Durham Smith Vest-Over-Pant Technique: Simple Procedure for a Complex Problem (Post-Hypospadias Repair Fistula)

Patil, Sunil; Bote, Sachin Madhukar; Siddiqui, Mohd Ayub Karam Nabi; Nikose, Jayant V.; Kandi, Anitha J

doi:10.1159/000455159

Cited by 7 publications

(3 citation statements)

References 7 publications

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“…In the present study, complications were de ned as any complaints that required surgical correction, including stula, urethral stricture, and diverticulum. The complication rate of primary operation was 39%, with stula (24 patients, 17.6%) being the most common complication, similar to the previous studies [35]. Both stula and urethral stricture were believed to be related to the poor blood supply to the neourethra and the native urethra[36] Cui et al suggested that surgeons should protect the vascular pedicle of the inner sheath of the foreskin, ensuring the transverse ap is as thick as possible so that the vascular tissue can be preserved.…”

Section: Resultssupporting

confidence: 90%

Reoperation Frequency after Transverse Preputial Island Flap Urethroplasty in Treating of Severe Hypospadias: A Single Center Study

Liu

Yang

et al. 2022

Preprint

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Background: Considering the continuing debate on the best technique to treat serve hypospadias, the reoperation frequency after Transverse Preputial Island Flap Urethroplasty (TPIFU) is lacking. In the present study, we reported our clinical outcomes of severe hypospadias treated with one-staged TPIFU and analyzed the operation frequency. Methods: We retrospectively analyzed the clinical data of severe hypospadias patients who underwent one-stage TPIFU from December 2018 to December 2019. A stepwise approach was used to manage the curvature. Severe hypospadias was defined as the residual curvature was > 30° after degloving. Urethroplasty complications included fistula, urethral stricture, and diverticulum. The short-term cure was identified as no complications occurring for 12 months after the date of last-time surgery. The reoperation rate and operation frequency of TPIFU were analyzed. Results: A total of 136 patients who underwent one-stage TPIFU were included in the study. The follow-up after primary urethroplasty ranged from 22 to 50 months. The median age at primary surgery was 22.5 months (range from 13 to 132 months). After primary TPIFU surgery, 53(39%) patients accepted reoperation handling with complications. Among them, 24 patients (17.6%) developed fistula, 17 patients (12.5%) developed urethral stricture and 11 patients (8.1%) developed diverticulum. After the second surgery, 5/17 patients remained fistula, 5/17 patients remained urethral stricture, and 7/17 patients remained diverticulum. Overall, 61% (85 patients) met the cured standard after the primary operation, and the two operations cure rate was 87.5% (119 patients). 91.2% (124 patients) were cured in three operations.Conclusions: The present study provides a novel perspective to evaluate the surgery technique through the surgery number to cure the patients, rather than simply comparing the complication rate. Our result demonstrated that the complication rates of primary TPIFU were relatively high, but the cure rate after two or three operations was acceptable.

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Section: Resultssupporting

confidence: 90%

Reoperation Frequency after Transverse Preputial Island Flap Urethroplasty in Treating of Severe Hypospadias: A Single Center Study

Liu

Yang

et al. 2022

Preprint

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show abstract

“…In the present study, complications were defined as any complaints that required surgical correction, including fistula, urethral stricture, and diverticulum. The complication rate of primary operation was 39%, with fistula (24 patients, 17.6%) being the most common complication, similar to the previous studies ( 38 ). Both fistula and urethral stricture were related to the poor blood supply to the neourethra and the native urethra ( 39 ).…”

Section: Discussionsupporting

confidence: 89%

Reoperation frequency after transverse preputial Island flap urethroplasty “Duckett’s technique” in treatment of severe hypospadias: A single center study

Liu²,

Yang³

et al. 2023

Front. Pediatr.

