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Costa E, Fraga JC, Salle JP, Rosito N. Does parental opinion differ from the health care team regarding cosmesis after hypospadias repair? ACTA ACUST UNITED AC 2021; 67:33-38. [PMID: 34161487 DOI: 10.1590/1806-9282.67.01.20200062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/20/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Hypospadias is the most common malformation of the male genitalia. Surgical correction has traditionally focused on anatomic and functional outcomes, with less attention being paid to cosmetic results. Our purpose is to compare the cosmetic results of hypospadias repair among different groups of observers, namely the patient's family and the health care team, using photography and a simple rating scale. METHODS Prospective observational study included 9 boys undergoing Snodgrass hypospadias repair. Photographs of the penis taken before, immediately after, and six months after surgery were assessed by a panel of 15 observers (parents and health care team) and a scale including three questions with diagrams for comparison with the pictures was used. Observers also assigned an overall postoperative score for the cosmetic result. RESULTS Interobserver agreement was noted for the group of parents of other children with hypospadias regarding the shape of the glans (k=0.404; p=0.008) and for the group of pediatric surgeons regarding the degree of residual curvature (k=0.467; p=0.005). Two observers in the pediatrician group have indicated good performance in the assessment of residual curvature (k=0.609; P=0.024). In the overall assessment of cosmetic outcomes, the highest scores were assigned by observers in the parents group and in the pediatrician group, while the pediatric surgeons group has one of the lowest scores (p<0.001). CONCLUSIONS Photography appears to be suitable for documenting corrections of hypospadias regarding penile curvature, and postoperative cosmetic result. Surgeons seem more concerned about cosmesis than parents.
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Affiliation(s)
- Eduardo Costa
- Universidade Federal do Rio Grande do Sul; Hospital de Clínicas de Porto Alegre - Porto Alegre (RS), Brasil
| | - José Carlos Fraga
- Universidade Federal do Rio Grande do Sul; Hospital de Clínicas de Porto Alegre - Porto Alegre (RS), Brasil
| | | | - Nicolino Rosito
- Hospital de Clínicas de Porto Alegre - Porto Alegre (RS), Brasil
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Zhang Y, Shen Z, Zhou X, Chi Z, Hong X, Huang Y, Huang H, Chen S, Lan K, Lin J, Wu W, Zhou Y, Zhang Y. Comparison of meatal-based flap (Mathieu) and tubularized incised-plate (TIP) urethroplasties for primary distal hypospadias: A systematic review and meta-analysis. J Pediatr Surg 2020; 55:2718-2727. [PMID: 32439182 DOI: 10.1016/j.jpedsurg.2020.03.013] [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: 01/23/2020] [Revised: 03/10/2020] [Accepted: 03/20/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE We conducted this meta-analysis to compare postoperative outcomes between meatal-based flap (Mathieu) and tubularized incised plate (TIP) techniques for distal hypospadias. METHODS A comprehensive literature search of PUBMED, Web of Science, EMBASE, and Cochrane Library was conducted. Outcomes evaluated in this review were fistula, meatal stenosis, wound dehiscence and flap necrosis. We calculated odds ratio (OR) with 95% confidential interval (CI) to compare postoperative outcomes between Mathieu and TIP after data extraction and literature identification. All data were analyzed using Review Manager 5.2. In order to find potential affective factors, meta-regression and subgroup analyses were applied. RESULTS 16 studies, 1386 patients, including 762 patients receiving Mathieu and 624 individuals subjected to TIP met the inclusion criteria. The synthetic data suggested that Mathieu and TIP were comparable in terms of fistula (OR = 0.93; 95% CI: 0.65 to 1.33; P = 0.70, I2 = 14%), wound dehiscence (OR = 0.89; 95% CI: 0.33 to 2.39; P = 0.81, I2 = 11%), and flap necrosis (OR = 1.9; 95% CI: 0.51 to 7.09; P = 0.20, I2 = 38%) without significant heterogeneity for each comparison group. Pooled estimates showed