Surgical management of primary severe hypospadias in children: an update focusing on penile curvature

Castagnetti, Marco; El-Ghoneimi, Alaa

doi:10.1038/s41585-021-00555-0

Cited by 18 publications

(19 citation statements)

References 76 publications

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“…Regarding the former, associated curvature is a known marker of severity of hypospadias, which determines the complexity of the repair, the risk of complications, and the final satisfaction [ 15 – 17 ]. Regarding the technique, present results corroborate our opinion that the staged approach is one of the most effective approaches to correct curvature and to prepare the glans for subsequent reconstruction [ 18 – 21 ].…”

Section: Discussionsupporting

confidence: 81%

Glans dehiscence after severe hypospadias repair. Is it a real complication? Clues from a study in post-pubertal patients

et al. 2023

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Introduction Glans dehiscence (GD) is reportedly a common complication after proximal hypospadias repairs. However, the need for surgical correction is controversial. The aim of this study was to assess awareness, risk factors, and outcome of GD in post-pubertal patients. The agreement with surgeon assessment was also evaluated. Methods The design was retrospective. All consecutive patients treated for proximal hypospadias between 2000 and 2011 were included. The presence of GD was self-reported, and the participants could optionally upload a photograph for surgeon assessment. Cosmetic and functional outcomes were assessed by validated questionnaires (HOSE, PPPS, KINDL®, IIEF-5). Results were compared between patients with and without GD. Results Of 219 patients, 34 (16%) participated. Fourteen of them (41%) self-reported GD. Eighteen patients (8%) also uploaded a photograph and, in ten of them (56%), the surgeon noted the presence of GD with poor agreement [k = − 0.444 (95 CI − 0.856 to − 0.033)] with patient report. Patients self-reporting GD had had more frequently a penile curvature at diagnosis (12/14 = 86%, p = 0.01), and had undergone a single-staged repair (100% vs. 65%, p = 0.03). No difference was found in cosmetic and functional outcomes. Results were similar also comparing groups with and without GD as assessed by the surgeon. Conclusion GD was a common finding after severe hypospadias repair. It was more common in case of surgeon assessment with poor agreement between patients and surgeons. GD did not prove to have clear clinical implications. Therefore, in our opinion, surgical repair of GD should be recommended only on patients request.

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Section: Discussionsupporting

confidence: 81%

Glans dehiscence after severe hypospadias repair. Is it a real complication? Clues from a study in post-pubertal patients

et al. 2023

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“…Castagnetti et al argued that surgeon experience is more important than the technique itself [42]. When choosing the type of repair, personal preference, training, and success rate when using a speci c technique should be considered as important variables.…”

Section: Resultsmentioning

confidence: 99%

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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“…Therefore, a definite classification can only be completed at intra-operative findings. The curvature and meatal position were both important factors to describe the severity of hypospadias ( 15 ). In 2010, Castagnetti et al ( 16 ) performed a systematic review of the management of primary severe hypospadias, and suggested 30° as the minimum cut-off point for defining a curvature as clinically significant.…”

Section: Discussionmentioning

confidence: 99%

“…Snodgrass et al suggested that to gain expertise from greater volumes of cases, surgeons/teams should be designated for proximal hypospadias repair in each center ( 43 ). Castagnetti et al argued that surgeon experience is more important than technique ( 15 ). When choosing the type of repair, personal preference, training, and success rate when using a specific technique should be considered as important variables.…”

Section: Discussionmentioning

confidence: 99%

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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Surgical management of primary severe hypospadias in children: an update focusing on penile curvature

Cited by 18 publications

References 76 publications

Glans dehiscence after severe hypospadias repair. Is it a real complication? Clues from a study in post-pubertal patients

Glans dehiscence after severe hypospadias repair. Is it a real complication? Clues from a study in post-pubertal patients

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

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