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Tang R, Wan L, Yi Z, Luo Y, Wei X, Wang S, Xiao C. The effect of the use of postoperative antibiotic prophylaxis compared with non-use for stented distal hypospadias repair wound: A meta-analysis. Int Wound J 2023; 20:3073-3080. [PMID: 37095731 PMCID: PMC10502256 DOI: 10.1111/iwj.14182] [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: 03/16/2023] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/26/2023] Open
Abstract
A meta-analysis investigation to measure the influence of the usage of postoperative antibiotic prophylaxis (POP) compared with non-usage for stented distal hypospadias repair (SDHR). A comprehensive literature inspection till February 2023 was applied and 1067 interrelated investigations were reviewed. The 10 chosen investigations enclosed 1398 individuals with SDHR in the chosen investigations starting point, 812 of them were using POP, and 586 were not using POP. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the effect of the usage of POP compared with non-usage for SDHR by the dichotomous and continuous approaches and a fixed or random model. No significant difference was found between individuals using POP and not using POP in posthypospadias repair problem (PRP) (OR, 0.99; 95% CI, 0.42-2.34, P = .97) with moderate heterogeneity (I2 = 69%), posthypospadias repair infection problem (PRIP) (OR, 0.56; 95% CI, 0.30-1.06, P = .08) with no heterogeneity (I2 = 15%), and overall composite posthypospadias repair wound healing associated problem (OCPRWHAP) (OR, 1.27; 95% CI, 0.61-2.63, P = .53) with moderate heterogeneity (I2 = 59%) for SDHR. No significant difference was found between individuals using POP and not using POP in PRP, PRIP, and OCPRWHAP for SDHR. However, cautilised of the small sample sizes of several chosen investigations for this meta-analysis, care must be exercised when dealing with its values, for example, the low P-value of the PRIP.
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Affiliation(s)
- Ruipeng Tang
- Department of UrologyGeneral Hospital of Pangang GroupPanzhihuaChina
| | - Li Wan
- Department of UrologyGeneral Hospital of Pangang GroupPanzhihuaChina
| | - Zhengjin Yi
- Department of UrologyGeneral Hospital of Pangang GroupPanzhihuaChina
| | - Yun Luo
- Department of UrologyGeneral Hospital of Pangang GroupPanzhihuaChina
| | - Xupan Wei
- Department of UrologyGeneral Hospital of Pangang GroupPanzhihuaChina
| | - Shubin Wang
- Department of UrologyGeneral Hospital of Pangang GroupPanzhihuaChina
| | - Chuan Xiao
- Department of UrologyGeneral Hospital of Pangang GroupPanzhihuaChina
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Ernst M, Klamer B, Thompson N, Alpert S, Dajusta D, Fuchs M, McLeod D, Jayanthi R, Ching C. Caregiver disclosure of common early childhood pediatric urologic surgeries. J Pediatr Urol 2023; 19:522.e1-522.e8. [PMID: 36898864 DOI: 10.1016/j.jpurol.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Certain pediatric urologic diagnoses can have serious long-term adverse health outcomes. As a result, it is important for a child to be aware of their diagnosis and a prior surgery. When children have surgery prior to the age of memory formation, it is incumbent upon their caregiver to disclose this surgery. When and how to disclose this information and even if this occurs, is not clear. OBJECTIVE We developed a survey to assess caregiver plans to disclose early childhood pediatric urologic surgery and evaluate for predictors of disclosure and resources needed. METHODS A questionnaire was distributed to caregivers of male children ≤4 years old undergoing single stage repair of hypospadias, inguinal hernia, chordee, or cryptorchidism as part of an IRB approved research study. These surgeries were chosen due to being outpatient surgeries with potential long-term complications and impact. The age criteria was chosen due to likely being before patient memory formation and thus reliance on caregiver disclosure of prior surgery. Surveys were collected the day of surgery and contained information on caregiver demographics, validated health literacy screening, and plans to disclose surgery. RESULTS 120 survey responses were collected (Summary Table). The majority of caregivers responded affirmatively to planning to disclose their child's surgery (108; 90%). There was no impact of caregiver age, gender, race, marital status, education level, health literacy, or personal surgical history on plans to disclose surgery (p ≥ 0.05). Plan to disclose was also not different across urologic surgery type. Race was significantly associated with being "concerned or nervous about disclosing the surgery to the patient". The median patient age for planned disclosure was 10 years (IQR: 7-13). Only 17 respondents (14%) stated they received any information about how to discuss this surgery with the patient, however 83 (69%) felt this information would be helpful. CONCLUSIONS Our study suggests that most caregivers plan to discuss early childhood urologic surgeries with children, however want further guidance in how to talk to their child. While no specific surgery or demographic factor was found to be significantly associated with plans to disclose surgery, it is concerning that one in ten patients will potentially never learn about impactful surgery they had as a child. There is an opportunity for us to better counsel our patients' families about surgical disclosure and fill this gap with quality improvement efforts.
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Affiliation(s)
- Michael Ernst
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Brett Klamer
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Nora Thompson
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Seth Alpert
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Daniel Dajusta
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Molly Fuchs
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Daryl McLeod
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Rama Jayanthi
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Christina Ching
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
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Indriasari V, Alimoeddin PO, Pamungkas KO. Correlation between Glans, Meatus, Shaft Score, and Penile Perception after Hypospadias Repair. J Indian Assoc Pediatr Surg 2022; 27:585-587. [PMID: 36530828 PMCID: PMC9757774 DOI: 10.4103/jiaps.jiaps_231_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 06/17/2023] Open
Abstract
AIMS The aim is to analyze the correlation between the degree of hypospadias based on the Glans-Urethral Meatus-Shaft (GMS) score and penile perception after hypospadias repair using pediatric penile perception score (PPPS). SETTINGS AND DESIGN Analytic observational study with a cross-sectional design. SUBJECTS AND METHODS Thirty-two children with hypospadias were included in this study. The severity of hypospadias was assessed using GMS score. Postoperatively, PPPS was rated by two external pediatric surgeons. STATISTICAL ANALYSIS USED Correlation between GMS score and PPPS were analyzed using the Spearman test, P ≤ 0.05: Significant. RESULTS Mean-GMS was 8.69 ± 2.303 (mean-G 2.67 ± 0.858, mean-M 3.27 ± 0.942, mean-S 2.75 ± 1.055). Mean-PPPS was 10.19 ± 1.287. GMS score and PPPS had a very weak correlation (r = -0.227; P > 0.05). CONCLUSIONS There was no correlation between GMS score and penile perception according to PPPS after hypospadias repair.
