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Cousin I, Basmaison C, Cousin E, Lebonvallet N, Germouty I, Leven C, De Vries P. Complication rates of proximal hypospadias: meta-analyses of four surgical repairs. J Pediatr Urol 2022; 18:587-597. [PMID: 36058812 DOI: 10.1016/j.jpurol.2022.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/28/2022] [Accepted: 08/12/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Proximal hypospadias surgery is impacted by a high complication rate. The goal of this work was to assess the overall composite complication rate, fistula rate and stenosis rate following proximal hypospadias surgery realized according to onlay urethroplasty, Duckett, Koyanagi and Bracka techniques. METHODS The databases MEDLINE, EMBASE, SCOPUS, Cochrane Library, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (CENTRAL) and Sciencedirect were searched. Studies had to report data about the mean age of population, the average duration of patient follow-up and the number of procedures required for surgical treatment of primary and proximal hypospadias. Two independent including one urologist reviewers screened all the articles and selected the articles to be included. RESULTS Overall composite complication rates were 32%, 34%, 49%, and 43%, for Onlay urethroplasty, Duckett's tubularized flaps urethroplasty, Koyanagi repair and Bracka 2 stages repair, respectively. Fistula rates were 13%, 18%, 21% and 23% respectively. The heterogeneity of complication rates reported in the different studies was not moderated by age, country, or patient's continent origin. DISCUSSION The classifications of complications used in articles were disparate and make comparisons between techniques difficult. The report of post-surgical complications in the literature is often poorly coded and follow-up times were often too short. CONCLUSION This meta-analysis attempts to determine to the extent possible, given the serious weaknesses in the hypospadias literature, plausible estimates of complication rates after skin flap urethroplasty. The patched onlay skin flap, the Duckett's tubularized skin flap technique, the Koyanagi's technique, and the Bracka's two-stage urethroplasty procedure lead to very high complication rates. Reported complication rates are comparable across techniques.
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Affiliation(s)
- Ianis Cousin
- Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire de Brest, Hôpital Augustin Morvan, 4 Avenue Foch, 29200 Brest, France; Laboratoire Intéraction épithéliums Neurones, Université de Bretagne Occidentale, 6 Rue Colbert, 29200 Brest, France.
| | - Camille Basmaison
- Laboratoire Intéraction épithéliums Neurones, Université de Bretagne Occidentale, 6 Rue Colbert, 29200 Brest, France
| | - Elie Cousin
- Department of Pediatry, Centre Hospitalier Universitaire de Rennes, 16 Boulevard de Bulgarie 35200 Rennes, France
| | - Nicolas Lebonvallet
- Laboratoire Intéraction épithéliums Neurones, Université de Bretagne Occidentale, 6 Rue Colbert, 29200 Brest, France
| | - Isabelle Germouty
- Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire de Brest, Hôpital Augustin Morvan, 4 Avenue Foch, 29200 Brest, France
| | - Cyril Leven
- Department of Pharmacology, Centre Hospitalier Régional Universitaire de Brest, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Philine De Vries
- Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire de Brest, Hôpital Augustin Morvan, 4 Avenue Foch, 29200 Brest, France; Laboratoire Intéraction épithéliums Neurones, Université de Bretagne Occidentale, 6 Rue Colbert, 29200 Brest, France
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¿Cuáles son los factores que afectan la dehiscencia del glande tras la cirugía de hipospadias? Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Karabulut R, Turkyilmaz Z, Atan A, Kaya C, Sonmez K. What are the factors affecting glanular dehiscence after hypospadias surgery? Actas Urol Esp 2021; 46:4-15. [PMID: 34838491 DOI: 10.1016/j.acuroe.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/29/2020] [Indexed: 10/19/2022]
Abstract
BACKGROUND Glanular dehiscence (GD) is one of the main complications after hypospadias surgery. There is a limited number of publications regarding GD in the literature. OBJECTIVE The aim of this work is to reveal the factors that affect GD after a literature review. EVIDENCE ACQUISITION A literature search for relevant articles was performed in database using the search term glans dehiscence without setting date range limit or any other limits. All articles related to GD after hypospadias surgery were included in this study. After collecting the information from full text articles, 71 articles were included in this systematic review. In these studies, localization of hypospadic meatus, type of surgery, and other clinical data which were thought to behave as risk factors for GD were obtained. Chi-Square test was used to evaluate the differences between the parameters, where p < 0.05 was taken as statistically significant. RESULTS After evaluating the 71 articles that met the inclusion criteria, 309 cases (3.48%) of GD after 8858 hypospadias repairs were obtained in this review. GD rates were found significantly high for proximal hypospadias (5%), two-stage hypospadia repairs (5%) and re-do hypospadias repair (8.75%) (p = 0.002, 0.022, and 0.004, respectively). Glans width <14 mm, urethral plate (UP) width <7 mm, hypospadias surgeries performed before 6 months of age and after puberty, and caudal block anesthesia increased the rate of GD. CONCLUSIONS The rate of GD increases after proximal, cripple and staged hypospadias surgeries, a glans width <15 mm and UP width <8 mm, postpubertal surgeries, and caudal anesthesia use during surgery.
