique for complications rate, outcomes of surgical procedure, and cosmetic results in comparison to transverse inner preputial flap technique. Patients and methods This was a prospective randomized controlled study that included 68 patients with anterior, mid-penile, and posterior penile hypospadias, with shallow and narrow urethral plate of size less than 6 mm, who underwent single-stage repair using preputial flaps, conducted at the department of pediatric surgery (Al-Azhar University, Cairo, Egypt), between May 2019 and October 2021, to evaluate double faced transverse preputial onlay island flap technique. Thirty-four patients underwent double faced transverse preputial onlay island flap (group A) and another 34 patients underwent inner transverse preputial onlay island flap (control group) (group B). The follow-up period ranged from 12 to 26 months. Results The overall complication rate was 20.5% (14 of 68 children). Complications developed in 5 cases (14.7%) in group A who underwent double face onlay island flap (2 glannular dehiscence, 1 penile rotation, 1 fistula, and 1 diverticulum), as opposed to 9 patients in group B (26.4%) who underwent transverse inner preputial flap (3 developed glannular dehiscence, 2 skin flap necrosis, 3 fistulae, and 1 diverticulum). After management of the complications, all patients had good surgical outcomes with satisfactory cosmetic results. Conclusion Double faced transverse preputial onlay island flap is an alternative option to reconstruct narrow urethral plate hypospadias. So that double faced transverse preputial onlay island flap technique appears to achieve satisfactory surgical outcomes with lower complication rate.
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Affiliation(s)
- Mohammad Daboos
- Pediatric Surgery Department, Al-Azhar University, Al-Houssain University Hospital, Darrasa, Cairo, Egypt.
| | - Khalid Hefney
- Pediatric Surgery Department, Al-Azhar University, Al-Houssain University Hospital, Darrasa, Cairo, Egypt
| | | | - Ahmed Salama
- Pediatric Surgery Department, Al-Azhar University, Al-Houssain University Hospital, Darrasa, Cairo, Egypt
| | - Yousef Mohammed
- Pediatric Surgery Department, Al-Azhar University, Al-Houssain University Hospital, Darrasa, Cairo, Egypt
| | - Mohammed Hussein
- Pediatric Surgery Department, Al-Azhar University, Al-Houssain University Hospital, Darrasa, Cairo, Egypt
| | - Mohamed Abdelmaboud
- Pediatric Surgery Department, Al-Azhar University, Al-Houssain University Hospital, Darrasa, Cairo, Egypt
| | - Tharwat Hussein
- Pediatric Surgery Department, Al-Azhar University, Al-Houssain University Hospital, Darrasa, Cairo, Egypt
| | - Yasser Ashour
- Pediatric Surgery Department, Al-Azhar University, Al-Houssain University Hospital, Darrasa, Cairo, Egypt
| | - Samir Gouda
- Pediatric Surgery Department, Al-Azhar University, Al-Houssain University Hospital, Darrasa, Cairo, Egypt
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Maurizi E, Adamo D, Magrelli FM, Galaverni G, Attico E, Merra A, Maffezzoni MBR, Losi L, Genna VG, Sceberras V, Pellegrini G. Regenerative Medicine of Epithelia: Lessons From the Past and Future Goals. Front Bioeng Biotechnol 2021; 9:652214. [PMID: 33842447 PMCID: PMC8026866 DOI: 10.3389/fbioe.2021.652214] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/23/2021] [Indexed: 12/13/2022] Open
Abstract
This article explores examples of successful and unsuccessful regenerative medicine on human epithelia. To evaluate the applications of the first regenerated tissues, the analysis of the past successes and failures addresses some pending issues and lay the groundwork for developing new therapies. Research should still be encouraged to fill the gap between pathologies, clinical applications and what regenerative medicine can attain with current knowledge.