a significantly lower rate of meatal stenosis with Mathieu than with TIP (OR = 0.41; 95% CI: 0.24 to 0.73; P = 0.002, I2 = 4%). Subgroup analyses showed that the difference between Mathieu and TIP was more obvious in the studies published before 2013 in meatal stenosis. The modified Mathieu technique and a running suture for urethroplasty might be relevant to a lower rate of meatal stenosis in the data, although no statistical significance in the present effects model overall was found. One-way sensitivity analysis showed that the results were stable. There was no publication bias detected using both funnel plot and Egger's test. CONCLUSION This meta-analysis suggested that Mathieu and TIP technique were equivalent for primary distal hypospadias in terms of fistula, wound dehiscence, and flap necrosis. Pooled estimates indicated that there was a lower rate of meatal stenosis with Mathieu rather than with TIP significantly. The modified Mathieu technique and a running suture for urethroplasty might be relevant to a lower rate of meatal stenosis. TYPE OF STUDY Meta-analysis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yuanfeng Zhang
- Department of Urology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Zeren Shen
- Department of Plastic Surgery,First affiliated hospital of Zhejiang University, Hangzhou, Zhejiang, China
| | - Xinye Zhou
- Department of Reproductive Medicine Center,Shantou Central Hospital, Shantou, Guangdong, China
| | - Zepai Chi
- Department of Urology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Xuwei Hong
- Department of Urology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Yi Huang
- Department of Urology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Hong Huang
- Department of Urology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Shaochuan Chen
- Department of Urology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Kaijian Lan
- Department of Urology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Jiahua Lin
- Department of Urology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Weichu Wu
- Department of Urology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Yizhou Zhou
- Department of Urology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Yonghai Zhang
- Department of Urology, Shantou Central Hospital, Shantou, Guangdong, China.
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Nonstented Tubularized Incised Plate Distal Hypospadias Repair: A Single Center 5 Years' Experience. Urology 2020; 146:207-210. [PMID: 32822686 DOI: 10.1016/j.urology.2020.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/01/2020] [Accepted: 08/09/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To report our immediate and delayed outcomes of nonstented tubularized incised plate (TIP) distal hypospadias repair. METHODS We retrospectively reviewed all charts of children who underwent distal hypospadias repair in a single children's hospital from 2013 to 2018. Patients' demographics, hypospadias characteristics, operative technique, and immediate and delayed outcomes were recorded. RESULTS Of 280 consecutive distal hypospadias repairs that were identified, 74 were excluded due to the use of a repair other than TIP. Eleven stented TIP repairs were excluded as well. Of 195 nonstented repairs, immediate postoperative voiding complications were recorded in 11 (5.6%) and included multiple/split stream in 6 (3%), dysuria and voiding difficulty in 2 (1%), urinary retention in 2 (1%), and gross hematuria that spontaneously resolved in 1 (0.5%). Late follow up was recorded in 142 of 195 (72.8%) repairs. Delayed urethroplasty/glansplasty complications were recorded in 12 (8.5%) and included urethrocutaneous fistula in 10 (7.0%), meatal stenosis in 6 (4.2%) and glans/urethroplasty dehiscence in 2 (1.4%). CONCLUSION Avoiding postoperative urethral stents in distal hypospadias TIP repair reduces the morbidity associated with the stent and is a feasible option that carries acceptable immediate and delayed complication rates. Avoiding the stent eliminates stent-related bladder spasms, the need for other medications, and the short-term office visit for stent removal, therefore reducing parental anxiety, patient discomfort, and reducing cost.