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Affiliation(s)
- Vita Indriasari
- Department of Surgery, Division of Pediatric Surgery, Faculty of Medicine, Padjadjaran University, RSUP Dr. Hasan Sadikin, Bandung, Indonesia
| | - Patricia Okitaviani Alimoeddin
- Department of Surgery, Division of Pediatric Surgery, Faculty of Medicine, Padjadjaran University, RSUP Dr. Hasan Sadikin, Bandung, Indonesia
| | - Kurniawan Oki Pamungkas
- Department of Surgery, Division of Pediatric Surgery, Faculty of Medicine, Padjadjaran University, RSUP Dr. Hasan Sadikin, Bandung, Indonesia
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Blankstein U, McGrath M, Randhawa H, Braga LH. A survey of parental perceptions and attitudes related to disclosure in hypospadias repair. J Pediatr Urol 2022; 18:178.e1-178.e7. [PMID: 35181223 DOI: 10.1016/j.jpurol.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Boys with hypospadias often undergo reconstructive surgery to improve cosmetic appearance and functional outcomes. While the ethics of physician-patient disclosure of illness are clear, parent-child disclosure is more ambiguous. There is a paucity of research regarding the parental disclosure of past urological procedures, specifically hypospadias repair. Our objective was to determine the rate of parental disclosure in boys undergoing hypospadias repair, and to evaluate the parental perspectives regarding concerns and amount of support in relation. METHODS A web-based questionnaire was distributed to parents of 240 hypospadias patients at our pediatric urology outpatient clinic over 12 months. The questionnaire assessed intent to disclose, decisional regret, and cosmetic perception. Data was analyzed using descriptive statistics and chi-square analyses. RESULTS Two hundred and twenty-three survey responses were collected. The majority of respondents were urban dwellers (72.2%), and the mothers of the child (80.9%). Distal hypospadias was the most common variant of condition (62.7%). When asked if they plan to disclose the repair to their child, 93% said "yes", and of those, the optimal mean age of disclosure was 7.49 ± 4.30 years. Ninety percent reported that they were not offered guidance on how/when to disclose, and 43% thought they would benefit from support on this. There was a significant difference in nervousness to disclose if the condition was distal versus proximal (χ2 = 15.19, p=<0.01), with proximal being more nervous. A significant difference was also observed regarding disclosure support with proximal being more likely to want formal support (χ2 = 4.55, p = 0.03). DISCUSSION AND CONCLUSIONS As hypothesized, the majority of parents intended to disclose their son's surgery to them, but no statistically significant difference was seen between those with a distal vs. proximal repair. Additionally, demographic characteristics which were hypothesized to influence this decision (e.g., parents' level of education and relationship to the child) did not discriminate parental intent to disclose. To our knowledge, this is the first study to evaluate perceptions and attitudes around disclosure in patients with hypospadias and their families. The majority of respondents were planning to disclose the operation to their child, and were not offered any guidance or support as to the optimal way to disclose. Half of those parents thought they could benefit from resources to help them with this process. Further research is required to understand the impact of disclosure and to create tools to help caregivers with this responsibility.
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Affiliation(s)
- Udi Blankstein
- Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Melissa McGrath
- Division of Urology, McMaster University, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Luis H Braga
- Division of Urology, McMaster University, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Deparment of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
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Wang X, Guan Y, Wu Y, Wang C, Ma X, Zhang Z, Zhang D. Evaluation of tunica vaginalis flap-covering combined with modified Glenn-Anderson in one-stage repair of proximal hypospadias with incomplete penoscrotal transposition. Front Pediatr 2022; 10:872027. [PMID: 36582507 PMCID: PMC9792690 DOI: 10.3389/fped.2022.872027] [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: 02/09/2022] [Accepted: 10/31/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To explore a novel repair method for proximal hypospadias with incomplete penoscrotal transposition in children and evaluate its safety and outcomes. METHODS A retrospective analysis of clinical data was conducted for 86 children with severe proximal hypospadias with incomplete penoscrotal transposition who were hospitalized in our department between June 2018 and February 2021. In total, 42 patients (Group A) underwent repair following a one-stage method in which tunica vaginalis flap-covering was combined with a modified Glenn-Anderson procedure, while 44 patients (Group B) underwent a two-step repair consisting of tunica vaginalis flap-covering using the Duplay technique and the modified Glenn-Anderson procedure. The two groups were compared on operation time, length of postoperative hospital stay, postoperative complications, and associated costs. RESULTS All operations were successful in both groups. No statistical difference was observed between the two groups in incidence of stenosis of the urinary meatus (2.38% vs. 4.54%, P = 0.279), urethral stricture (2.38% vs. 2.27%, P = 0.948), urinary fistula (7.14% vs. 6.82%, P = 0.907), or urinary infection (7.14% vs. 4.55%, P = 0.309). Additionally, there was no statistical difference between the groups in operation time (63.21 ± 5.20 vs. 62.07 ± 4.47 min, P = 0.059), postoperative off-bed time (7.02 ± 1.32 vs. 6.84 ± 1.20 days, P = 0.456), or duration of hospitalization (10.55 ± 1.15 vs. 10.15 ± 1.45 days, P = 0.092). However, Group B patients underwent an additional second-stage operation, incurring extra costs. Three months after surgery, Group A were judged more positively on the PPPS (specifically receiving higher scores on shaft skin and general appearance) by both the parents (shaft skin: 2.10 ± 0.82 vs. 1.93 ± 0.62, P = 0.024; general appearance: 2.16 ± 0.91 vs. 1.93 ± 0.72, P = 0.042) and the surgeon (shaft skin: 2.42 ± 0.70 vs. 2.25 ± 0.58, P = 0.025; general appearance: 2.38 ± 0.69 vs. 2.29 ± 0.51, P = 0.041). In most cases, the parents and surgeon were satisfied with the appearance of the genitals after one-stage repair. CONCLUSION The advantages of the novel repair technique include use of a single-stage operation, producing a better appearance at a lower cost. The tunica vaginalis flap-covering method is not only demonstrated to be safe and effective, but it is also a simpler method than the conventional operation.
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Affiliation(s)
- Xin Wang
- Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin, PR China
| | - Yong Guan
- Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin, PR China
| | - Yong Wu
- Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin, PR China
| | - Cong Wang
- Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin, PR China
| | - Xiong Ma
- Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin, PR China
| | - Zhenhua Zhang
- Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin, PR China
| | - Dongzheng Zhang
- Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin, PR China
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Ceccarelli PL, Lucaccioni L, Poluzzi F, Bianchini A, Biondini D, Iughetti L, Predieri B. Hypospadias: clinical approach, surgical technique and long-term outcome. BMC Pediatr 2021; 21:523. [PMID: 34836527 PMCID: PMC8620229 DOI: 10.1186/s12887-021-02941-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Hypospadias is one of the most common congenital abnormalities in male newborn. There is no universal approach to hypospadias surgical repair, with more than 300 corrective procedures described in current literature. The reoperation rate within 6–12 months of the initial surgery is most frequently used as an outcome measure. These short-term outcomes may not reflect those encountered in adolescence and adult life. This study aims to identify the long-term cosmetic, functional and psychosexual outcomes. Methods Medical records of boys who had undergone surgical repair of hypospadias by a single surgical team led by the same surgeon at a single centre between August 2001 and December 2017 were reviewed. Families were contacted by telephone and invited to participate. Surgical outcome was assessed by combination of clinical examination, a life-related interview and 3 validated questionnaires (the Penile Perception Score-PPS, the Hypospadias Objective Score Evaluation-HOSE, the International Index of Erectile Function-5-IIEF5). Outcomes were compared according to age, severity of hypospadias, and respondent (child, parent and surgeon). Results 187 children and their families agreed to participate in the study. 46 patients (24.6%) presented at least one complication after the repair, with a median elapsed time of 11.5 months (6.5–22.5). Longitudinal differences in surgical corrective procedures (p < 0.01), clinical approach (p < 0.01), hospitalisation after surgery (p < 0.01) were found. Cosmetic data from the PPS were similar among children and parents, with no significant differences in child’s age or the type of hypospadias: 83% of children and 87% of parents were satisfied with the cosmetic result. A significant difference in functional outcome related to the type of hypospadias was reflected responses to HOSE amongst all groups of respondents: children (p < 0.001), parents (p=0.02) and surgeon (p < 0.01). The child’s HOSE total score was consistently lower than the surgeon (p < 0.01). The HOSE satisfaction rate on functional outcome was 89% for child and 92% for parent respondents. Conclusion Surgeons and clinicians should be cognizant of the long-term outcomes following hypospadias surgical repair and this should be reflected in a demand for a standardised approach to repair and follow-up.