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Affiliation(s)
| | - Davide Adamo
- Interdepartmental Centre for Regenerative Medicine “Stefano Ferrari”, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Giulia Galaverni
- Interdepartmental Centre for Regenerative Medicine “Stefano Ferrari”, University of Modena and Reggio Emilia, Modena, Italy
| | - Eustachio Attico
- Interdepartmental Centre for Regenerative Medicine “Stefano Ferrari”, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Lorena Losi
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Graziella Pellegrini
- Holostem Terapie Avanzate S.r.l., Modena, Italy
- Interdepartmental Centre for Regenerative Medicine “Stefano Ferrari”, University of Modena and Reggio Emilia, Modena, Italy
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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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Satjakoesoemah AI, Situmorang GR, Wahyudi I, Rodjani A. Single-stage urethroplasty: An eight-year single-centre experience and its associated factors for urethrocutaneous fistula. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820941746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: This study aimed to describe single-stage urethroplasty and to determine factors associated with urethrocutaneous fistula after the procedure at our institution. Methods: All hypospadias patients without any prior surgery who underwent single-stage urethroplasty from July 2010 to January 2018 were included. In total, 179 patients were followed for at least one year postoperatively. Information on types of hypospadias, operation techniques, chordee degree, preoperative pyuria (urine white blood cell count >5/HPF), urethral defect length and urethrocutaneous fistula formation was collected. Results: We obtained 103 cases of posterior (57.5%), middle (57 cases) and anterior (19 cases) hypospadias on whom onlay preputial island flap (71 cases), tubularized incised plate (46 cases) and Duckett’s transverse preputial island flap (35 cases) were conducted. After 47.1±25.8 months of follow-up, urethrocutaneous fistula were found in 23 (12.8%) patients associated with posterior hypospadias occurrence ( p=0.025), longer urethral defect ( p=0.007) and preoperative pyuria ( p<0.001). Chordee degree ( p=0.886) and age ( p=0.187) were not significant factors associated with urethrocutaneous fistula formation. Conclusion: Single-stage urethroplasty is a versatile procedure for various hypospadias cases, with a urethrocutaneous fistula rate of 12.8%. Posterior hypospadias, preoperative pyuria and longer urethral defect were associated with urethrocutaneous fistula formation. Level of evidence Level 2B.
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Affiliation(s)
- Adistra Imam Satjakoesoemah
- Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Indonesia
| | - Gerhard Reinaldi Situmorang
- Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Indonesia
| | - Irfan Wahyudi
- Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Indonesia
| | - Arry Rodjani
- Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Indonesia
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Ru W, Shen J, Tang D, Xu S, Wu D, Tao C, Chen G, Gao L, Wang X, Shen Y. Width proportion of the urethral plate to the glans can serve as an appraisal index of the urethral plate in hypospadias repair. Int J Urol 2018; 25:649-653. [PMID: 29717506 DOI: 10.1111/iju.13585] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To find a new appropriate evaluation for urethral plate quality in hypospadias repair, with particular interest in the width proportion of the urethral plate to the glans, serving as an appraisal index. METHODS Data were prospectively collected from prepubertal boys who underwent primary tubularized incised plate hypospadias repair between January 2014 and April 2016 in one center. Intrinsic parameters of the penis (meatal location, glans width, urethral plate width and curvature degree) were measured during the operation. Urethroplasty complications were recorded during follow up. The correlation between width proportion of the urethral plate to the glans and urethroplasty complications was analyzed. RESULTS Primary tubularized incised plate repair was carried out in 442 patients (mean age 2.8 years, range 0.5-12 years). At mean follow up of 26 months (range 12-38 months), urethroplasty complications occurred in 59 (13.3%) patients. The width proportion of the urethral plate to the glans was weakly correlated to both the glans width and meatal location. The width proportion of the urethral plate to the glans ranged from 0.18 to 0.73, with a mean of 0.39. The cut-off value of width proportion of the urethral plate to the glans was determined to be 0.36 by the receiver operating characteristic curve. Urethroplasty complications occurred in 17 out of 254 patients (6.7%) with width proportion of the urethral plate to the glans >0.36, and 42 out of 188 patients (22.3%) with width proportion of the urethral plate to the glans ≤0.36. The width proportion of the urethral plate to the glans ≤0.36 showed an increased odds of 4.819-fold (95% confidence interval 2.548-9.112, P < 0.001) risk of urethroplasty complications compared with width proportion of the urethral plate to the glans >0.36. Midshaft and proximal meatal location also increased the risk of urethroplasty complications. CONCLUSIONS The present study highlights the value of the width proportion of the urethral plate to the glans for objectivity and accuracy in urethral plate evaluation, which in turn serves as an independent factor influencing outcomes in tubularized incised plate repair.
