Challenges in managing proximal hypospadias: A 17-year single-center experience

Misra, Devesh; Elbourne, Ceri; Vareli, Anastasia; Banerjee, Anita; Joshi, Ashwini; Friedmacher, Florian; Skerritt, Clare

doi:10.1016/j.jpedsurg.2019.04.019

Cited by 11 publications

(9 citation statements)

References 24 publications

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“…The study sample comprised 12 children. Post-surgery outcomes after 42 months of postoperative follow up showed no children had meatal stenosis or urethrocutaneous fistula formation which is similar to the findings of this study, however, Nerli et al reported two cases of tear of skin on the ventral shaft with the post-surgical complication of 16.6% [16][17][18][19][20][21]. Findings of these clinical reports showed that significant postoperative complications were observed only in one study with meatal stenosis and urethrocutaneous fistula.…”

Section: Discussionsupporting

confidence: 88%

Assessing the Effectiveness of Dorsal Flap in Surgical Repair of Hypospadias by Tubularized Incised Plate Urethroplasty

Adnan¹,

Baloch²,

Mal³

et al. 2022

PJMHS

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Background: Hypospadias is a congenital abnormality of the urethral meatus opening which is located anywhere along the length of the penis except the tip of the glans. The management of this congenital disease is surgical and comprises orthoplasty, urethroplasty, glanuloplasty and cosmetic correction. Urethroplasty is the key step of surgical correction of hypospadias. . Tubularized incision plate (TIP) urethroplasty by dorsal flap is frequently used for distal hypospadias. The reason for the preference is usually wide acceptability of low post-surgical complications and optimum cosmetic results. Other techniques include urethral plate augmentation and urethral plate replacement. Aims: The aim of this study is to assess the effectiveness of dorsal flap assisted TIP urethroplasty in patients with hypospadias of recruited population. The effectiveness will be measured against postoperative outcomes such as wound rupture, wound necrosis, meatal stenosis, and urethrocutaneous fistula formation. Methodology: This prospective study was conducted on 11 primary hypospadias cases undergoing TIPU in Dr Ziauddin Hospital, Karachi for the period of one year from November 2020 to October 2021. The inclusion criteria included infants with distal and midshaft hypospadias with sufficient width of the urethral plate. Whereas individuals with proximal hypospadias or other factors complicating the surgical procedure were excluded from the study population. Result: The total number of participants included was 11 children. The age of participants varied between 18 – and 28 months with a mean age of 24.2 ± 3.1 months. The meatus opening was seen at the distal end near the coronal sulcus in 8 participants whereas 3 participants showed preoperative meatus opening in the distal third of the shaft. An immediate follow up was done at 2 weeks intervals to assess wound health and situation. 1 out of 11 infants showed wound dehiscence which was immediately corrected. A late follow up was carried out after 2-3 years, no case presented with significant complications such as urethrocutaneous fistula or stenosis of the meatus. Conclusion: the study shows measured the post-operative complications followed by TIP urethroplasty using a dorsal flap. Immediate complications showed a single case of wound dehiscence. Whereas all long term follows up after 2-3 years showed no significant complications. After predisposing the clinical outcomes of this research against and in favour of pre-existing literature, it is concluded that dorsal flaps assisted TIP urethroplasty is a safe surgical procedure and is effective in terms of avoiding postoperative complications in individuals with hypospadias. Keywords: Dorsal flap, Hypospadias, Tubularized incised plate urethroplasty

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Section: Discussionsupporting

confidence: 88%

Assessing the Effectiveness of Dorsal Flap in Surgical Repair of Hypospadias by Tubularized Incised Plate Urethroplasty

Adnan¹,

Baloch²,

Mal³

et al. 2022

PJMHS

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“…The debate over repair of proximal hypospadias continues, two-stage or single-stage, and neither method is accepted universally. In terms of the current technical level, the vast majority of severe hypospadias operations can be performed in one stage [ 4 , 5 ], and Duckett [ 6 ] and Koyanagi [ 7 ] urethroplasties are currently the most commonly used one-stage procedures. For patients with severe hypospadias (treated initially) and failed hypospadias, a staged operation may be a wise choice.…”

Section: Discussionmentioning

confidence: 99%

Staged transverse preputial island flap urethroplasty for some proximal hypospadias with moderate-to-severe chordee