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Affiliation(s)
- Pier Luca Ceccarelli
- Pediatric Surgical Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
| | - Laura Lucaccioni
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
| | - Francesca Poluzzi
- Pediatric Surgical Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
| | - Anastasia Bianchini
- Pediatric Surgical Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
| | - Diego Biondini
- Pediatric Surgical Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy.
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
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Long-Term Undesirable Consequences of Penile Skin Island Flap to Correct Penoescrotal Transposition: A Case Report and Review of Literature. Case Rep Urol 2021; 2021:6656540. [PMID: 33505761 PMCID: PMC7815407 DOI: 10.1155/2021/6656540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/05/2021] [Indexed: 11/18/2022] Open
Abstract
Hypospadias is a congenital malformation of the male lower urinary tract, consisting of a ventral urethral opening proximal to the glans penis. This condition is corrected surgically in the paediatric age, with a great variety of techniques available. Traditionally, a tubularized genital skin was used for one- or two-stage repairs. Nowadays, the tendency is to use preputial or oral mucosa grafts, dorsally located, to avoid diverticula formation and prevent hair growth in the neourethra. We present a case of a patient born with proximal hypospadias with penoscrotal transposition, surgically corrected in his childhood, using dorsal penile skin island flap. The patient is referred to urology consultation in his adulthood for a weak urinary stream, recurrent infections, and a large amount of hair exiting through the urethral meatus.
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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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Ngoo A, Hirst J, Wong D, Winkle D. Penile squamous cell carcinoma following childhood hypospadias repair. BMJ Case Rep 2020; 13:13/12/e238459. [PMID: 33318276 PMCID: PMC7737036 DOI: 10.1136/bcr-2020-238459] [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: 12/15/2022] Open
Abstract
We report a case of a 46-year-old man who presented with recurrent lower urinary tract infections and obstructive voiding symptoms on the background of a proximal hypospadias repair at 4 years of age. A mass was later identified at his distal urethra, which on biopsy was found to be a penile squamous cell carcinoma. The lesion was excised en bloc, and at 10 months post-excision, the patient has no evidence of local or regional recurrence.
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Affiliation(s)
- Alexander Ngoo
- Urology, Mater Hospital Brisbane, Brisbane, Queensland, Australia
| | - Jodi Hirst
- Urology, Mater Hospital Brisbane, Brisbane, Queensland, Australia
| | - David Wong
- Anatomical Pathology, Mater Hospital Brisbane, Brisbane, Queensland, Australia
| | - David Winkle
- Urology, Mater Hospital Brisbane, Brisbane, Queensland, Australia
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10
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Sexual functions and fertility outcomes after hypospadias repair. Int J Impot Res 2020; 33:149-163. [PMID: 33262531 DOI: 10.1038/s41443-020-00377-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 01/13/2023]
Abstract
Hypospadias is a common abnormality of the urogenital tract with a wide range of variety in its presentation and severity. The primary aim to correct hypospadias is to restore normal penile function and appearance. Although it can be corrected at any age, early correction between the 6 and 18 months of life is recommended. The functional and cosmetic outcomes have been very-well presented in the literature, although the aspects of sexuality and fertility of hypospadias repair in the long term are vague. In this narrative review, we aimed to gather the data around the sexuality and fertility outcomes of hypospadias repair and acknowledge urologists and parents of boys with hypospadias who will have a correction surgery about future sexual and fertility concerns.
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Andersson M, Sjöström S, Doroszkiewicz M, Örtqvist L, Abrahamsson K, Sillén U, Holmdahl G. Urological results and patient satisfaction in adolescents after surgery for proximal hypospadias in childhood. J Pediatr Urol 2020; 16:660.e1-660.e8. [PMID: 32800709 DOI: 10.1016/j.jpurol.2020.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Proximal hypospadias repair is associated with a considerable complication risk. Long-term follow-up is required to present realistic expectations in pre-operative counseling. OBJECTIVE To investigate adolescents after childhood surgery for proximal hypospadias in a prospective cohort study describing the urological outcome, complication rates and patient satisfaction with penile appearance. STUDY DESIGN 39 adolescents ≥14 years with penoscrotal to perineal hypospadias and primary urethroplasty (tubularized incised plate (TIP), preputial flap as Onlay or tubularized (Duckett)) from 1996 to 2005 at a single center were evaluated. The clinical assessment, at Md 16.5 years (14-25), included voiding history, genital examination including the Hypospadias Objective Scoring Evaluation (HOSE), uroflowmetry plus chart data from previous urinary flows and evaluation of patient satisfaction using the Penile Perception Score (PPS). RESULTS Twenty-nine patients with penoscrotal and 10 with scrotal/perineal hypospadias underwent surgery with TIP (N = 14), Onlay (N = 14) and Duckett (N = 11). Uroflows improved significantly compared with prepubertal maximal flows. Impaired flow rate (<10 mL/s) was found in 14% (5/36). Fifty-one percent (20/39) required reoperations, 29% (4/14) of TIP, 50% (7/14) of Onlay and 82% (9/11) of Duckett (p = 0.0062). Median penile length in adolescence was 8.7 cm (4.0-11.0). Forty-four percent (12/27) of patients were dissatisfied with penile length. Patients were 'satisfied' or 'very satisfied' with meatal position and shape despite HOSE for meatal position being 11% (4/38) distal, 76% (29/38) proximal glanular and 13% (5/38) coronal. TIP patients had more curvature at puberty than Duckett (p = 0.0062). Patients that had a decurvature procedure had shorter penile length (p = 0.019). DISCUSSION A high complication rate is previously described, predominantly within the first years. Our study shows 50% of reoperations were performed after >3 years, illustrating the need for long-term follow-up. Patient satisfaction with a deviant meatal position is rarely reported [1,2]. Our results support a conservative approach to an asymptomatic retracted meatus. Limitations of this descriptive study are the non-comparable groups and the retrospective data for correlation, impeding evaluation of prognostic outcome-factors. The shorter penile length found in patients after plication, and increased curvature after TIP, is therefore merely descriptive. However, the findings are in line with earlier publications suggesting limited use of TIP, and plication (recommending ventral lengthening instead) to avoid penile shortening and curvature in these cases [3-5]. CONCLUSIONS The urological long-term outcome after proximal hypospadias repair is good, although late reoperations are common. In adolescence, patients were dissatisfied with the short penile length but satisfied with meatal position, indicating that in proximal hypospadias, preserving penile length and correcting curvature are prioritized over a distal meatus.
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Affiliation(s)
- Marie Andersson
- Sahlgrenska Academy, Women's and Children's Health, Gothenburg, Sweden; The Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia's Children's Hospital, Gothenburg, Sweden.
| | - Sofia Sjöström
- Sahlgrenska Academy, Women's and Children's Health, Gothenburg, Sweden; The Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia's Children's Hospital, Gothenburg, Sweden.
| | - Monika Doroszkiewicz
- The Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia's Children's Hospital, Gothenburg, Sweden.
| | - Lisa Örtqvist
- Department of Women's and Children's Health and Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
| | - Kate Abrahamsson
- Sahlgrenska Academy, Women's and Children's Health, Gothenburg, Sweden; The Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia's Children's Hospital, Gothenburg, Sweden.
| | - Ulla Sillén
- Sahlgrenska Academy, Women's and Children's Health, Gothenburg, Sweden; The Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia's Children's Hospital, Gothenburg, Sweden.
| | - Gundela Holmdahl
- Sahlgrenska Academy, Women's and Children's Health, Gothenburg, Sweden; The Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia's Children's Hospital, Gothenburg, Sweden.