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Affiliation(s)
- Ramazan Karabulut
- Gazi University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey.
| | - Z Turkyilmaz
- Gazi University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - A Atan
- Gazi University, Faculty of Medicine, Department of Urology, Ankara, Turkey
| | - C Kaya
- Gazi University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - K Sonmez
- Gazi University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
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Elmoghazy H, Saber M, Mamdoh A, Rashed E, Badawy AA, Riayd AM. Cosmetic and functional outcome for the use of stitch by stitch technique in hypospadias surgery; results of 235 patients. J Pediatr Urol 2020; 16:436.e1-436.e6. [PMID: 32386854 DOI: 10.1016/j.jpurol.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION One of the essential goals of hypospadias surgery is to create a cosmetically and functionally accepted penis with a near-normal looking glans and external meatus. AN OBJECTIVE We developed our technique stitch by stitch to allow glans closure in a conical manner with centrally located external urethral meatus in hypospadias repair using onlay flap. STUDY DESIGN (PATIENT AND METHODS) A total of 235 hypospadias male patients (0.5-30 years old) were included in the study. All of them treated by flap urethroplasty techniques and meatoglanuloplasty using stitch by stitch technique. Operative technique (described in details by illustrations); starts with penile degloving, preparation of the flap (Site of hypospadic meatus is determined after degloving). Creation of a narrow strip of the urethral plate with wide glanular wings is done using bilateral incisions which are extended to the tip of the glans. The width of the urethral plate is about 3 mm then we suture the flap to the narrow urethral plate in two layers in continuous manner using vicryl 6/0 over a suitable plastic catheter. Triangular (V shape) area of the distal part of the flap is excised at the midline. After this we anastomose the flap to the tip of the glans. The glans appears opened in the midline as inverted V shape. Closure of the glans is finished in the midline using three mattress interrupted sutures with another three simple stitches are used in between. RESULTS From February 2007 to December 2016; 235 hypospadias patients fulfilled criteria and were included in our prospective cohort study table (1). DISCUSSION The meatoplasty technique and stitch-by-stitch glans closure were used in all patients. Excellent results were achieved with an overall degree of satisfaction of 87% in patients older than six years (based on the Pediatric Penile Perception Score), and 84% in patients younger than six years. The complication rate was low at 8.5% and was related to a failure of the flap technique. Many surgical techniques have been described for glans closure and meatoplasty with variable outcomes, but none of them fits all patients with hypospadias; each procedure has its limitations and demands specific selection criteria. Limitations of this study come from a relatively short follow-up, and a single surgeon experience that needs to be reproduced by other surgeons. CONCLUSION Meatoglanuloplasty using stitch-by-stitch technique provides satisfactory cosmetic and functional results in hypospadias patients.