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PurposeTransverse Preputial Island Flap Urethroplasty (TPIFU) is one of the most common techniques for treating severe hypospadias. Studies on the reoperation frequency after TPIFU is lacking. In the present study, we reported our clinical outcomes of severe hypospadias treated with one-staged TPIFU and analyzed the operation frequency.MethodsWe retrospectively analyzed the clinical data of severe hypospadias patients who underwent one-stage TPIFU from December 2018 to December 2019 in the department of Urology at Beijing Children's Hospital. A stepwise approach was used to manage the curvature. Severe hypospadias was defined as those residual curvature was higher than 30° after degloving. Urethroplasty complications included fistula, urethral stricture, and diverticulum. The short-term cure was identified as no complications occurring for 12 months after the date of last-time surgery. The reoperation rate and operation frequency of TPIFU were analyzed.ResultsA total of 136 patients who underwent one-stage TPIFU were included in the study. The follow-up after primary urethroplasty ranged from 22 to 50 months. The median age at primary surgery was 22.5 months (range from 13 to 132 months). After primary TPIFU surgery, 53 (39%) patients underwent additional surgical interventions to treat postoperative complications. Among them, 24 patients (17.6%) developed fistula, 17 patients (12.5%) developed urethral stricture and 11 patients (8.1%) developed diverticulum. After the second surgery, five patients remained fistula, five patients remained urethral stricture, and seven patients remained diverticulum. Overall, 61% (85 patients) met the cured standard after the primary operation, and the two operations cure rate was 87.5% (119 patients). 91.2% (124 patients) were cured in three operations.ConclusionsAlthough the complication rates after primary TPIFU were relatively high, more than half of patients achieved short-term cured through a single operation, and the cure rate after two or three operations was acceptable.

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“…Therefore, we usually cover the free graft by rotation of thin subcutaneous tissue, which might explain the relatively high rate of urethrocutaneous fistula in our series. For management of urethrocutaneous fistula, Gite et al [16] reported excellent results of the Durham Smith vest-over-pant technique.…”

Section: Discussionmentioning

confidence: 99%

Free Tube Graft Urethroplasty for Repair of Hypospadias

et al. 2019

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Introduction: We aimed to assess the outcome of free tube graft urethroplasty for single-stage repair of hypospadias with chordee in children. Materials and Methods: We retrospectively evaluated a series of 56 patients (16 months to 9 years old, median 24 months) who underwent free graft urethroplasty for repair of hypospadias with chordee between May 2005 and November 2017. The median follow-up was 7 years (range 1-11). Results: After releasing the chordee, the hypospadiac orifice was retracted to become penile in 32 patients (57%), penoscrotal in 18 patients (32%), and scrotal in 6 patients (11%). Single-stage repair was achieved without complications in 42 patients (75%). Of the remaining 14 patients with postoperative complications requiring surgical intervention, 2 had meatal stenosis, 9 had urethrocutaneous fistula, 1 had urethral diverticulum without meatal stenosis, and 1 had meatal regression. One patient who complained the urine stream went upwards in an arc underwent cut-back meatoplasty to correct the stream. In all patients, a neomeatus with a vertically oriented slit-like appearance was eventually achieved at the tip of the glans. Conclusion: A free graft is an appropriate choice for repairing hypospadias with chordee. Our procedure achieved favorable functional and cosmetic outcomes with a low postoperative morbidity rate.

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Durham Smith Vest-Over-Pant Technique: Simple Procedure for a Complex Problem (Post-Hypospadias Repair Fistula)

Cited by 7 publications

References 7 publications

Reoperation Frequency after Transverse Preputial Island Flap Urethroplasty in Treating of Severe Hypospadias: A Single Center Study

Reoperation Frequency after Transverse Preputial Island Flap Urethroplasty in Treating of Severe Hypospadias: A Single Center Study

Reoperation frequency after transverse preputial Island flap urethroplasty “Duckett’s technique” in treatment of severe hypospadias: A single center study

Free Tube Graft Urethroplasty for Repair of Hypospadias

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