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Shirazi M, Mohammadi AA, Shamohammadi I, Mahboubi A, Makarem A. Efficacy Of Silicone Gel In Reducing Scar Formation After Hypospadias Repair: A Randomized Placebo-Controlled Trial. Res Rep Urol 2019; 11:291-298. [PMID: 31819863 PMCID: PMC6848987 DOI: 10.2147/rru.s224660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 10/22/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hypospadias is one of the most common congenital disorders of the urogenital system that is repaired by surgical method. Literature review shows that silicone gel is effective in preventing and improving hypertrophic scars after surgery. Thus, we conducted this study to evaluate the effect of silicone gel on scar reduction after surgical repair of hypospadias. MATERIALS AND METHODS In this randomized double-blind clinical trial, 64 patients who had undergone surgical repair of hypospadias were divided into two groups: 32 patients in the intervention group (silicone gel) and 32 in the control group (placebo). Then, the patients in the silicone gel treatment group were treated twice per day for two months on the site of surgical wound, and the patients in the control group were treated with Vaseline twice per day for two months on the site of surgical wound, too. Scar characteristics (pigmentation, vascularity, pliability, and height) were recorded based on Vancouver's scars scale. Finally, the results of the two treatments on reduction of scars after surgical repair were compared between the two groups. Data were analyzed using SPSS-24. RESULTS There were significant differences between the two groups in scar characteristics after surgical repair of hypospadias, such as vascularity, pliability, and height (P˂0.05); however, there was no significant difference in pigmentation (P>0.05). CONCLUSION The results of this study showed that silicone gel had considerable effects on reduction of scars after surgical repair of hypospadias. However, further studies with larger sample size are recommended to confirm our conclusion.
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Affiliation(s)
- Mehdi Shirazi
- Department of Urology, Shiraz University of Medical Science, Shiraz, Iran
| | - Ali Akbar Mohammadi
- Burn & Wound Healing Research Center, Division of Plastic & Reconstruction Surgery, Department of Surgery, Shiraz University of Medical Science, Shiraz, Iran
| | - Iman Shamohammadi
- Resident of Urology, Shiraz University of Medical Science, Shiraz, Iran
| | - Amirhassan Mahboubi
- Professor of Urology, Fellowship in Pediatric Urology, Department of Urology, Tehran Children’s Hospital, Tehran, Iran
| | - Alireza Makarem
- Resident of Urology, Shiraz University of Medical Science, Shiraz, Iran
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Örtqvist L, Engberg H, Strandqvist A, Nordenström A, Holmdahl G, Nordenskjöld A, Frisén L. Psychiatric symptoms in men with hypospadias - preliminary results of a cross-sectional cohort study. Acta Paediatr 2019; 108:1156-1162. [PMID: 30466142 DOI: 10.1111/apa.14658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 07/12/2018] [Accepted: 11/19/2018] [Indexed: 11/30/2022]
Abstract
AIM Population studies have shown an increased risk of neurodevelopmental disorders in males born with the congenital condition hypospadias, where the opening of the urethra is on the underside of the penis. We investigated overall psychiatric morbidity in cases and matched controls. METHODS This study compared 167 men born with hypospadias from 1959 to 1994 in Stockholm or Gothenburg in Sweden using hospital registers. They were compared with controls from the Swedish population registry, who were contacted by regular mail and students who were recruited by local advertisements. The total sample had a mean age of 33.5 years (range: 19-54). They completed self-rating scales for depressive, anxiety and obsessive-compulsive symptoms and symptoms of attention deficit hyperactivity disorder. In addition, 33 cases and 47 controls underwent psychiatric morbidity interviews that covered the 17 most common psychiatric diagnoses. RESULTS A fifth (21%) of both the cases and controls reported current or previous psychiatric symptoms. There were no significant differences in self-rated depression, anxiety or obsessive-compulsive disorder symptoms between the patients and controls or between the different phenotype groups. The distribution was not significantly affected by the severity of hypospadias. CONCLUSION Psychiatric morbidity was no higher in men with hypospadias than population-based controls.
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Affiliation(s)
- Lisa Örtqvist
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
- Department of Paediatric Surgery Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
| | - Hedvig Engberg
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| | - Anna Strandqvist
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Anna Nordenström
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
- Department of Pediatric Endocrinology Astrid Lindgren Children's Hospital, Karolinska Stockholm Sweden
| | - Gundela Holmdahl
- Women's and Children's Health University Hospital Sahlgrenska Academy Gothenburg Sweden
- Department of Pediatric Surgery Queen Silvia's Children's Hospital Gothenburg Sweden
| | - Agneta Nordenskjöld
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
- Department of Paediatric Surgery Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
| | - Louise Frisén
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
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14
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Voiding patterns of adult patients who underwent hypospadias repair in childhood. J Pediatr Urol 2017; 13:78.e1-78.e5. [PMID: 27887915 DOI: 10.1016/j.jpurol.2016.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 08/01/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aimed at evaluating the voiding patterns of adult patients who underwent hypospadias repair in childhood. METHOD Following IRB approval 103 (22.7%) of 449 adult patients who underwent hypospadias repair between 1978 and 1993 responded to the following questionnaires: International Prostate Symptom Score (I-PSS) and Short Form 12 questionnaire (SF-12). Uroflowmetry (UF) was performed for all patients. The patients were divided into three groups according to the primary meatus localization. Group I had 63 patients (61.5%) treated for glanular hypospadias, group II had 19 patients (18.4%) treated for distal hypospadias, and group III comprised the remaining 21 patients (20.4%) treated for proximal hypospadias. RESULTS The mean ± SD I-PSS score for all patients who responded to the questionnaire was 2.3 ± 2.4, and UF was 21.1 ± 4.3 mL/s. The patients from groups I and III had fewer urinary symptoms compared with those of the group II: 1.3 ± 1.5, 5.5 ± 2.4, and 1.6 ± 1.4, respectively (p < 0.0001). With regards to UF, the patients from the groups I and III did better compared with those from the group II: 22.1 ± 4.1 mL/s, 18.91 ± 4.2 mL/s, and 20.11 ± 3.42 mL/s, respectively (p = 0.021) (Figure). The UF was better in patients with normal vs. abnormal IPSS (p = 0.0064). The physical component summary was 49.8 ± 10.3, 51.1 ± 3.6, and 46.4 ± 0.3 in groups I, II, and III, respectively. The mental summary component was 42.64 ± 4.1, 42.2 ± 2.4, and 39.89 ± 2.9 in groups I, II, and III, respectively. CONCLUSIONS Most of the adult patients who underwent hypospadias repair in childhood had normal or mild voiding disturbance, with no effects on their physical or mental status.