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Affiliation(s)
- Hazem Elmoghazy
- Department of Urology, Sohag University Hospital, Sohag, Egypt.
| | - Mohamed Saber
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | - Ahmed Mamdoh
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | - Elnisr Rashed
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | | | - Ahmed M Riayd
- Department of Urology, Sohag University Hospital, Sohag, Egypt
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Adamyan RT, Kamalov AA, Ehoyan MM, Starceva OI, Urshevich EN, Sinelnikov MY. Scrotal Tissues: The Perfect Material for Urogenital Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2948. [PMID: 32802649 PMCID: PMC7413779 DOI: 10.1097/gox.0000000000002948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/08/2020] [Indexed: 02/06/2023]
Abstract
Correction of male urogenital pathology of different severity is complicated by the anatomical aspects of the penis. Skin texture, internal structures, and perfusion dynamics of the urogenital area make it a difficult area to reconstruct. We provide our experience with axial scrotal flaps for correction of penile defects of different severity and believe that these local flaps offer sufficient tissue characteristics for proper restoration of this complex region. METHODS Forty-eight patients were divided into 3 groups depending on penile defect genesis and severity. Axial scrotal flap reconstruction was used for the correction of defects in all cases, when necessary in combination with other flaps. RESULTS Axial scrotal flaps for total and subtotal penile reconstruction serve as valuable material for reconstruction of the urogenital area, and are to be combined with other flaps for restoration of bulk tissues. Localized defects of the penis and urethra reconstructed by axial scrotal flaps provide excellent aesthetic results with minimal scaring, stable perfusion dynamics, and high satisfaction rate. CONCLUSIONS Scrotal tissues provide an excellent reconstruction material for penile defects because of their highly similar tissue structure as that of the penis. Scrotal axial flaps do not provide excess bulking in the postoperative period and are recommended for reconstruction of urethral and localized penile defects. Multistage surgery is recommended in cases of severe tissue damage, in combination with other flaps (inguinal, thoracodorsal, and radial).
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Affiliation(s)
- Ruben T. Adamyan
- From the Department of Plastic and Reconstructive Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
- Department of Oncology, Radiotherapy and Plastic Surgery, Sechenov University, Moscow, Russian Federation
| | - Armais A. Kamalov
- From the Department of Plastic and Reconstructive Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
- Department of Oncology, Radiotherapy and Plastic Surgery, Sechenov University, Moscow, Russian Federation
| | - Misak M. Ehoyan
- From the Department of Plastic and Reconstructive Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
- Department of Oncology, Radiotherapy and Plastic Surgery, Sechenov University, Moscow, Russian Federation
| | - Olesya I. Starceva
- From the Department of Plastic and Reconstructive Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
- Department of Oncology, Radiotherapy and Plastic Surgery, Sechenov University, Moscow, Russian Federation
| | - Eduard N. Urshevich
- From the Department of Plastic and Reconstructive Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
- Department of Oncology, Radiotherapy and Plastic Surgery, Sechenov University, Moscow, Russian Federation
| | - Mikhail Y. Sinelnikov
- From the Department of Plastic and Reconstructive Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
- Institute of Regenerative Medicine, Sechenov University, Moscow, Russian Federation
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Elmoghazy H. Use of Bipedicled Dorsal Penile Flap With Z Release Incision: A New Option in Redo Hypospadias Surgery. Urology 2017; 106:188-192. [PMID: 28495506 DOI: 10.1016/j.urology.2017.04.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/25/2017] [Accepted: 04/30/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To solve the challenge in redo hypospadias surgery, we tried to use a bipedicled dorsal penile flap with a Z release incision in failed hypospadias cases and reported the outcome. MATERIALS AND METHODS Thirty male children with 3 or 4 previous unsuccessful hypospadias surgeries were included in our study. Our technique was done after at least 6 months from the last surgery. A flap of the dorsal penile skin was preserved and the skin lateral to the flap was dissected on each side. A small opening was done in the dartos proximal to flap. The glans was withdrawn through this opening with a ventral transposition of the flap. Z-plasty was used to compensate for the deficient dorsal skin; the Z-plasty had 3 limbs and all were made of equal length. RESULTS The mean age of the patients was 5.4 ± 1.8 years and the mean follow-up was 2.1 ± 0.7 years. The technique was successful in 80%. Reoperation was required in 3 cases; all cases were managed using a 2-stage buccal mucosal graft. A small fistula at the coronal level developed in 2 cases but closed spontaneously within 1 month. All patients were voiding well and had a vertically oriented meatus at the tip of the glans and satisfactory cosmetic results. CONCLUSION Repair of failed hypospadias using a bipedicled dorsal penile skin flap with Z release incision is a safe and simple procedure offering high success rates.
