Long-term results with a one-stage complex primary hypospadias repair strategy (the three-in-one technique)

Macedo, António; Liguori, Riberto; Ottoni, Sérgio Leite; Garrone, Gilmar; Damázio, Eulálio; Mattos, Ricardo Marcondes; Ortiz, Valdemar

doi:10.1016/j.jpurol.2011.02.024

Cited by 22 publications

(6 citation statements)

References 18 publications

(20 reference statements)

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“…Newer approaches to onlay grafting, such as the widely anchored patch recently suggested by Djordjevic and colleagues may improve the results of a 1-stage approach for these complicated patients [21]. Thus far, we have found buccal mucosal grafting to be unnecessary for primary hypospadias repairs, although other authors have reported success with this technique for cases of hypospadias with severe chordee [22]. …”

Section: Discussionmentioning

confidence: 99%

Use of buccal mucosa grafts for urethral reconstruction in children: a retrospective cohort study

et al. 2014

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BackgroundThe use of buccal mucosa grafts (BMG) for urethral reconstruction has increased in popularity over the last several decades. Our aim was to describe our institutional experience with and outcomes after BMG urethroplasty.MethodsWe conducted a retrospective cohort study of boys undergoing BMG urethral reconstruction. Preoperative and perioperative characteristics and postoperative outcomes were evaluated.ResultsTwenty-nine patients (median age 8.2 years) underwent BMG urethroplasty from 1995–2012. Of the 10 patients undergoing 1-stage repairs, 6 had tubularized grafts, the last of which was performed in 2000 due to an unacceptably high revision rate (100%). A 2-stage approach was elected for 19 patients (median follow-up 21.3 months). Complications including stricture, fistula, or chordee were seen in 60% of patients completing both stages and 32% required ≥1 revision. However, 71% of 2-stage patients were free of significant problems at last follow-up.ConclusionsWe found BMG to be a reasonable option for use in complex pediatric urethral reconstruction. Tubularized grafts had poor results, and we no longer use them. We favor a 2-stage approach for all patients except those with “simple” non-hypospadiac strictures. Although revision procedures were not uncommon, the majority of patients were ultimately free of long-term problems.

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Section: Discussionmentioning

confidence: 99%

Use of buccal mucosa grafts for urethral reconstruction in children: a retrospective cohort study

et al. 2014

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“…However, there is a lack of exploration of one-stage reconstruction using tubularized graft. In some cases, onlay grafts may not be suitable and tubularized urethroplasty is necessary [20,21]. We previously performed urethroplasty in a rabbit model with saphenous vein patch as onlay graft and gained encouraging results [7].…”

Section: Discussionmentioning

confidence: 99%

Tubularized Urethral Reconstruction Using Everted Saphenous Vein Graft in A Beagle Model

Shen

2020

Preprint

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Background: The repair of anterior urethral stricture and hypospadias require urethral reconstruction. We conduct the study to investigate the efficacy of anterior urethral reconstruction using everted saphenous vein graft in tubular fashion. Methods: Twelve male beagles were randomly divided into three groups: experimental group( n=5), control group( n=5) and normal group( n=2). A 3 cm defect in anterior urethra was created. Autologous saphenous vein graft was harvested. In experimental group, urethral defect was replaced by everted saphenous vein graft in tubular fashion. In control group, urethral reconstruction was performed using uneverted saphenous vein graft. At 6 months postoperatively, beagles in all groups received retrograde urethrography to evaluate urethral patency and were killed for histological examination. Results: Retrograde urethrography showed the urethral caliber of beagles in experimental group were similar to those of normal. Ether urethral stricture or fistula were detected in all animals in control group. In experimental group, the everted saphenous vein graft completely integrated into the urethra. The reconstructed urethra had a wide lumen and was completely covered by urothelium. The subepithelial collagen and muscle fibers were well formed and highly organized. Everted saphenous vein graft had a high ability of neovascularization. In control group, the reconstructed segment had a fibrotic urethral lumen in which urothelium was not intact. And there were few newly formed capillaries. Conclusions: Everted saphenous vein graft can be used as tubular substitute material for anterior urethral strictures and hypospadias.

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“…Macedo et al [29] described the ‘three-in-one’ technique using buccal mucosa, an onlay with a vertical skin flap, and a tunica vaginalis cover, in 40 children. The complication rate was 37%, including four with meatal stenosis, four with a diverticulum, five with fistula, two with residual curvature and two with recurrent UTIs, with a re-operative rate of only 31.5% for a second surgery.…”

Section: Discussionmentioning

confidence: 99%

Single- vs. multi-stage repair of proximal hypospadias: The dilemma continues

Badawy

Fahmy²

2013

Arab Journal of Urology

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IntroductionThe surgical reconstruction of distal penile hypospadias in a single stage is the standard practice for managing anterior hypospadias. Unfortunately, it is not simple to extrapolate the same principle to proximal hypospadias. There is no consensus among hypospadiologists about whether a single- or multi-stage operation is the optimal treatment for proximal hypospadias. In this review, we assess the currently reported outcomes and complications of both techniques in proximal hypospadias repair.MethodsWe searched Medline, Pubmed, Scopus and Ovid for publications in the last 10 years (2002–2012) for relevant articles, using the terms ‘proximal hypospadias’, ‘posterior hypospadias’ ‘single stage’, ‘multiple stage’, and ‘complications’. Articles retrieved were analysed according to the technique of repair, follow-up, complications, success rate, number of included children, and re-operative rate.Results and conclusionsThe reported complications in both techniques were similar, including mostly minor complications in the form of fistula, meatal stenosis, partial glans dehiscence, and urethral diverticulum, with their easy surgical repair. The outcomes of single- and multistage repairs of proximal hypospadias are comparable; no technique can be considered better than any other. Thus, it is more judicious for a hypospadiologist to master a few of these procedures to achieve the best results, regardless of the technique used.

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Long-term results with a one-stage complex primary hypospadias repair strategy (the three-in-one technique)

Cited by 22 publications

References 18 publications

Use of buccal mucosa grafts for urethral reconstruction in children: a retrospective cohort study

Use of buccal mucosa grafts for urethral reconstruction in children: a retrospective cohort study

Tubularized Urethral Reconstruction Using Everted Saphenous Vein Graft in A Beagle Model

Single- vs. multi-stage repair of proximal hypospadias: The dilemma continues

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