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15
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Hypospadias reconstruction: 11-year follow-up study of outcomes and patient satisfaction. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-016-1231-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Ardelt PU, Cederqvist M, Barth M, Frankenschmidt A. The SIGHT questionnaire: A novel assessment tool for Satisfaction In Genital Hypospadias Treatment. J Pediatr Urol 2017; 13:33.e1-33.e8. [PMID: 27889217 DOI: 10.1016/j.jpurol.2016.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 10/04/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE Psychosexual development is currently underrepresented in hypospadias outcome research. The aim of this study was to develop and validate a questionnaire addressing psychosexual long-term satisfaction, specifically of adolescent patients, after hypospadias repair. MATERIALS AND METHODS In a multistep participative design we identified key interests of adolescent patients with hypospadias. Next, a questionnaire addressing specifically the psychosexual satisfaction of adolescents after hypospadias repair was established. A population of 109 former patients with hypospadias was then assessed using this questionnaire. Furthermore, functional and cosmetic aspects, behavioural anomalies, and sexual activity were investigated. Age-matched patients undergoing circumcision served as control patients. Possible influence factors on patient satisfaction were investigated. Clinical trial registry site: German Registry of Clinical Trials DRKS, Freiburg, Germany (Reference: DRKS00003432). RESULTS Key interests of adolescent patients were "normal appearance of the penis", "normal function of the penis regarding voiding and sexual activity", "no limitations regarding cosmetic appearance to others", "no limitations to sexual activity", and an "unimpaired masculine identity". The "Satisfaction In Genital Hypospadias Treatment" (SIGHT) questionnaire was developed using these items and using previously published evaluation systems. Nine questions address psychosexual aspects and two additional questions address current sexual activity. Internal consistency was high and retest reliability acceptable. The patient population showed a normal strength and difficulties score (SDQ). Overall satisfaction was high and similar to that of the control group. In a Spearman correlation a high SDQ value, erectile problems, and complications correlated negatively with satisfaction. CONCLUSION To date, few studies have examined patients' satisfaction and psychosexuality. To our knowledge, the SIGHT questionnaire is the first to be developed participatively and in a stepwise fashion in collaboration with a paediatric psychologist and an open approach to determine items specifically important for adolescents. The SIGHT questionnaire can thus offer a relevant assessment of patients' psychosexual satisfaction. It is most suitable to supplement current strategies that so far mostly neglect the impact on psychosexual wellbeing.
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Affiliation(s)
- Peter U Ardelt
- Department of Urology, University Hospital Basel, Switzerland.
| | - Marco Cederqvist
- Department of Urology and Paediatric Urology, Medical School, Albert-Ludwigs-University of Freiburg, Germany
| | - Michael Barth
- Department of Paediatric Psychology, Medical School, Albert-Ludwigs-University of Freiburg, Germany
| | - Alexander Frankenschmidt
- Department of Urology and Paediatric Urology, Medical School, Albert-Ludwigs-University of Freiburg, Germany
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Nozohoor Ekmark A, Arnbjörnsson E, Svensson H, Hansson E. Patient-reported long-term outcome after primary hypospadias repair. J Plast Surg Hand Surg 2016; 51:172-177. [PMID: 27687614 DOI: 10.1080/2000656x.2016.1212713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Long-term evaluation of the surgical outcome after puberty, particularly patient reported outcome is rare in the literature. The aims of this study were to investigation the patients' satisfaction with the long-term results and their views and memories of their childhood surgery and follow-up. METHODS A modified version of previously used questionnaire was sent to 134 patients ages 18 years or older previously primarily repaired due to hypospadias by one of the authors (HS) between 1989 -2009. RESULTS Thirty-nine patients responded. Eighty-two per cent were satisfied with the appearance of their penis, 87% were satisfied with their ability to urinate and their sexual function and 92% were satisfied with the overall surgical results. Ninety per cent of patients were positive to the current duration of our post-pubertal follow-up program or would have preferred an even longer follow-up. CONCLUSIONS The majority of patients were satisfied with the long-term surgical results and the duration of follow-up. Despite having problems patients does not always contact the health care system spontaneously, which warrants long-term follow-up.
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Affiliation(s)
- Ann Nozohoor Ekmark
- a Department of Clinical Sciences in Malmö , Lund University , Lund , Sweden.,b Department of Paediatric Surgery , Skåne University Hospital , Lund , Sweden
| | - Einar Arnbjörnsson
- b Department of Paediatric Surgery , Skåne University Hospital , Lund , Sweden.,c Department of Clinical Sciences Lund , Lund University , Lund , Sweden
| | - Henry Svensson
- a Department of Clinical Sciences in Malmö , Lund University , Lund , Sweden.,d Department of Plastic and Reconstructive Surgery , Skåne University Hospital , Lund , Sweden
| | - Emma Hansson
- a Department of Clinical Sciences in Malmö , Lund University , Lund , Sweden.,d Department of Plastic and Reconstructive Surgery , Skåne University Hospital , Lund , Sweden
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18
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Higuchi T, Holmdahl G, Kaefer M, Koyle M, Wood H, Woodhouse C, Wood D. International Consultation on Urological Diseases: Congenital Anomalies of the Genitalia in Adolescence. Urology 2016; 94:288-310. [DOI: 10.1016/j.urology.2016.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Adams J, Bracka A. Reconstructive surgery for hypospadias: A systematic review of long-term patient satisfaction with cosmetic outcomes. Indian J Urol 2016; 32:93-102. [PMID: 27127350 PMCID: PMC4831515 DOI: 10.4103/0970-1591.179178] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Research on long-term results of hypospadias has focused on surgical techniques and functional outcomes, and it is only recently that patient satisfaction with appearance and psychosocial outcomes have been considered. The aim of this study was to provide an evidence-based systematic review of adolescent and adult patient perceptions of cosmetic outcomes following childhood surgery for hypospadias. METHODS A systematic review was performed in accordance with the PRISMA and PICO guidelines, and studies assessed using the Oxford Centre for Evidence-Based Medicine system. MEDLINE, PsycInfo, EMBASE, and CINAHL databases were searched from 1974 to 2014 for clinical studies containing patient perceptions of appearance, deformity, and social embarrassment following hypospadias surgery. RESULTS A total of 495 publications were retrieved, of which 28 met the inclusion criteria. Due to study design/outcome measure, heterogeneity data were synthesized narratively. Results indicate (i) patient perceptions of penile size do not differ greatly from the norm; (ii) perceptions of appearance findings are inconsistent, partially due to improving surgical techniques; (iii) patients who are approaching, or have reached, sexual maturity hold more negative perceptions and are more critical about the cosmetic outcomes of surgery than their prepubertal counterparts; (iv) patients report high levels of perceptions of deformity and social embarrassment; and (v) there is a lack of data using validated measurement tools assessing long-term patient perceptions of cosmetic outcomes, particularly with patients who have reached genital maturity. CONCLUSIONS Protocols for clinical postpuberty follow-up and methodologically sound studies, using validated assessment tools, are required for the accurate assessment of cosmetic and psychological outcomes of hypospadias surgery.
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Affiliation(s)
- Julie Adams
- Department of Applied Health, Faculty of Health, Edge Hill University, Ormskirk, Lancashire, UK
| | - Aivar Bracka
- Formerly at the Dudley Group of Hospitals, West Midlands, UK
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Bracka A, Papeš D. Re: Tunneled Buccal Mucosa Tube Grafts for Repair of Proximal Hypospadias: R. Fine, E. F. Reda, P. Zelkovic, J. Gitlin, J. Freyle, I. Franco and L. S. Palmer J Urol, suppl., 2015;193:1813-1817. J Urol 2015; 195:226-7. [PMID: 26432936 DOI: 10.1016/j.juro.2015.07.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | - Dino Papeš
- Department of Surgery, Clinical Hospital Center Zagreb, Zagreb, Croatia.