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Bagnara V, Giammusso B, Castagnetti M, Esposito C, Bianchi A. Distal hypospadias repair using the needle point bipolar cutting-coagulation forceps. J Pediatr Urol 2020; 16:69.e1-69.e5. [PMID: 31740147 DOI: 10.1016/j.jpurol.2019.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To determine the outcome of distal hypospadias repairs performed using bipolar diathermy (BD) for all the dissection. METHODS Retrospective review of 310 patients undergoing distal hypospadias (264 subcoronal/distal penile and 46 coronal/glanular) over a 11-year period. Median age at surgery was 2.0 years (range 9 months-15 years). Caudal anesthesia was performed in all patients. All children underwent an in situ tubularization of the urethral plate, which was combined with midline incision of the plate in 30 (10%). Preputial reconstruction was performed in 303 (98%) patients. BD forceps was used for coagulation and for all the dissection including skin incision, elevation of glans wings, separation of the corpus spongiosum from the corpora cavernosa, and urethral plate incision, when deemed appropriate. The authors assessed surgical complications and cosmetic results. The latter using the hypospadias objective score (HOSE), with a score ≥ 14 considered as acceptable. RESULTS The average operative time was 70 min. There was no postoperative bleeding or hematomas that required surgical intervention. There were no wound infections or necrosis. Complications occurred in 37 patients (11.9%). Urethral fistula formation was the commonest (n = 18). Postoperative persistent preputial swelling occurred in 3.5% of cases. Two hundred twelve patients (90.6%) had a HOSE score ≥ 14, and no patient required revision surgery for skin problems after a median follow-up of 8.1 (range 1.2-13.1) years. DISCUSSION The study is limited by its retrospective nature and by the fact that a number of other pre-operative, intra-operative, and postoperative variables can affect outcome. CONCLUSIONS Bipolar diathermy can be safely used for distal hypospadias repairs. It allowed careful control of intra-operative bleeding and also clear visualization of tissue planes. Complication rate overall compares favorably with the literature, and cosmetic results were satisfactory.
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Affiliation(s)
- V Bagnara
- Paediatric Surgery Unit, Polyclinic G.B. Morgagni, Catania, Italy.
| | - B Giammusso
- Paediatric Surgery Unit, Polyclinic G.B. Morgagni, Catania, Italy
| | - M Castagnetti
- Section of Paediatric Urology, Department of Surgical, Oncological and Gastrointestinal Sciences, University Hospital of Padova, Padua, Italy
| | - C Esposito
- Paediatric Surgery Unit, University Hospital of Naples, Naples, Italy
| | - A Bianchi
- Specialist Paediatric Reconstructive Surgeon, Royal Manchester Children's Hospital, United Kingdom
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Distal Urethroplasty and Glanuloplasty Procedure Can be Suitable for All Types of Glanular/Subcoronal Hypospadias. Urology 2019; 124:248-253. [DOI: 10.1016/j.urology.2018.06.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/08/2018] [Accepted: 06/18/2018] [Indexed: 11/18/2022]
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Keays MA, Dave S. Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes. Can Urol Assoc J 2017; 11:S48-S53. [PMID: 28265319 DOI: 10.5489/cuaj.4386] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In this article, we present the current approach to hypospadias, a review of the classification, preoperative evaluation, and factors that enable decision-making during surgery. We will then discuss patient-reported outcomes, evaluating the patients' and parents' perspectives regarding hypospadias repair.
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Affiliation(s)
- Melise A Keays
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Sumit Dave
- Division of Urology, Department of Surgery and Pediatrics, London Health Sciences Centre, London, ON, Canada
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Abstract
This review summarizes data regarding commonly used surgical techniques to repair distal and proximal hypospadias. We review evidence concerning indications for various procedures used in primary hypospadias repair, and their complications, urinary function and esthetic results. Available evidence suggests TIP is preferable to Mathieu for distal hypospadias correction. Current data do not identify a clear preference between TIP and onlay flap for proximal repair when there is ventral curvature <30°, or between various flap and graft options when curvature is >31°. A review of objective data helps clarify decision-making for distal hypospadias repair. Additional objective evidence is needed to identify preferred options for proximal hypospadias repair. Measuring glansplasty dimensions (meatal size and distance from meatus to corona) may improve urinary function assessments, and provide additional objective data for decision-making between various surgical techniques.
