Comparison of Flaps Versus Grafts in Proximal Hypospadias Surgery

Powell, Curt R.; McAleer, Irene M.; Alagiri, Madhu; Kaplan, George W.

doi:10.1016/s0022-5347(05)67762-2

Cited by 58 publications

(16 citation statements)

References 21 publications

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“…[4,9,10] Our results are better than others perhaps as we did the study in distal and mid penile hypo spadias only.…”

Section: Discussioncontrasting

confidence: 63%

“…[1] However, the use of tubularized free graft as required in cases of posterior hypospadias has been re ported to be complicated by stricture formation. [2,3,4] Kaplan GW used preputial free graft for neourethral con struction in 21 patients of proximal hypospadias (17 as tubed graft and 4 as onlay graft) and reported few com plications and found his method statistically better than the combined results of other reports (c 2 = 5.38, p<0.05). [5] Stock JA et al studied a total of 77 patients with proximal hypospadias who underwent a single stage hypospadias repair using a preputial free graft for neourethral construc tion and a preputial pedicle flap for ventral skin coverage of which 84% achieved excellent functional and cosmetic results with one procedure.…”

Section: Discussionmentioning

confidence: 98%

“…Graft harvesting is often easier than dissecting out the vascular pedicle of a flap. [4] 3. Placing a thin graft on the urethra produces less tis sue bulk than a flap and there is no torsion of the repair as there may be with a flap.…”

Section: Second Layer Closure By Dartosmentioning

confidence: 99%

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Onlay free preputial graft for mid and distal penile hypospadias

Gangopadhyay

Sharma

Mongha

2005

J Indian Assoc Pediatr Surg

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Onlay free preputial graft for mid and distal penile hypospadias Onlay free preputial graft for mid and distal penile hypospadias Onlay free preputial graft for mid and distal penile hypospadias Onlay free preputial graft for mid and distal penile hypospadias Onlay free preputial graft for mid and distal penile hypospadias ABSTRACT ABSTRACT ABSTRACT ABSTRACT ABSTRACTTubularized free preputial graft for hypospadias repair had been tried in the past and discarded due to high incidence of graft shrinkage causing stricture formation. We have tried to revive the technique using onlay method thus avoiding stricture formation. The technique was used in 33 subjects (Group A) and compared with 33 subjects in control group (Group B) in whom other techniques of urethroplasty were used. The study was a randomized controlled trial. The mean length of the free preputial graft was 22.06 + 4.68 mm (16-35 mm) and breadth was 9.0 + 1.32 mm (7-11 mm). Fistulae developed in 3 patients in group A out of which one healed spontaneously. In group B, 6 patients had fistula formation. Complications developed in 18% cases in group A and 50% cases in group B. There was significant difference between the cosmetic results (p < 0.05) with 58% excellent results in group A and 27% in group B. Free preputial graft onlay urethroplasty has better functional and cosmetic results. KEY WORDS: Hypospadias, Free preputial graft, Onlay urethroplastyHypospadiology is an over expanding field as none of the current methods of urethroplasty have been proved su perior over the others in terms of achieving the goal of excellent functional and cosmetic results. We have de scribed our experience with free inner preputial full thick ness onlay graft urethroplasty in mid and distal penile hypospadias and compared our results with currently used technique.

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“…[4,9,10] Our results are better than others perhaps as we did the study in distal and mid penile hypo spadias only.…”

Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 98%

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Onlay free preputial graft for mid and distal penile hypospadias

Gangopadhyay

Sharma

Mongha

2005

J Indian Assoc Pediatr Surg

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“…The results are better with flap urethroplasties than grafts. [1] Rebirth of two-stage procedures with reduced complication rates has given a wider choice of procedures to the hypospadialogist for repair of proximal hypospadias. Complications after surgical procedures are not infrequent.…”

mentioning

confidence: 99%

Acute postoperative complications of hypospadias repair

Bhat

Mandal

2008

Indian J Urol

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PurposeComplications in hypospadias surgery are higher than other reconstructive procedures. The incidence of complications can be reduced if proper preventive measures are taken. The review aims to highlight incidences, causes, and preventive measures of acute complications of hypospadias repair.Materials and MethodsLiterature reports were reviewed in Pubmed by giving the key word acute complications of hypospadias repair, wound infection, wound dehiscence, flap necrosis, edema, penile torsion, urethral fistula, bleeding and hematoma and urethral stents problems. Summaries of all articles were reviewed with full text of relevant article and results were analyzed.ResultsBesides mentioning the complications of hypospadias repair in individual articles on the subject, we did not come across any separate article on this subject in the published English literature. Fistula is the commonest complication followed by edema and penile torsion.ConclusionsMost acute complications can be prevented with adherence to principles of plastic and microsurgery, meticulous preoperative planning, and judicious postoperative care. Deviation from these principles may lead to disaster and even failure of the repair. The aim in hypospadias surgery should be following these principles and bring down the complication rates < 5% in distal hypospadias and < 10% in proximal hypospadias.

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“…These procedures are associated with a secondary surgery rate ranging from 30 to 90% without any apparent advantage of flaps over grafts. [16–19]…”

Section: Introductionmentioning

confidence: 99%

Two-stage repair in hypospadias

Haxhirexha

Castagnetti²,

Rigamonti

et al. 2008

Indian J Urol

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We provide the reader with a nonsystematic review concerning the use of the two-stage approach in hypospadias repairs. A one-stage approach using the tubularized incised plate urethroplasty is a well-standardized approach for the most cases of hypospadias. Nevertheless, in some primary severe cases, in most hypospadias failures and in selected patients with balanitis xerotica obliterans a two-stage approach is preferable. During the first stage the penis is straightened, if necessary and the urethral plate is substituted with a graft of either genital (prepuce) or extragenital origin (oral mucosa or postauricular skin). During the second stage, performed around 6 months later, urethroplasty is accomplished by graft tubulization. Graft take is generally excellent, with only few cases requiring an additional inlay patch at second stage due to graft contracture. A staged approach allows for both excellent cosmetic results and a low morbidity including an overall 6% fistula rate and 2% stricture rate. Complications usually occur in the first year after the second stage and are higher in secondary repairs. Complications tend to decrease as experience increases and use of additional waterproofing layers contributes to reduce the fistula rate significantly. Long-term cosmetic results are excellent, but voiding and ejaculatory problems may occur in as much as 40% of cases if a long urethral tube is constructed. The procedure has a step learning curve but because of its technical simplicity does not require to be confined only to highly specialized centers.

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Comparison of Flaps Versus Grafts in Proximal Hypospadias Surgery

Cited by 58 publications

References 21 publications

Onlay free preputial graft for mid and distal penile hypospadias

Onlay free preputial graft for mid and distal penile hypospadias

Acute postoperative complications of hypospadias repair

Two-stage repair in hypospadias

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