Modified Byars’ flaps for securing skin closure in proximal and mid-penile hypospadias

AbouZeid, Amr Abdelhamid

doi:10.1177/1756287211427722

Cited by 18 publications

(15 citation statements)

References 16 publications

(29 reference statements)

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“…Late complications in the form of a urethrocutaneous fistula, meatal stenosis, and wound dehiscence or infection developed in eight (10%) patients (one patient of group A and seven of group B). The subcuticular uninterrupted suturing technique seems to have a lower complication rate when compared with the use of full-thickness interrupted sutures in the repair of distal hypospadias by TIP urethroplasty [13]. In my series, the continuous interlocking sutures were taken and with every fifth suture a knot was taken.…”

Section: Discussionmentioning

confidence: 93%

Ten Commandments of Hypospadias Surgery

Jawale¹

2017

JPNC

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Submit Manuscript | http://medcraveonline.com penile in 77(30%) and proximal Hypospadias in 46(18%) patients. Tubularized incised plate urethroplasty (TIP) by Dr. Warren Snodgrass and Byar's two stage urethroplasty were the only two basic methods applied. Only 13 patients (5%) of total required two stage repairs. Subsequent 10 years, I operated 512 cases of hypospadias with the Ten Commandments. Tubularized incised plate urethroplasty (TIP) Warren Snodgrass repair and Byar's two stage urethroplasty were the only two basic methods applied. Distal Hypospadias was found in 230(45%), Mid penile in 180(35%) and proximal Hypospadias in 102(20%) patients. Only 23 patients (4.5%) of total required two stage repair. Results:The results of Tubularized incised plate urethroplasty (TIP) Warren Snodgrass repair are as follows: fistula rate of 10 % and 21% respectively for distal and proximal hypospadias. Meatal Stenosis in 3% cases. No patient had urethral stricture and glanular dehiscence. No patient had a residual chordee. Complication of two staged urethroplasty are fistula rate 24%, meatal stenosis 3%, no patients had residual chordee and complete disruption. The two staged urethroplasties done with buccal mucosa as an onlay graft are very bad with 50-100 % failure, many centers have discontinued these repairs. Hence I did not perform any of these repairs in my series. The results of my series with 257 cases before the protocol(group A) were as follows: 33 patients (12.8%) developed meatal stenosis for which only one urethral dilatation under GA was required. 78 patients(30.35%) developed fistula and 18 of them closed spontaneously with conservative treatment and 60(23.34%) required fistula repair. Total complication rate was 66.5 % .The results of my series with 512 cases done with Ten Commandments (group B) were as follows: 17 patients (3%) developed meatal stenosis for which only one urethral dilatation under GA was required. Although 9 patients developed fistula 6 of them closed spontaneously with conservative treatment and only three required fistula repair (0.6%). Total complication rate was 3.6 %.No patient developed a urethral stricture. Incidance of meatal stenosis, fistula formation, fistula closure operation and total complication rate of group A was compared to group B and all the complications were found to be far less frequent in group B compared to group A and the difference was found to be statistically significant. The results of group B were compared to the series of Warren Snodgrass and Aseem Shukla who are the international authorities on the subject and have written a chapter on Hypospadias in paediatric urology text book Kelalis and King. They have a fistula rate of 10 % and 21% respectively for distal and proximal hypospadias which is 17 and 35 times higher than my series. Other international series on Hypospadias have more or less similar outcomes. III. Suprapubic diversion for three weeks. Healing takes about 3-4 weeks and removing urethral stent in one week time is too early. Urine flows in forc...

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Section: Discussionmentioning

confidence: 93%

Ten Commandments of Hypospadias Surgery

Jawale¹

2017

JPNC

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“…But as the dartos is used to cover the neourethra created from the prepuce this method leads to skin necrosis, and dorsal penile skin used causes preputial skin necrosis due to its poor blood supply. [15] Abou Zeid [8] published a modified Byar's flap technique for skin closure combined with TIPU. He divided the prepuce after degloving and urethroplasty.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, each patient has only one prepuce usually serving one function in the repair, In TIPU, urethral plate is used for urethroplasty and dartos layer created from the prepuce and dorsal penile skin are used for covering the neourethra, in cases of ventral penile skin defect, Byar's method of using preputial skin to cover the ventral aspect of the penis results in ventral skin loss in 21% as the skin is deficient from its blood supply. [8] The aim of this study is to use the prepuce for double functions one as a second layer for the neourethra to decrease the incidence of urethrocutaneous fistula and the second one as a skin covering for the ventral aspect of the penis.…”