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21
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Two-Stage Repair for Severe Proximal Hypospadias Using Oral Mucosal Grafts: Combination of a Modified Bracka Method and a Modified Byars Flap Method: Should Local Flaps be Used for Urethral Reconstruction in Hypospadias Repair? Ann Plast Surg 2015. [PMID: 26207540 DOI: 10.1097/sap.0000000000000569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Long-term followup of men born with hypospadias: urological and cosmetic results. J Urol 2014; 193:975-81. [PMID: 25268894 DOI: 10.1016/j.juro.2014.09.103] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2014] [Indexed: 11/21/2022]
Abstract
PURPOSE We present data on long-term functional and cosmetic results after hypospadias surgery. MATERIALS AND METHODS Males older than 18 years with hypospadias treated in Sweden were asked to participate in the study, as well as age matched controls and circumcised men. All participants answered questionnaires, and a subgroup was examined during an outpatient visit. Relationships with outcome were analyzed using analysis of variance and regression analysis. RESULTS A total of 167 patients with a mean age of 34 years and 169 controls with a mean age of 33 years answered the questionnaire. Of the patients 63% had distal, 24% mid and 13% proximal hypospadias. A total of 46 patients and 49 controls presented for physical examination. Patients were significantly less satisfied with the penile cosmetic outcome regarding all parameters of the Penile Perception Score. There was a difference in penile length between patients and controls (mean 9.7 vs 11.6 cm, p <0.001). More patients than controls reported voiding dysfunction symptoms (p = 0.003). Patients had a lower maximum urinary flow rate than controls (p = 0.001). These differences were most prominent between patients with proximal hypospadias and controls. CONCLUSIONS Men operated on for hypospadias were less satisfied with the cosmetic result than controls, and had a shorter penile length. Patients presented with more symptoms of voiding dysfunction and displayed a lower maximum urinary flow rate. Patients with proximal hypospadias were more affected than those with milder hypospadias. Our results indicate that patients with hypospadias can be subgrouped and that those with severe phenotypes should be followed more closely during childhood as well as later in adulthood.
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Papeš D, Bracka A. Re: Yang et al.: Two-stage repair with long channel technique for primary severe hypospadias (Urology 2014;84:198-201). Urology 2014; 84:985-6. [PMID: 25260459 DOI: 10.1016/j.urology.2014.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 06/18/2014] [Accepted: 06/20/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Dino Papeš
- Department of Surgery, Clinical Hospital Center Zagreb, Zagreb, Croatia
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Metzler IS, Nguyen HT, Hagander L, Jalloh M, Nguyen T, Gueye SM, deVries CR, Meara JG. Surgical Outcomes and Cultural Perceptions in International Hypospadias Care. J Urol 2014; 192:524-9. [DOI: 10.1016/j.juro.2014.01.101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Ian S. Metzler
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
- Department of Plastic and Oral Surgery, Children's Hospital Boston, Boston, Massachusetts
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Hiep T. Nguyen
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts
- IVUmed, Salt Lake City, Utah
| | - Lars Hagander
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
- Department of Plastic and Oral Surgery, Children's Hospital Boston, Boston, Massachusetts
- Pediatric Surgery and International Pediatrics, Department of Clinical Sciences, Lund Faculty of Medicine, Lund University, Lund, Sweden
| | | | | | | | - Catherine R. deVries
- IVUmed, Salt Lake City, Utah
- Department of Urology, Primary Children's Medical Center, Salt Lake City, Utah
| | - John G. Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
- Department of Plastic and Oral Surgery, Children's Hospital Boston, Boston, Massachusetts
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Soave A, Riechardt S, Engel O, Rink M, Fisch M. Komplikationen bei Hypospadiekorrekturen. Urologe A 2014; 53:1001-5. [DOI: 10.1007/s00120-014-3498-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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26
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Ratan SK, Aggarwal SK, Mishra TK, Saxena A, Yadav S, Pandey RM, Sharma A, Dhanwal D. Hormonal profile in children with isolated hypospadias associates better with comprehensive score of local anatomical factors as compared to meatal location or degree of chordee. Indian J Endocrinol Metab 2014; 18:558-564. [PMID: 25143917 PMCID: PMC4138916 DOI: 10.4103/2230-8210.137519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND To evaluate if hormonal profile of children with isolated hypospadias (IH) associates better with comprehensive local anatomical factor score (LAFS) than with clinically adjudged urethral meatus location or severity of chordee/k.j. MATERIAL AND METHODS Ninety-nine children with IH were enrolled, as per inclusion criteria. Meatal location was recorded at first clinical examination in OPD; while LAFS was computed per-operatively using indigenously devised scale, except for neonates. Hypospadiacs were first classified into three standard meatal based groups and subsequently into LAFS based two groups (≤19, >19). For all participants, pre HCG and post HCG (96 hour post- injection) estimation of serum gonadotropins, DHEA-S, estrogen (E), progesterone (P), testosterone (T) and Dihydrotestosterone (DHT) was done. Statistical tests were applied to assess significance of hormonal levels with respect to meatal location, chordee and LAFS. RESULTS Only FSH levels differed significantly among meatal based groups; while among LAFS groups, multiple hormonal differences were noted; with poor LAFS associated significantly with higher FSH, LH and lower E, T/DHT. Children with severe degree of chordee had poorer T output and a significantly lower LAFS as compared to those with moderate/mild chordee. CONCLUSION Serotoli cell dysfunction, indirectly indicated by high FSH was found among midpenile hypospadiacs and those with poorer LAFS. Since groups based on LAFS revealed multiple intergroup hormonal differences than what was seen for meatal/chordee based groups; LAFS should be considered a better guide for prognostication and for deciding about hormonal supplementation. Lower androgenic output was particularly noted in children with severe chordee.
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Affiliation(s)
- Simmi K. Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Satish K. Aggarwal
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Tarun Kumar Mishra
- Department of Biochemistry, Maulana Azad Medical College, New Delhi, India
| | - Alpna Saxena
- Department of Biochemistry, Maulana Azad Medical College, New Delhi, India
| | - Sangeeta Yadav
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - Ravindra M. Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Anju Sharma
- Department of Biochemistry, Maulana Azad Medical College, New Delhi, India
| | - Dinesh Dhanwal
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
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Khan M, Majeed A, Hayat W, Ullah H, Naz S, Shah SA, Tahmeed T, Yousaf K, Tahir M. Hypospadias repair: a single centre experience. PLASTIC SURGERY INTERNATIONAL 2014; 2014:453039. [PMID: 24579043 PMCID: PMC3918360 DOI: 10.1155/2014/453039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/06/2013] [Accepted: 11/04/2013] [Indexed: 11/20/2022]
Abstract
Objectives. To determine the demographics and analyze the management and factors influencing the postoperative complications of hypospadias repair. Settings. Hayatabad Medical Complex Peshawar, Pakistan, from January 2007 to December 2011. Material and Methods. All male patients presenting with hypospadias irrespective of their ages were included in the study. The data were acquired from the hospital's database and analyzed with Statistical Package for Social Sciences (SPSS). Results. A total of 428 patients with mean age of 8.12 ± 5.04 SD presented for hypospadias repair. Midpenile hypospadias were the most common. Chordee, meatal abnormalities, cryptorchidism, and inguinal hernias were observed in 74.3%, 9.6%, 2.8%, and 2.1% cases, respectively. Two-stage (Bracka) and TIP (tubularized incised urethral plate) repairs were performed in 76.2% and 20.8% of cases, respectively. The most common complications were edema and urethrocutaneous fistula (UCF). The complications were significantly lower in the hands of specialists than residents (P-value = 0.0086). The two-stage hypospadias repair resulted in higher complications frequency than single-stage repair (P value = 0.0001). Conclusion. Hypospadias surgery has a long learning curve because it requires a great deal of temperament, surgical skill and acquaintance with magnifications. Single-stage repair should be encouraged wherever applicable due to its lower postoperative complications.
