Two-layer versus one-layer closure in transverse island flap repair of posterior hypospadias

Chuang, Jiin‐Haur; Shieh, Chie-Song

doi:10.1016/0022-3468(95)90705-x

Cited by 24 publications

(20 citation statements)

References 13 publications

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“…In particular, only one fistula developed among the 70 patients who underwent the repair. Chuang and Shieh repaired 103 patients with moderately severe hypospadias by the Duckett procedure 20 . They reported that the overall complication rate was significantly lower in two‐layer closure than in one‐layer closure (15% vs 45%).…”

Section: Discussionmentioning

confidence: 99%

“…Duckett adopted tubularized island flaps urethroplasty to those with a very proximal meatus in the perineum by taking the inner‐skin margin as a flap as long as 6–7 cm 24 . In contrast, Chuang and Shieh reported that those with a neourethra less than 3 cm in length had significantly less complications than those with a neourethra longer than 3 cm 20 . These findings show that one‐stage Duckett urethroplasty is appropriate for the repair of moderately severe hypospadias, although probably not for the repair of extremely severe hypospadias.…”

Section: Discussionmentioning

confidence: 99%

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One‐stage repair of moderately severe hypospadias using a transverse preputial tubularized island flap

et al. 2001

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Background: Transverse preputial tubularized island flap (TPTIF) urethroplasty has been used for the repair of moderately severe hypospadias since Duckett described the procedure in 1980. In spite of the excellent results reported by Duckett, subsequent studies showed high complication rates. A TPTIF procedure modified to reduce the complication rate is presented. Methods: Between 1996 and 1997, 13 boys with moderately severe hypospadias were repaired with the TPTIF procedure. Patient age ranged from 10 months to 3 years with an average age of 23 months. To prevent urethrocutaneous fistula, the neourethra was constructed with a two-layer closure and the portion of anastomosis was wrapped between the native urethra and the neourethra with the tissue of the corpus spongiosum. Results:The moderately severe hypospadias was repaired without complication in 12 of 13 patients. A urethrocutaneous fistula developed at the midshaft of the penis in one patient. No meatal stenosis, urethral stricture or diverticulum developed. Conclusion: Transverse preputial tubularized island flap urethroplasty provided excellent cosmetic and functional results for moderately severe hypospadias, and postoperative complications could be decreased by the two-layer closure of the neourethra and application of the wrapping technique of the proximal anastomosed portion with corpus spongiosum tissue.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

One‐stage repair of moderately severe hypospadias using a transverse preputial tubularized island flap

et al. 2001

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“…Then he stopped using dartos and instead routinely covered the neourethra with tunica vaginalis, and the last published series of patients had no fistulas [18]. A retrospective review analyzed preputial flap repair for proximal hypospadias tubularizing the neourethra in either one or two layers and also reported a significant reduction in fistulas in those with two-layer urethroplasty [19]. …”

Section: Urethroplastymentioning

confidence: 99%

Recent advances in understanding/management of hypospadias

Snodgrass¹,

Bush²

2014

F1000Prime Rep

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Hypospadias is the second most common birth anomaly, affecting 1 of every 300 males. The abnormal position of the urinary opening, and associated downward curvature of the penis in some cases, potentially impact both urinary and sexual function. Modern surgical correction most often involves tubularization of the urethral plate, those tissues which normally should have completed urethral development.This article discusses recent progress in hypospadias repair. Prospective data collection in consecutive patients promotes better understanding of both patient and technical factors that influence surgical complications. Patients with a proximal urinary opening near or within the scrotum, those failing prior to repairs, and/or those with a small glans diameter have increased likelihood for urethroplasty complications. Quality review of reliable data led to two layer urethroplasty covered with tunica vaginalis in proximal repairs, significantly reducing postoperative fistulas. Neither preoperative androgens used to grow a small diameter glans, nor a change in sutures used to approximate the glans wings reduced wound dehiscence, but a recent technical modification of the glansplasty with more extensive dissection before suturing has. The observation that reoperation increases risk for further complications three-fold suggests the less common proximal repairs and reoperations should be subspecialized so that designated surgeons can gain greater expertise.In addition, surgeons performing hypospadias repair must better define the complications that occur so that scientific reporting of outcomes becomes more standardized. Standardized objective means to assess results are also needed so that surgeons performing different repairs can compare outcomes.

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“…Coverage of the urethroplasty with multiple layers of well-vascularized tissue is particularly important for both distal and proximal hypospadias. [47][48][49] The flaps most commonly used for uethroplasty coverage include flaps of subcutaneous dartos elevated from around the urethral plate, the prepucial pedicle transposed ventrally, and the tunica vaginalis flap. The importance of suture materials is unclear.…”

Section: Technical Detailsmentioning

confidence: 99%

“…52,53 Postoperative management In one study, early mobilization (within 48 h postoperatively) was shown to decrease the incidence of fistulas from 22% to 9.8%, whereas factors such as catheter dislodgement and blockage, presence of postoperative erections, constipation-related straining, and interference with dressings were associated with increased complication rates. 54 However, type and duration of urinary diversion, type of dressing, catheter size, and anaesthetic regime have been shown not to significantly influence outcomes, 55 and a recent review of the literature on perioperative management of primary severe hypospadias concluded that most interventions, such as postoperative antibiotic prophylaxis or wound dressing, [56][57][58] are based on weak evidence and their influence on repair outcomes is poorly defined. 23 Only postoperative urinary drainage has been consistently shown to be a critical factor in reducing the complication rate.…”

Section: Technical Detailsmentioning

confidence: 99%

Failed hypospadias in paediatric patients

et al. 2013

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| Failed hypospadias refers to any hypospadias repair that leads to complications or causes patient dissatisfaction. The complication rate after hypospadias repairs ranges from 5-70%, but the actual incidence of failed hypospadias is unknown as complications can become apparent many years after surgery and series with lifelong follow-up data do not exist. Moreover, little is known about uncomplicated repairs that fail in terms of patient satisfaction. Risk factors for complications include factors related to the hypospadias (severity of the condition and characteristics of the urethral plate), the patient (age at surgery, endocrine environment, and wound healing impairment), the surgeon (technique selection and surgeon expertise), and the procedure (technical details and postoperative management). The most important factors for preventing complications are surgeon expertise (number of cases treated per year), interposition of a barrier layer between the urethroplasty and the skin, and postoperative urinary drainage. Major complications associated with failed hypospadias include residual curvature, healing complications (preputial dehiscence, glans dehiscence, fistula formation, and urethral breakdown), urethral obstruction (meatal stenosis, urethral stricture, and functional obstruction), urethral diverticula, hairy urethra, and penile skin deficiency.

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Two-layer versus one-layer closure in transverse island flap repair of posterior hypospadias

Cited by 24 publications

References 13 publications

One‐stage repair of moderately severe hypospadias using a transverse preputial tubularized island flap

One‐stage repair of moderately severe hypospadias using a transverse preputial tubularized island flap

Recent advances in understanding/management of hypospadias

Failed hypospadias in paediatric patients

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