Section: Introductionmentioning

confidence: 99%

Pedicled preputial island flap for double functions in hypospadias surgery

Omar

Khalil

Sherif

et al. 2018

Turkish Journal of Urology

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Objective: To use the prepuce for double functions one as a second layer for the neourethra to decrease the incidence of urethrocutaneous fistula and the second as a skin covering for the ventral aspect of the penis. Material and methods:From January 2013 to December 2016, 37 cases of hypospadias with mild to moderate chordee were included in this study. The cases with ventral penile skin defect were managed by tubularized incised plate urethroplasty (TIPU) using pedicled preputial flap. Recurrent cases, cases with severe chordee which necessitated division of the urethral plate, and cases with penoscrotal hypospadias were excluded from this study.Results: Thirty-seven cases of hypospadias aged 9-60 months with a mean age of 24.8 months were included in this study. Coronal (n= 9 cases; 24.3%), distal penile (n=11; 29.9%), and midpenile hypospadias (n= 17; 45.9%) were detected in respective number of patients. Postoperative complications consisted of external meatal stenosis (n=2; 8.1%), and one case with urethrocutaneous fistula. Skin necrosis was not reported in this study. Follow-up visits were performed at 1, 3 and 6 months which showed good cosmetic appearance that was accepted by their parents. Conclusion:This technique was beneficial in decreasing the rate of skin necrosis, as it keeps the blood supply to the preputial skin intact, and decreases the incidence of urethrocutaneous fistula.Keywords: Hypospadias; prepuce; skin necrosis; urethrocutaneous fistula. ÖZAmaç: Sünnet derisini çift fonksiyonlu kullanmak. Birincisi üretrokutanöz fistül insidansını azaltmak için neoüretranın ikinci katmanı ve ikincisi penisin ventral yüzünü kaplayan deri katmanı olarak kullanmak. Gereç ve yöntemler:Ocak 2013 ile Aralık 2016 arası hafif-orta derecede kordisi olan 37 hipospadiyas olgusu bu çalışmaya dahil edilmiştir. Ventral penis deri defekti olan olgular pediküllü prepisyum flepiyle tübülarize üretral plağın kullanıldığı üretroplasti (TIPU) yöntemiyle tedavi edilmiştir. Nüks olgular, üretral plağın ikiye bölünmesini gerektiren ağır kordili olgularla penoskrotal hipospadiyas olguları çalışmadan çıkartılmıştır.Bulgular: Yaş ortalaması 24.8 ay olan (9-60 ay arası) 37 hipospadiyas olgusu bu çalışmaya alınmıştır. Koronal (n=9; %24,3), distal penil (n=11; %29,9) ve midpenil hipospadiyas (n=17; %45,9) olgusu saptanmıştır. Postoperatif komplikasyonlar eksternal mea stenozu (n=2; %8,1) ve üretrokutanöz fistülden (n=1) ibaretti. Bu çalışmada deri nekrozu bildirilmemiştir. Birinci, 3., ve 6. aylarda gerçekleştirilen kontrollerde hastaların anababalrını da kabul edilebilir bulduğu iyi kozmetik sonuçlar saptanmıştır.Sonuç: Bu teknik sünnet derisine giden kan akımını bozmadığı, üretrokutanöz fistül ve deri nekrozu insidansını azalttığı için yararlı bir teknikti.Anahtar Kelimeler: Hipospadiyas; sünnet derisi; deri nekrozu; üretrokutanöz fistül.

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“…With distal hypospadias, covering the urethroplasty by a dorsal dartos flap is most popular, whereas with proximal hypospadias, the tunica vaginalis flap is another attractive alternative having the advantage of sparing intact vascularity of the dorsal skin to be used for coverage of the ventral shaft [22,23] . We have applied some modifications to facilitate covering the urethroplasty in proximal hypospadias by dartos flaps as well [12,13] . By these modifications, we managed to minimize skin complications and avoid unnecessary dissection around the testis and spermatic cord for preparing the tunica vaginalis flap.…”

Section: Discussionmentioning

confidence: 99%

“…To decrease postoperative skin complications, we apply a modification by splitting the dorsal prepuce into two halves (Byars flaps): one half supplies dartos for covering the urethroplasty, and the other half is spared to reconstruct the ventral penile skin ( Fig. 4b and d) [12] . For a long urethroplasty, another dartos flap is dissected from the nearby scrotum to cover proximal urethroplasty ( Fig.…”

Section: Surgical Techniquementioning

confidence: 99%

Tubularized Incised Plate Urethroplasty for Primary Hypospadias Repair: Versatility versus Limitations

AbouZeid

2017

JGS

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Introduction: Several techniques have been described for the repair of hypospadias but without any definitive privilege of one technique over the others. The choice of the repair remains largely dependent on the judgment and personal experience of the operating surgeon. Aim of Study: The aim of this study was to identify the most commonly encountered complications following tubularized incised plate (TIP) urethroplasty and their rate of occurrence in relation to different forms of hypospadias. Patients and Methods: This study was conducted on patients with different degrees of hypospadias (ranging from distal penile to scrotal hypospadias) who underwent primary TIP urethroplasty. All included cases were operated by the same surgeon (the author) at two tertiary centers for pediatric surgery during the period 2007 through 2016. Data analysis was performed in a retrospective manner based on retrieved medical records, in addition to saved digital photography documenting the preoperative phenotypic severity of the hypospadiac phallus, operative steps, appearance at follow-up visits, postoperative investigations, and reoperations. Results: We retrieved data of 193 patients with different degrees of hypospadias who underwent a primary TIP urethroplasty during the 10-year period of the study. All cases in the study completed their early postoperative follow-up (at 1 and 4 weeks). Approximately 40% of cases completed more than 1-year follow-up (mean: 2.3 years, median: 2 years). Rate of reoperation was 21.7% (20 cases for fistula, five recurrences of chordee, one meatal stenosis, and 16 skin refashioning and correction of penoscrotal interposition). All cases who returned for reoperation underwent urethral calibration under anesthesia±cystoscopy. Conclusion: TIP urethroplasty is a versatile technique that can be used for the repair of different degrees of hypospadias with low rate of complications. The main limitation is the presence of considerable chordee (moderate or severe) when urethral plate preservation and dorsal penile plication might be a suboptimal way of management that is liable for recurrence of the ventral curvature.

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Modified Byars’ flaps for securing skin closure in proximal and mid-penile hypospadias

Cited by 18 publications

References 16 publications

Ten Commandments of Hypospadias Surgery

Ten Commandments of Hypospadias Surgery

Pedicled preputial island flap for double functions in hypospadias surgery

Tubularized Incised Plate Urethroplasty for Primary Hypospadias Repair: Versatility versus Limitations

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