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Affiliation(s)
- Wei Ru
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
| | - Jing Shen
- Amcare Women's and Children's Hospital, Hangzhou, China
| | - Daxing Tang
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
| | - Shan Xu
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
| | - Dehua Wu
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
| | - Chang Tao
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
| | - Guangjie Chen
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
| | - Lei Gao
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
| | - Xiaohao Wang
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
| | - Yiding Shen
- Zhejiang University School of Medicine Children's Hospital, Hangzhou, China
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Snodgrass W, Bush N. Staged Tubularized Autograft Repair for Primary Proximal Hypospadias with 30-Degree or Greater Ventral Curvature. J Urol 2017; 198:680-686. [DOI: 10.1016/j.juro.2017.04.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
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Keays MA, Dave S. Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes. Can Urol Assoc J 2017; 11:S48-S53. [PMID: 28265319 DOI: 10.5489/cuaj.4386] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In this article, we present the current approach to hypospadias, a review of the classification, preoperative evaluation, and factors that enable decision-making during surgery. We will then discuss patient-reported outcomes, evaluating the patients' and parents' perspectives regarding hypospadias repair.
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Affiliation(s)
- Melise A Keays
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Sumit Dave
- Division of Urology, Department of Surgery and Pediatrics, London Health Sciences Centre, London, ON, Canada
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Abstract
This review summarizes data regarding commonly used surgical techniques to repair distal and proximal hypospadias. We review evidence concerning indications for various procedures used in primary hypospadias repair, and their complications, urinary function and esthetic results. Available evidence suggests TIP is preferable to Mathieu for distal hypospadias correction. Current data do not identify a clear preference between TIP and onlay flap for proximal repair when there is ventral curvature <30°, or between various flap and graft options when curvature is >31°. A review of objective data helps clarify decision-making for distal hypospadias repair. Additional objective evidence is needed to identify preferred options for proximal hypospadias repair. Measuring glansplasty dimensions (meatal size and distance from meatus to corona) may improve urinary function assessments, and provide additional objective data for decision-making between various surgical techniques.
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Springer A, Tekgul S, Subramaniam R. An Update of Current Practice in Hypospadias Surgery. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.eursup.2016.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Snodgrass W, Bush N. Primary hypospadias repair techniques: A review of the evidence. Urol Ann 2016; 8:403-408. [PMID: 28057982 PMCID: PMC5100143 DOI: 10.4103/0974-7796.192097] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 02/28/2016] [Indexed: 11/23/2022] Open
Abstract
This review summarizes data regarding commonly used surgical techniques to repair distal and proximal hypospadias. We review evidence concerning indications for various procedures used in primary hypospadias repair, and their complications, urinary function and esthetic results. Available evidence suggests TIP is preferable to Mathieu for distal hypospadias correction. Current data do not identify a clear preference between TIP and onlay flap for proximal repair when there is ventral curvature <30°, or between various flap and graft options when curvature is >31°. A review of objective data helps clarify decision-making for distal hypospadias repair. Additional objective evidence is needed to identify preferred options for proximal hypospadias repair. Measuring glansplasty dimensions (meatal size and distance from meatus to corona) may improve urinary function assessments, and provide additional objective data for decision-making between various surgical techniques.
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Elmoghazy H, Hussein MM, Mohamed E, Badawy A, Alsagheer G, Abd Elhamed AM. A novel technique for repair of mid-penile hypospadias using a preputial skin flap: results of 110 patients. Int Urol Nephrol 2016; 48:1943-1949. [PMID: 27623810 DOI: 10.1007/s11255-016-1416-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/01/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several techniques have been used to repair mid-penile hypospadias; however, high failure rates and major complications have been reported. In this study, we describe a novel technique using a well-vascularized flap of the inner and outer preputial skin. METHODS A total of 110 male children with hypospadias underwent repair by our technique between 2008 and 2015. The inclusion criteria were children with mid-penile or slightly more proximal hypospadias, with or without ventral chordae, and an intact prepuce of the cobra eyes variety. Recurrent cases, patients with other preputial types, and circumcised children were excluded from this study. The prepared flap was sutured in its natural longitudinal orientation to the created urethral plate strip to form a neo-urethra over a urethral catheter. Outcome measures included surgical success without the formation of a urethra-cutaneous fistula, no ischaemia of the flaps, glans dehiscence or infection and functional outcome and cosmetic appearance. RESULTS The median follow-up duration was 3.3 years. There were 63 cases of mid-penile hypospadias (57.3 %), and in 47 cases (42.7 %), the meatus was slightly more proximal. The age of the patients ranged from 1.1 to 8.0 years, with a mean age of 4.6 ± 1.2 years. Surgery was successful in 106 (96.4 %) cases. Minor complications occurred in 11 patients (10 %) and included oedema of glans in ten patients and bluish discoloration on the ventral aspect of the glans close to the suture line in three patients. All patients improved within 2 weeks after surgery. Long-term follow-up revealed a properly functioning urethra with a forward, projectile, single, compact, and rifled urinary stream of adequate calibre and cosmetically acceptable repair. No cases of meatal retraction, meatal stenosis, urethral stricture, or acquired urethral diverticulum occurred. DISCUSSION Our technique is different from the split prepuce in situ technique. We create a narrow strip of the urethral plate that facilitates glanular closure, and we use the inner and adjacent outer skin in a vertical manner to preserve excess skin for penile coverage. Prepuce is split at midline to preserve more preputial skin with favourable dartos tissue for penile skin coverage. The glans is closed using a stitch-by-stitch method that has not been described previously. CONCLUSION This study presents a novel technique for mid-penile hypospadias repair using a preputial skin flap with excellent results in terms of short- and long-term outcomes.