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Affiliation(s)
- Mansoor Khan
- Plastic & Reconstructive Surgery, Hayatabad Medical Complex, IV Hayatabad, P.O. Box 25100, Peshawar, Pakistan
| | - Abdul Majeed
- Plastic & Reconstructive Surgery, Hayatabad Medical Complex, IV Hayatabad, P.O. Box 25100, Peshawar, Pakistan
| | - Waqas Hayat
- Plastic & Reconstructive Surgery, Hayatabad Medical Complex, IV Hayatabad, P.O. Box 25100, Peshawar, Pakistan
| | - Hidayat Ullah
- Plastic & Reconstructive Surgery, Hayatabad Medical Complex, IV Hayatabad, P.O. Box 25100, Peshawar, Pakistan
| | - Shazia Naz
- Plastic & Reconstructive Surgery, Hayatabad Medical Complex, IV Hayatabad, P.O. Box 25100, Peshawar, Pakistan
| | - Syed Asif Shah
- Plastic & Reconstructive Surgery, Hayatabad Medical Complex, IV Hayatabad, P.O. Box 25100, Peshawar, Pakistan
| | - Tahmeedullah Tahmeed
- Plastic & Reconstructive Surgery, Hayatabad Medical Complex, IV Hayatabad, P.O. Box 25100, Peshawar, Pakistan
| | - Kanwal Yousaf
- Plastic & Reconstructive Surgery, Hayatabad Medical Complex, IV Hayatabad, P.O. Box 25100, Peshawar, Pakistan
| | - Muhammad Tahir
- Plastic & Reconstructive Surgery, Hayatabad Medical Complex, IV Hayatabad, P.O. Box 25100, Peshawar, Pakistan
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Abstract
Hypospadias, epispadias with or without exstrophy, and disorders of sex development are among the most common anomalies of genitalia that occur during childhood. Considering the tremendous effect of genitourinary reconstruction on adult life, the evaluation of the long-term results of different techniques of genitoplasty in pediatrics is of the utmost importance. After reviewing the literature, the authors summarize the available long-term outcomes of genitoplasty in childhood, specifically focusing on the cosmetic, psychosocial, psychosexual and functional results, and emphasize that, contrary to the widely available data on early outcomes of genital reconstruction in the pediatric population, very few well described controlled studies have evaluated the long-term effect of genitoplasty in puberty and adulthood, in the sense that the surgeon should describe the peroperative findings in more detail and also be more structured in evaluating the postoperative result at follow-up visits. Finally, the authors conclude that more attention should be paid to the impact of these techniques on cosmetic aspects and psychosexual development in these patients after puberty, as they play a crucial role in their adult quality of life.
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Chertin B, Natsheh A, Ben-Zion I, Prat D, Kocherov S, Farkas A, Shenfeld OZ. Objective and subjective sexual outcomes in adult patients after hypospadias repair performed in childhood. J Urol 2013; 190:1556-60. [PMID: 23306088 DOI: 10.1016/j.juro.2012.12.104] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE We evaluated sexual function and psychosexual adjustment in adults who underwent hypospadias repair in childhood. MATERIALS AND METHODS After receiving institutional review board approval, 119 of 449 adult patients (26.6%) who underwent hypospadias repair between 1978 and 1993 responded to questionnaires on penile appearance and sexual life. Patients were divided into 3 groups according to primary meatal location in childhood, including group 1-45 (37.8%) with glanular hypospadias, group 2-56 (48.2%) with distal hypospadias and group 3-18 (14%) with proximal hypospadias. RESULTS All group 1 and 2 patients, and 11% in group 3 were satisfied with the penile appearance. Of group 1 patients 8.9% reported mild erectile dysfunction, as did 50% and 72.2% in groups 2 and 3, respectively. A total of 99 patients (83.2%) complained of premature ejaculation. All group 1 and 2 patients reported excellent self-esteem and relationship on the Self-Esteem and Relationship questionnaire. Most group 3 patients were satisfied with their relationship and only 1 (5.6%) was not satisfied. Two-thirds of the patients in groups 1 and 2 reported that sexual quality of life was excellent and the others described it as good. In group 3 sexual quality of life was somewhat decreased in all patients and 1 (5.6%) had poor sexual quality of life. Physical and mental component summaries were satisfactory in all patients reviewed. CONCLUSIONS Our data show that the high incidence of mild erectile dysfunction and premature ejaculation should not be disregarded and requires appropriate counseling before surgery.
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Affiliation(s)
- Boris Chertin
- Departments of Pediatric Urology and Urology, Shaare Zedek Medical Center, Jerusalem and Leumit National Health Services, Tel Aviv, Israel.
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Deibert CM, Hensle TW. The psychosexual aspects of hypospadias repair: A review. Arab J Urol 2011; 9:279-82. [PMID: 26579312 PMCID: PMC4150566 DOI: 10.1016/j.aju.2011.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 10/16/2011] [Accepted: 10/16/2011] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To review the psychosexual effects on men after hypospadias repair. METHODS We reviewed all English-language publications in the MEDLINE database from the US National Library of Medicine with the search terms 'hypospadias adult', 'psychosexual hypospadias', 'psychosocial hypospadias', and 'social hypospadias'. Each term returned 1036, 35, 19 and 68 results, respectively, which were reviewed. RESULTS While improvements in surgical techniques have improved function, the abnormality and repair still causes a disruption in perceived quality of life for many men. After repair, many men suffer from a negative view of their genitals and some degree of sexual inhibition. However, they still maintain a satisfactory sex life. CONCLUSIONS Psychosexual effects of hypospadias repair they endure in adulthood, although affected men maintain satisfaction with their sexual life.
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Affiliation(s)
- Christopher M Deibert
- Columbia University, College of Physicians and Surgeons, 161 Fort Washington Ave, 11th Floor, New York, NY 10032, USA
| | - Terry W Hensle
- Columbia University, College of Physicians and Surgeons, Teaneck, NJ, USA
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31
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Functional, cosmetic and psychosexual results in adult men who underwent hypospadias correction in childhood. J Pediatr Urol 2011; 7:504-15. [PMID: 21429804 DOI: 10.1016/j.jpurol.2011.02.008] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 02/12/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Long-term results of hypospadias repair are scarce. Previous reviews mostly described mid-term results making extrapolation to long-term results difficult. This systematic review on long-term results in postpubertal men after hypospadias repair in childhood, aims to inform urologists and parents of a newborn boy with hypospadias about future expectations. METHODS AND MATERIALS The Pubmed/Medline and Embase databases were searched until February 2010. Inclusion criteria stated that patients with hypospadias were operated before the age of 6 years and were older than 14 years at follow up. Results were pooled and analyzed using SPSS 16.0. Data on proximal hypospadias patients and controls are described separately. RESULTS Twenty eligible studies investigating micturition, cosmesis and psychosexual functioning were found. Hypospadias patients report more urinary symptoms and have a lower Qmax than controls. Patients are less satisfied with penile appearance compared to controls. Objectively assessed cosmetic results are good. Sexually, patients are as active as controls, but are less satisfied. Patients less often have an intimate relationships compared to controls. CONCLUSION Study outcomes were heterogeneous due to operation techniques and a lack of validated questionnaires and control groups. Long-term results of hypospadias patients should be measured in a prospective design using validated measurement tools.
