[One-stage urethroplasty with the modified OUPF IV for proximal hypospadias]

Results of the one-stage proximal hypospadias repair with modified Koyanagi technique: A prospective cohort study in a single Vietnam centre

Introduction

Proximal hypospadias is the most severe type of hypospadias. Our approach to Koyanagi technique for proximal hypospadias aims to improve the blood supply to the neourethral flaps and reduce meatal complications.

Methods

Our prospective study included 75 patients who were operated for proximal hypospadias by our Koyanagi technique at Viet Duc hospital between January 2019 and December 2020. The clinical information obtained included a detailed medical history; preoperative, intraoperative, and postoperative data; short-term outcomes by the HOSE score were evaluated by a different physician.

Results

The mean (range) age was 3.59 ± 2.41 years (1.5–14), 86.7% under 5 years old. There are 31 penoscrotal, 31 scrotal, and 13 perineal hypospadias. The length of the neourethra ranged from 3.5 to 8 cm, mean 5.02 ± 0.88 cm. Evaluation of the surgeon at 6 months after surgery: primary success 81.3%. Complications occurred in 14 cases (18.7%), included 10 urethrocutaneous fistula and 4 dehiscence of the urethra. No cases of meatal stenosis or recession, urethral stricture, urethral diverticula. The mean HOSE score was found to be 14.47 ± 1.35, ranged 11 to 16. 57 patients (76%) had a total HOSE 14 and above and 18 patients had score below 14 (24%)

Conclusion

Our modified Koyanagi technique give us a good result for one-stage reconstruction of proximal hypospadias. Applying the HOSE score makes postoperative evaluation of hypospadias more objective and reliable.

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Proximal hypospadias is one of the most challenging conditions.

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Modified Koyanagi techniques improve the blood supply to the neourethral flaps.

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The HOSE score is an objective appraisal of the outcome of hypospadias repair.

Double-face preputial island flap revisited: is it a reliable one-stage repair for severe hypospadias?

PURPOSE

We have studied outcome of double-face preputial island flap (DFPIF) technique in severe types of hypospadias: penoscrotal, scrotal and perineal.

METHODS

We have used DFPIF in 75 boys at a median age of 1.1 years (1.0-1.5). The meatus was penoscrotal, scrotal or perineal after de-gloving the penis. The inner face of the foreskin was used for urethroplasty and the outer face for ventral skin covering. Modifications were added: proximal anastomosis was protected by a spongioplasty; in case of urethral plate transection, we anastomosed on onlay proximal and distal segments of the flap (onlay-tube-onlay) and the tubularized part was sutured to corpus cavernosa. FU was scheduled at one month then every 3 months for a year then annually. At each consultation, the surgeon filled out a detailed cosmetic and functional sheet including flowmeter.

RESULTS

Thirty-four patients had onlay preputial flap repair with urethral plate preservation. Forty-one had the onlay-tube-onlay technique. All children had a curvature, 19 had a significant residual curvature after dissection, corrected by dorsal plication (n = 9) and ventral lengthening (n = 10). Median FU was 4.2 years (2.7-6.5). 36 children (48%) had complications and needed redo surgery: 12 fistulas, 11 diverticula, 7 meatal stenosis, 3 strictures and 2 residual curvatures. All children but three voided within the normal limits for their age.

CONCLUSION

DFPIF remains a good option for a one-stage repair of severe hypospadias. After a median of 1.8 procedures, the final success rate was 96%. The healthy well-vascularized ventral skin allows safe redo surgery when needed.

Primary and salvage urethroplasty using Mathieu meatal-based flip-flap technique for distal hypospadias

BACKGROUND

Numerous surgical procedures have been attempted for correction of distal hypospadias. The Mathieu procedure was employed in this study for secondary cases as well as primary cases.

METHODS

The length of the skin flap is determined by measuring the distance from the meatus to the glans tip and then the ventral meatal-based skin flap is incised. The proximal skin flap is flipped and anastomosed to the distal urethral plate. Additionally, subcutaneous tissue of the flipped flap is sutured to cover the original suture lines completely.

RESULTS

The Mathieu urethroplasty was successful in one stage in 13 of the 16 primary repair cases (81%). Twelve of the 13 (92%) who underwent a secondary Mathieu procedure were successfully repaired with no problems. An overall success rate of 86% was achieved at the first operation for both primary and secondary cases. In the remaining 14% of the cases, success was achieved with only one additional procedure.

CONCLUSIONS

The Mathieu flip-flap procedure is feasible for relatively short urethral defects if the ventral penile skin demonstrates adequate mobility and there is no chordee. Even in patients who require revisional hypospadias surgery, the Mathieu procedure can give excellent functional and cosmetic results.