Lin

Wang

et al. 2021

BMC Urol

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Background We aimed to assess the outcome of staged transverse preputial island flap (TPIF) urethroplasty for repairing certain cases of primary proximal hypospadias with moderate-to-severe chordee in children. Methods Nighty-two consecutive boys who underwent either one-stage or staged TPIF urethroplasty for the repair of proximal hypospadias with moderate-to-severe chordee between August 2015 and December 2019 were evaluated retrospectively. Patients were divided into two groups: one-stage TPIF urethroplasty group (n = 44) and staged TPIF urethroplasty group (n = 48). We noted and compared the postoperative complications, including urethrocutaneous fistula, urethral diverticula, residual penile curvature, and urethral stricture in both groups. Results Both groups were followed up for 1–5 years, with an average of 3 years. No cases of residual or recurrence of penile chordee were reported in either group. In Group A, 9 patients (9/44, 20.4%) had postoperative urethrocutaneous fistula, and all patients underwent urinary fistula repair or urethroplasty. In Group B, postoperative urethrocutaneous fistula occurred in 2 cases (2/48, 4.1%), and one patient developed a urethrocutaneous fistula after the first operation, which was successfully repaired during the second operation. A urethrocutaneous fistula occurred in 1 case after completion of the second-stage operation; urethral fistula repair was performed successfully 6 months later. There were 2 cases of urethral stricture in Group A (2/44, 4.5%) and none in Group B. There were 6 cases of urethral diverticulum in Group A (6/44, 13.6%) and no cases of urethral diverticulum in Group B. The operative success rates were 61.3% and 95.8% in Group A and Group B, respectively (P < 0.001). Conclusions Compared with one-stage TPIF urethroplasty, staged TPIF urethroplasty in the treatment of certain cases of primary proximal hypospadias with moderate-to-severe chordee resulted in fewer postoperative fistulas, urethral strictures and urethral diverticula. The staged TPIF urethroplasty procedure was effective in reducing the operation difficulty and complication rate of hypospadias, improving the curative effect of complex hypospadias and having good clinical application value.

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“…It was observed that the buccal mucosa was slightly lighter in color and was noticeable from the surrounding tissue. In the histopathological examination, differences in (22). In our study, in order to protect the endothelial surface of the jugular free vein graft, the graft was anastomosed reversely to the defective urethral plate.…”

Section: Resultsmentioning

confidence: 94%

Autologous Free Reverse Inlay Vein Graft in the Treatment of Cripple Hypospadias; an experimental rabbit model

Çalışkan¹,

SÜRER

GÜNHAN>

2023

Türkiye Çocuk Hast Derg

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Objective: The aim of this study is using the autologous reverse inlay jugular vein graft as a substitute for defective urethral plate and the incorporation of the graft to the urethral plate. Cripple hypospadias are the patients who have a history of previous multiple unsuccessful hypospadias surgery and still having anatomical and functional complications. Insufficient local or support tissue for the repair of defective urethral plate is always a problem. Material and Methods: In the study fourteen male 8-10 months old which is weighting four kg, New Zealand type rabbit are divided into two equal groups. Juguler vein graft (1st group) and buccal mucosal graft (2nd group) harvested and transferred to defective area in the urethral plate as a free flap. Results: In the histopatologic examination, epithelization, fibrosis and inflammation degrees were evaluated between the groups and in-groups. In the histopatological examination of the 1st group, uroepithelization is complete or nearly complete, fibrotic activity is (+) and the inflammation was found minimal. In the second group after 21st day, the uroepithelization on the graft is nearly thirty percent, fibrotic activity is (++) and the inflammation is also found minimal. Conclusion: From the results of the study, in the treatment of defective urethra in cripple hypospadias cases, reverse free juguler vein graft can be used as an alternative for buccal mucosa graft as a substitution material which has been used for a long time.

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Challenges in managing proximal hypospadias: A 17-year single-center experience

Cited by 11 publications

References 24 publications

Assessing the Effectiveness of Dorsal Flap in Surgical Repair of Hypospadias by Tubularized Incised Plate Urethroplasty

Assessing the Effectiveness of Dorsal Flap in Surgical Repair of Hypospadias by Tubularized Incised Plate Urethroplasty

Staged transverse preputial island flap urethroplasty for some proximal hypospadias with moderate-to-severe chordee

Autologous Free Reverse Inlay Vein Graft in the Treatment of Cripple Hypospadias; an experimental rabbit model

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