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Lambert SM, Snyder HM, Canning DA. The History of Hypospadias and Hypospadias Repairs. Urology 2011; 77:1277-83. [DOI: 10.1016/j.urology.2010.10.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 09/18/2010] [Accepted: 09/18/2011] [Indexed: 11/30/2022]
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Kiss A, Sulya B, Szász AM, Romics I, Kelemen Z, Tóth J, Merksz M, Kemény S, Nyírády P. Long-Term Psychological and Sexual Outcomes of Severe Penile Hypospadias Repair. J Sex Med 2011; 8:1529-39. [DOI: 10.1111/j.1743-6109.2010.02120.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Akhavan A, Stock JA. Long-term follow-up and late complications following treatment of pediatric urologic disorders. Med Clin North Am 2011; 95:15-25. [PMID: 21095408 DOI: 10.1016/j.mcna.2010.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Many pediatric urologic disorders have sequelae that may affect patients well into adulthood. Despite adequate treatment, many patients are at risk for progressive urologic deterioration years after surgical reconstruction. While many pediatric urologists follow their patients years after surgery, screening for late complications is a shared responsibility with primary care providers. This article discusses potential late complications and appropriate follow-up for patients who have a history of ureteral reimplantation, pyeloplasty, hypospadias repair, posterior urethral valve ablation, and intestinal interposition.
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Affiliation(s)
- Ardavan Akhavan
- Department of Urology, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA
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35
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Aulagne MB, Harper L, de Napoli-Cocci S, Bondonny JM, Dobremez E. Long-term outcome of severe hypospadias. J Pediatr Urol 2010; 6:469-72. [PMID: 20053585 DOI: 10.1016/j.jpurol.2009.12.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 12/14/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate, from the patient's point of view, long-term urinary and sexual outcome of surgery for severe hypospadias. PATIENTS AND METHOD Patients treated for severe posterior hypospadias during childhood and now aged 20-35 years were included. Outcome was evaluated using the Hypospadias Objective Scoring Evaluation and our own quality of life questionnaire. RESULTS Of 48 patients, 13 were lost to follow up. The questionnaire was thus sent to 35 patients of whom 27 agreed to answer (77% response rate). Fifteen presented proximal and 12 scrotal hypospadias. Average age at surgery was 3.3 years and the children underwent an average of 3.7 procedures. There were 40% early complications, and 59% late complications, including 33% fistulae and 26% stenosis. At present, 70% of patients have an apical meatus, 82% have a straight penis, 37% present difficulty initiating voiding, and one patient has a persistent fistula; 74% say their penis looks abnormal, either because of the absence of foreskin, penis size or scarring. Sexual and global satisfaction rates, determined using a visual analogue scale, are respectively 68% and 63%. Satisfaction is statistically correlated to the presence of early complications or stenosis, but not fistula. It decreases if the patient thinks his penis is not normal, even if the anatomical result is good. CONCLUSION Urinary and sexual outcome is good for most patients though the results are variable. Satisfaction seems more affected by subjective feelings than the anatomical result.
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Affiliation(s)
- M B Aulagne
- Department of Pediatric Surgery, Centre Hospitalier Universitaire Pellegrin-Enfants, Bordeaux, France
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36
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Jiao C, Wu R, Xu X, Yu Q. Long-term outcome of penile appearance and sexual function after hypospadias repairs: situation and relation. Int Urol Nephrol 2010; 43:47-54. [PMID: 20556511 DOI: 10.1007/s11255-010-9775-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 05/18/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to assess the long-term cosmetic and sexual outcomes of hypospadias surgery performed in childhood and to analyze the relation between them. METHODS A long-term follow-up was made to 174 patients who were operated for hypospadias in this institute between 1984 and 1992. Their records were analyzed retrospectively, and a detailed questionnaire was mailed to them. Responses from returned questionnaires were pooled and analyzed. RESULTS Forty-three (24.7%) of 174 patients finished the questionnaire. The mean patient age of the 43 patients was 21.6 years. Twenty-three (53.5%) of 43 patients were dissatisfied with penile appearance. The main reason for dissatisfaction was smaller penile size and curvature. Thirty-six (83.7%) of 43 patients were satisfied with overall sexual function. Of these 43 patients, 76.7% reported good quality of erection, but 23.3% reported the existence of problems during erection. The main complaint was smaller penile size and curvature. There were 17 patients (39.5%) with ejaculation problems, mainly including impotent ejaculation. Sixteen (88.9%) of the 18 patients who had experienced sexual intercourse reported no problems during intercourse. Depending on the severity of hypospadias, these patients with proximal hypospadias were more dissatisfied with penile appearance than those with distal hypospadias (76.5 vs. 38.5%, P < 0.025). And they complained more problems during erection (41.2 vs. 11.5%, P < 0.05), ejaculation (100 vs. 0%), and sexual intercourse (50 vs. 0%, P < 0.05), and were less likely to experience sexual intercourse (23.5 vs. 53.8%, P < 0.05), compared to those with distal hypospadias. Depending on their self-evaluation on penile appearance, these patients who were satisfied with penile appearance had less problems in achieving erection (5.0 vs. 39.1%, P < 0.025) and ejaculation (20 vs. 56.5%, P < 0.025) and were more likely to experience sexual intercourse (60 vs. 26.1%, P < 0.05), compared to those who were dissatisfied. The self-rated satisfaction scale correlates positively with the penile appearance and sexual function (r = 0.469, P < 0.01). CONCLUSIONS Patients who had been operated for hypospadias have a significantly careful concern on penile appearance. Penile size can obviously impact satisfaction with penile appearance and sexual function. Some patients have erection, ejaculation, and intercourse problems in adulthood, but majority have a rather normal sexual function. The more severe the hypospadias, the more dissatisfactory the long-term outcome. Better cosmetic outcome is related to better sexual outcome. Although remaining challenging, it is necessary to follow up hypospadias patients after surgeries into adulthood.
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Affiliation(s)
- Chenwei Jiao
- Department of Pediatric Surgery, Provincial Hospital Affiliated to Shandong University, 250021, Jinan, Shandong, People's Republic of China
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Abstract
PURPOSE To review the evolution of the technique of hypospadias repair. METHODS A search of Pubmed, Medline and the Journal of Pediatric Urology was performed, and papers dealing with surgical techniques for hypospadias repair were critally reviewed. Special emphasis was given to papers on the effects in the long term of hypospadias repair on voiding and sexual dysfunction. RESULTS The techniques for hypospadias repair have evolved over the years. The most popular technique now is tubularized incised plate urethroplasty. Long-term results with the use of the new techniques of the hypospadias repair in terms of voiding and sexual problems should be addressed. CONCLUSION There is a need for valid studies on the outcomes of hypospadias repair in adults that were performed in childhood in terms of cosmetic appearance, voiding and sexual performance.
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Affiliation(s)
- Boris Chertin
- Division of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
| | - Dan Prat
- Division of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
| | - Ofer Z Shenfeld
- Department of Urology, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
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Lorenzo AJ. The "perfect" hypospadias repair: Are we there yet? Can Urol Assoc J 2008; 2:115-116. [PMID: 18542744 PMCID: PMC2422907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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