Redo hypospadias surgery: current and novel techniques

Kulkarni, Sanjay; Joglekar, Omkar; Alkandari, Mohammad H; Joshi, Pankaj

doi:10.2147/rru.s142989

Cited by 8 publications

(5 citation statements)

References 13 publications

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“…Authors also consider redo urethroplasty as gold standard for recurrent strictures with or without fistula as suggested by other researchers. [ 18 , 19 ]…”

Section: Discussionmentioning

confidence: 99%

Urinary Flow Rates in Anterior Hypospadias

Panigrahi¹,

Sharma²,

Chowdhary³

et al. 2023

African Journal of Paediatric Surgery

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Context: Hypospadias is a common urological anomaly which could be surgically corrected with good cosmetic results. Aims: We aimed to detect changes in urinary flow parameters both before and after tubularised incised plate urethroplasty (TIPU) using uroflowmetry. Settings and Design: Data collected were clinically implemented hypothesising the probability of urethrocutaneous fistula following stricture with Qmax variation. Materials and Methods: This study is a prospective analysis done from December 2017 to October 2019. A total of 104 cases of anterior hypospadias were included in the study. A single surgical unit did TIPU. Pre-operative and post-operative uroflowmetry was done, and Qmax was recorded at 3 months, 6 months and 1 year after surgery. Mean Qmax was calculated for all intervals. A significant decrease in Qmax of a child (<2 standard deviation) was ascertained. Urethral calibration was done in those cases with a significant decrease of Qmax and analysed statistically. Results: The mean age was 6.97 ± 2.41 years. Out of 104 children, 73 (70.2%) and 31 (29.8%) had distal and mid-shaft hypospadias, respectively. The pre-operative mean Qmax of the population was 6.20 ± 0.42 ml/s. Arithmetic mean Qmax at 3 months, 6 months and 1 year was 8.53 ± 0.42, 11.18 ± 0.47 and 13.71 ± 0.44 ml/s, respectively. On comparing the pre-operative with post-operative mean Qmax, a significant increase was found postoperatively ( P < 0.0001). Twenty-four patients had significantly decreased Qmax value after 6 months. In these patients, follow-up urethral dilation was done with significant improvement. Conclusion: The changes in maximum flow rate (Qmax) are suitable for use in routine follow-up. A significant decrease in Qmax over time indicates the onset of urethral stricture. These cases are to be intervened before venturing to redo urethroplasty.

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“…Authors also consider redo urethroplasty as gold standard for recurrent strictures with or without fistula as suggested by other researchers. [ 18 , 19 ]…”

Section: Discussionmentioning

confidence: 99%

Urinary Flow Rates in Anterior Hypospadias

Panigrahi¹,

Sharma²,

Chowdhary³

et al. 2023

African Journal of Paediatric Surgery

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“…During follow-up of more than 4 years there were nine complications (30%): eight meatal stenoses (five with fistulas) and one isolated fistula. [15] Kulkarni et al [16] reported that determining the type of urethroplasty to be performed depended on the following factors namely scarring of the urethral plate, width of urethral plate, width of glans, degree of chordee and ventral skin. Dorsal inlay graft technique is indicated whenever the urethral plate has been removed and only a strip of grossly healthy skin remained in its place.…”

Section: Discussionmentioning

confidence: 99%

Redo Hypospadias Repair: Our Experience in a Tertiary Care Centre

Chandra¹,

Patel²,

Nerli³

et al. 2021

IJCU

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Introduction: Treating children following a failed hypospadias repair can be challenging. Complications include urethrocutaneous fistulas, glans dehiscence, meatal stenosis and urethral strictures. Glans dehiscence remains the most common indication for re-operative urethroplasty. The repair can be challenging because of several factors including significant scarring and paucity of genital skin. We report our experience in the management of failed hypospadias repairs at our centre. Materials & Methods: We retrospectively reviewed and analysed the inpatient and outpatient records of children/adolescents undergoing redo-hypospadias repairs during the period Jan 2010 to Dec 2019. Results: A total of 37 children with a mean age of 8.62±3.76 (2 -17) years underwent a redo repair of hypospadias. Twenty children underwent two stage buccal mucosa urethroplasty, 11 underwent tubularized incised plate (TIP) urethroplasty, 5 dorsal inlay graft urethroplasty and 1 onlay flap urethroplasty. A total of three (8.10%) children developed an urethrocutaneous fistula needing an additional stage for repair. Uroflowmetry done in all children showed adequate maximum flow rates, with minimal to nil residuals. Conclusions: The majority of hypospadias failures can be salvaged with one stage surgery including Mathieu flip flap Urethroplasty, Tubularized incised plate urethroplasty and dorsal inlay graft urethroplasty. A two stage buccal mucosa urethroplasty may be necessary in cases wherein the urethral plate or skin substitute is grossly scarred, or the ventral curvature greater than 30 degrees. Complications do occur following redo procedures but eventually excellent functional and cosmetic results can be achieved.

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“…Over time, reconstructive surgeons have developed alternative approaches in order to decrease the burden of surgery. 8,9 Nowadays, the correction of ventral penile curvature is usually achieved with dorsal plications preceded by complete NVB mobilisation, without further disassembling. However, even if this approach appears to be less burdensome compared to the total disassembling, complete NVB mobilisation is still associated with a non-negligible risk of complications.…”

Section: Discussionmentioning

confidence: 99%

Partial mobilisation of the neurovascular bundle for ventral penile curvature correction: A proof-of-concept study

Joshi

Bandini

Barbagli

et al. 2021

Journal of Clinical Urology

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Background: To lift the neurovascular bundle (NVB) is a critical step during dorsal plications for ventral penile curvature correction. Indeed, this procedure may hesitate in nerves and vascular damage. Herein, we present a revolutionary approach of partial NVB mobilisation that avoids dissection among 10 and 2 o’clock positions decreasing the risk of injuring nerves and vessels. Methods: We assessed ventral penile curvature after penile degloving, marking the level of maximal bending. Bilateral para urethral incisions were made and the Buck’s fascia carefully mobilised from the tunica albuginea. The mobilisation of NVB was carried until 10 and 2 o’clock, avoiding the area between 10 and 2 o’clock positions, where nerves and vessels are more concentrated. The 10 and 2 o’clock positions correspond also to the dorsal edges of the two cavernosa cylinders, where plications are more effective. Penile straightening after surgery was defined as residual curvature less than 10 degrees. Results: Between 2016 and 2020, we have operated 33 men and 32 boys with ventral penile curvature. The severity of penile curvature was mid (<30 degrees) in 13 (20%) patients, moderate (30–60 degrees) in 33 (51%) patients, and severe (> 60 degrees) in 19 (29%) patients. Penile straight was achieved for all patients. We recorded three haematoma, three glans skin erosion, and one curvature recurrence after 13 months of follow-up. No patient reported erectile dysfunction. Conclusion: This proof-of-concept study shows that partial NVB mobilisation is technically easier and safer compared to complete NVB mobilisation, without compromising the success of surgery. Level of evidence: Not applicable

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Redo hypospadias surgery: current and novel techniques

Cited by 8 publications

References 13 publications

Urinary Flow Rates in Anterior Hypospadias

Urinary Flow Rates in Anterior Hypospadias

Redo Hypospadias Repair: Our Experience in a Tertiary Care Centre

Partial mobilisation of the neurovascular bundle for ventral penile curvature correction: A proof-of-concept study

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