Hypospadias Repair in Adults: Adventures and Misadventures

Hensle, Terry W.; Tennenbaum, Steven Y.; Reiley, Elizabeth A.; Pollard, Jason D.

doi:10.1097/00005392-200101000-00019

Cited by 114 publications

(70 citation statements)

References 12 publications

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“…Fourteen participants, 5 currently living as men (1-5) and 9 currently living as women (22)(23)(24)(25)(26)(27)(28)(29)(30), were classified as having partial androgen insensitivity syndrome (PAIS) on the basis of androgen receptor studies in cultured genital skin fibroblasts. These participants had either a low number of receptor binding sites for dihydrotestosterone or a low binding affinity.…”

Section: Participantsmentioning

confidence: 99%

“…Another follow-up assessment of hypospadias repair in adults included 8 men with perineoscrotal hypospadias. 25 In all cases, multiple hypospadias repairs were attempted with a postoperative complication rate of 64%. Repeated surgical procedures and complications are of particular concern because of scarring and loss of tissue associated with each surgery, 26 as well as the presumed negative impact on sexual function.…”

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confidence: 99%

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Ambiguous Genitalia With Perineoscrotal Hypospadias in 46,XY Individuals: Long-Term Medical, Surgical, and Psychosexual Outcome

et al. 2002

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ABSTRACT. Objectives. To identify and study adults (21 years or older) who have a 46,XY karyotype and presented as infants or children with genital ambiguity, including a small phallus and perineoscrotal hypospadias, reared male or female.Methods. Participants were classified according to the cause underlying their intersex condition based on review of medical and surgical records. Long-term medical and surgical outcome was assessed with a written questionnaire and physical examination. Long-term psychosexual development was assessed with a written questionnaire and semistructured interview.Results. Thirty-nine (72%) of 54 eligible patients participated. The cause underlying genital ambiguity of participants included partial androgen insensitivity syndrome (n ‫؍‬ 14; 5 men and 9 women), partial gonadal dysgenesis (n ‫؍‬ 11; 7 men and 4 women), and other intersex conditions. Men had significantly more genital surgeries (mean: 5.8) than women (mean: 2.1), and physician-rated cosmetic appearance of the genitalia was significantly worse for men than for women. The majority of participants were satisfied with their body image, and men and women did not differ on this measure. Most men (90%) and women (83%) had sexual experience with a partner. Men and women did not differ in their satisfaction with their sexual function. The majority of participants were exclusively heterosexual, and men considered themselves to be masculine and women considered themselves to be feminine. Finally, 23% of participants (5 men and 4 women) were dissatisfied with their sex of rearing determined by their parents and physicians.Conclusions. Either male or female sex of rearing can lead to successful long-term outcome for the majority of cases of severe genital ambiguity in 46,XY individuals.We discuss factors that should be considered by parents and physicians when deciding on a sex of rearing for such infants. Pediatrics 2002;110(3). URL: http://www. pediatrics.org/cgi/content/full/110/3/e31; intersex, sex assignment, gender, androgen insensitivity, gonadal dysgenesis, psychosexual, genital reconstruction, hormone replacement.ABBREVIATIONS. PAIS, partial androgen insensitivity syndrome; PGD, partial gonadal dysgenesis. D uring fetal sex differentiation, genetic males who are unable to masculinize their sex ducts and external genitalia can be classified into 2 major etiologic groups: 1) the inability of the fetus to produce sufficient amounts of testosterone and dihydrotestosterone or 2) the inability of the fetus to respond to androgens that are present in normal amounts. 1 We previously described a population of 46,XY subjects who presented to the Pediatric Endocrinology Clinic of Johns Hopkins Hospital with varying degrees of undermasculinized genitalia. 2 In this population, the most difficult group to treat in terms of gender assignment is that of individuals who were born with ambiguous genitalia that includes a small phallus and perineoscrotal hypospadias. 3 For this group of patients, there is a lack of agreement about optimal sex ...