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Affiliation(s)
- Hazem Elmoghazy
- Department of Urology, Sohag University Hospital, Alshark District, Sohag, Sohag Governorate, Egypt.
| | - Mohamed M Hussein
- Department of Urology, Sohag University Hospital, Alshark District, Sohag, Sohag Governorate, Egypt
| | - Elnisr Mohamed
- Department of Urology, Sohag University Hospital, Alshark District, Sohag, Sohag Governorate, Egypt
| | - Abdelbasset Badawy
- Department of Urology, Sohag University Hospital, Alshark District, Sohag, Sohag Governorate, Egypt
| | - Gamal Alsagheer
- Department of Urology, South Valley University Hospital, Qena, Egypt
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Elbakry A, Hegazy M, Matar A, Zakaria A. Tubularised incised-plate versus tubularisation of an intact and laterally augmented plate for hypospadias repair: A prospective randomised study. Arab J Urol 2016; 14:163-70. [PMID: 27489745 PMCID: PMC4963157 DOI: 10.1016/j.aju.2016.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 03/21/2016] [Accepted: 03/30/2016] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To compare the outcome of hypospadias repair using tubularised incised-plate (TIP) urethroplasty and tubularisation of an intact and laterally augmented urethral plate. PATIENTS AND METHODS This prospective randomised study included 370 patients with primary distal hypospadias. All had urethral plate widths of 8-10 mm and a glans of ⩾15 mm. Exclusion criteria were previous repair, circumcision, a wide urethral plate of >10 mm or a narrow plate of <8 mm in diameter, a small glans of <15 mm in diameter, chordee of >30°, and hormonal stimulation. Patients were randomised into two groups: Group 1 (185 patients) underwent TIP urethroplasty and Group 2 (185 patients) underwent tubularisation of the intact plate with lateral augmentation of the urethral plate using penile skin. The follow-up period was 12-28 months. RESULTS There were 172 evaluable patients in Group 1 and 177 in Group 2. The urethroplasty was successful in 83.2% and 94.4% in Groups 1 and 2, respectively. Complications occurred in 16.8% in Group 1 and 5.6% in Group 2 (P = 0.001). Meatal stenosis occurred in 7% and 3.4% in Groups 1 and 2, respectively (P = 0.130). There were statistically significant differences in the wound dehiscence, fistula, and re-operation rates of Group 1 versus Group 2, at 6% versus 0%, 9.8% versus 2.8%, and 13.4% versus 5.6%, respectively. The presence of mild chordee did not affect the complication rate (P = 0.242). The mean (SD) operative time was 56.7 (8.9) min in Group 1 and 93.7 (8.3) min in Group 2 (P < 0.001). CONCLUSION The outcome of tubularised intact and laterally augmented plate is better than classical TIP urethroplasty of hypospadias. Further trials are mandatory to extend the indications of the technique.
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Affiliation(s)
- Adel Elbakry
- Department of Urology, Suez Canal University Hospital, Ismailia, Egypt
| | - Mahmoud Hegazy
- Department of Urology, Suez Canal University Hospital, Ismailia, Egypt
| | - Adel Matar
- Department of Urology, Suez Canal University Hospital, Ismailia, Egypt
| | - Ahmed Zakaria
- Department of Urology, Suez Canal University Hospital, Ismailia, Egypt
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