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Liu Y, Ma W, Liu B, Wang Y, Chu J, Xiong G, Shen L, Long C, Lin T, He D, Butnaru D, Alexey L, Zhang Y, Zhang D, Wei G. Urethral reconstruction with autologous urine-derived stem cells seeded in three-dimensional porous small intestinal submucosa in a rabbit model. Stem Cell Res Ther 2017; 8:63. [PMID: 28279224 PMCID: PMC5345143 DOI: 10.1186/s13287-017-0500-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 12/31/2016] [Accepted: 02/09/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Urethral reconstruction is one of the great surgical challenges for urologists. A cell-based tissue-engineered urethra may be an alternative for patients who have complicated long strictures and need urethral reconstruction. Here, we demonstrated the feasibility of using autologous urine-derived stem cells (USCs) seeded on small intestinal submucosa (SIS) to repair a urethral defect in a rabbit model. METHODS Autologous USCs were obtained and characterized, and their capacity to differentiate into urothelial cells (UCs) and smooth muscle cells (SMCs) was tested. Then, USCs were labeled with PKH67, seeded on SIS, and transplanted to repair a urethral defect. The urethral defect model was surgically established in New Zealand white male rabbits. A ventral urethral gap was created, and the urethral mucosa was completely removed, with a mean rabbit penile urethra length of 2 cm. The urethral mucosal defect was repaired with a SIS scaffold (control group: SIS with no USCs; experimental group: autologous USC-seeded SIS; n = 12 for each group). A series of tests, including a retrograde urethrogram, histological analysis, and immunofluorescence, was undertaken 2, 3, 4, and 12 weeks after the operation to evaluate the effect of the autologous USCs on urethral reconstruction. RESULTS Autologous USCs could be easily collected and induced to differentiate into UCs and SMCs. In addition, the urethral caliber, speed of urothelial regeneration, content of smooth muscle, and vessel density were significantly improved in the group with autologous USC-seeded SIS. Moreover, inflammatory cell infiltration and fibrosis were found in the control group with only SIS, but not in the experimental autologous USC-seeded SIS group. Furthermore, immunofluorescence staining demonstrated that the transplanted USCs differentiated into UCs and SMCs in vivo. CONCLUSIONS Autologous USCs can be used as an alternative cell source for cell-based tissue engineering for urethral reconstruction.
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Affiliation(s)
- Yang Liu
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, 400014 China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Child Urogenital Development and Tissue Engineering, Chongqing, 400014 China
| | - Wenjun Ma
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, 400014 China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Child Urogenital Development and Tissue Engineering, Chongqing, 400014 China
- Chongqing Engineering Research Center of Stem Cell Therapy, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Liu
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, 400014 China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Child Urogenital Development and Tissue Engineering, Chongqing, 400014 China
| | - Yangcai Wang
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, 400014 China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Child Urogenital Development and Tissue Engineering, Chongqing, 400014 China
| | - Jiaqiang Chu
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, 400014 China
- Chongqing Engineering Research Center of Stem Cell Therapy, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Geng Xiong
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, 400014 China
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27101 USA
| | - Lianju Shen
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Child Urogenital Development and Tissue Engineering, Chongqing, 400014 China
| | - Chunlan Long
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Child Urogenital Development and Tissue Engineering, Chongqing, 400014 China
| | - Tao Lin
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, 400014 China
| | - Dawei He
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, 400014 China
| | - Denis Butnaru
- Research Institute for Uronephrology, Sechenov First Moscow State Medical University, Moscow, 119991 Russia
| | - Lyundup Alexey
- Biomedical Research Department of Institute of Molecular Medicine, Sechenov First Moscow State Medical University, Moscow, 119991 Russia
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27101 USA
| | - Deying Zhang
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, 400014 China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Child Urogenital Development and Tissue Engineering, Chongqing, 400014 China
| | - Guanghui Wei
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, 400014 China
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