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Section: Participantsmentioning

confidence: 99%

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confidence: 99%

Ambiguous Genitalia With Perineoscrotal Hypospadias in 46,XY Individuals: Long-Term Medical, Surgical, and Psychosexual Outcome

et al. 2002

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“…The current recommendation of American Academy of Pediatrics is to perform a primary hypospadias repair at the age 6 to 12 months based on a review of psychological, aesthetic and surgical factors 5 . We included in group I children before toilet training, in Group II toilet trained children who had started going to school, in Group III school going children with rebellion attitude, in group IV pubertal boys with a penile growth spurt with rising testosterone level leading to increase in vascularity of tissue, and in Group V adolescents and adults with problems of nocturnal and day time erections.…”

Section: Discussionmentioning

confidence: 99%

“…Overall complication rates reported in various studies are higher in older patients as compared to pediatric patients. [5][6][7] Other important variables in the outcome of hypospadias surgery are severity of hypospadias, degree of curvature, size of penis and glans, width of the urethral plate, development of spongiosum, preputial reconstruction, surgical skill, type of repair and suture material used. To the best of our knowledge, there is no such prospective study in literature evaluating the results with reference to all these factors.…”

Section: Introductionmentioning

confidence: 99%

A Prospective Study to Evaluate the Role of Different Variables in Results of TIPU for Hypospadias

Bhat¹,

Bhat²,

Sabharwal³

et al. 2014

UROL

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The objective of this article is to evaluate the role of different variables affecting the results of tubularised incised plate repair for hypospadias.We prospectively evaluated 125 patients of TIPU repair from April 2009 to October 2011. Study parameters were age, severity of hypospadias, degree of curvature and torsion, size of penis and glans, width of urethral plate, development of spongiosum and complication rate. Patients were classified into five groups by age; Group I-6 months to 2 years, Group II-2 to5 years, Group III-5 to10 years, Group IV-10 to 15 years and Group V-older than 15 years. Results were analyzed with reference to different variables.Age ranged from 6 months to 26 years (mean 8.8 years). Complication rate when comparing group V and youngest patients (groups I & II) was 20% Vs 3.6% (p=0.08), and when comparing older children (G-III and IV) with youngest patients (group I & II) was 15% Vs 3.6% (p=0.135). More severe hypospadias had higher complications (30% in proximal, 5.7% in distal (p = 0.001). The complication rate was 3.6%, 38.8% and 35.7% respectively in cases with mild, moderate and severe curvature (p = 0.001). Complications were higher in patients with poor spongiosum and higher age (p = 0.001) and in patients with narrow urethral plate (p = 0.0001). Follow up period was from about 10 months to 2 years (mean = 20 months).Urethral fistula and stricture were the most commonly reported complications. Important factors in outcome of TIPU repair were the degree of curvature, width of urethral plate development of spongiosum, age of child and severity of hypospadias. The development of urethral plate and spongiosum is directly proportional to the complication rate. Complications increase significantly with the increasing age of the patient.

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“…Meatusun lokalizasyonu, kordi varlığı, geçirilmiş hipospadias cerrahi öyküsü ve cerrahın tecrübesi uygulanacak cerrahi yöntemin karar verilmesinde en önemli noktalardır (11,12). Barcat ve Mathieu yöntemlerinde %15-%20'lere varan fistül oranları yöntemlerin tecih edilirliğini azaltmıştır.…”

Section: Discussionunclassified

Distal Hipospadias Cerrahisinin Devlet Hastanesinde Uygulanabilirliği: 48 Vakanın Geriye Dönük Analizi

Özgör¹,

Sarılar²,

Berberoğlu³

et al. 2014

Haseki

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Hypospadias Repair in Adults: Adventures and Misadventures

Cited by 114 publications

References 12 publications

Ambiguous Genitalia With Perineoscrotal Hypospadias in 46,XY Individuals: Long-Term Medical, Surgical, and Psychosexual Outcome

Ambiguous Genitalia With Perineoscrotal Hypospadias in 46,XY Individuals: Long-Term Medical, Surgical, and Psychosexual Outcome

A Prospective Study to Evaluate the Role of Different Variables in Results of TIPU for Hypospadias

Distal Hipospadias Cerrahisinin Devlet Hastanesinde Uygulanabilirliği: 48 Vakanın Geriye Dönük Analizi

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