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Snodgrass W, Bush N. Primary hypospadias repair techniques: A review of the evidence. Urol Ann 2016; 8:403-408. [PMID: 28057982 PMCID: PMC5100143 DOI: 10.4103/0974-7796.192097] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 02/28/2016] [Indexed: 11/23/2022] Open
Abstract
This review summarizes data regarding commonly used surgical techniques to repair distal and proximal hypospadias. We review evidence concerning indications for various procedures used in primary hypospadias repair, and their complications, urinary function and esthetic results. Available evidence suggests TIP is preferable to Mathieu for distal hypospadias correction. Current data do not identify a clear preference between TIP and onlay flap for proximal repair when there is ventral curvature <30°, or between various flap and graft options when curvature is >31°. A review of objective data helps clarify decision-making for distal hypospadias repair. Additional objective evidence is needed to identify preferred options for proximal hypospadias repair. Measuring glansplasty dimensions (meatal size and distance from meatus to corona) may improve urinary function assessments, and provide additional objective data for decision-making between various surgical techniques.
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Wang F, Xu Y, Zhong H. Systematic review and meta-analysis of studies comparing the perimeatal-based flap and tubularized incised-plate techniques for primary hypospadias repair. Pediatr Surg Int 2013; 29:811-21. [PMID: 23793987 DOI: 10.1007/s00383-013-3335-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE To conduct a systematic review and meta-analysis of studies comparing the perimeatal-based flap (PBF) and tubularized incised-plate (TIP) techniques for primary hypospadias repair and determine whether the two techniques had similar reported outcomes. METHODS The PubMed, Embase and Cochrane databases were searched using the terms: hypospadias, Snodgrass, TIP*, tubularized incised plate, tubularized incised-plate, Mathieu*, perimeatal-based flap, perimeatal flap, meatal-based flap and meatal based flap. No other limits were used. Inclusion criteria included: primary hypospadias repair only; both including the PBF and TIP techniques; at least one of the quantitative outcomes obtainable from study; comparative studies. RESULTS Twelve studies fulfilled the inclusion criteria and were included in the final analysis. Meta-analysis showed that there were no significant differences between the two techniques when comparing fistula (OR = 1.47; 95 % CI: 0.82-2.63; P = 0.20), meatal stenosis (OR = 0.53; 95 % CI: 0.24-1.16; P = 0.11), and wound dehiscence (OR = 0.82; 95 % CI: 0.24-2.84; P = 0.76). Both the studies which assessed cosmesis objectively showed a consistent better cosmetic result of the TIP technique (P < 0.05). CONCLUSION There were no significant differences of complication rates between the two techniques, and the TIP technique was usually of better cosmesis. Given the large clinical heterogeneity among studies, future more well-designed studies with full data and uniform criterion were awaited.
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Affiliation(s)
- Furan Wang
- Ningbo Women and Children's Hospital, No. 339 Liuting Street, Ningbo, Zhejiang, 315012, People's Republic of China.
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Weber DM, Landolt MA, Gobet R, Kalisch M, Greeff NK. The Penile Perception Score: an instrument enabling evaluation by surgeons and patient self-assessment after hypospadias repair. J Urol 2012; 189:189-93. [PMID: 23174225 DOI: 10.1016/j.juro.2012.08.178] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Studies of the outcome of hypospadias repair must document quality, including assessment of complications and appraisal of appearance. To our knowledge the Pediatric Penile Perception Score is the first validated instrument for the outcome assessment of hypospadias repair in prepubertal males by surgeons and patients. We validated the instrument for adult genitalia. MATERIALS AND METHODS Standardized photographic documentation was prepared for 19 men after hypospadias repair and 3 with normal genitalia after circumcision. This was sent to 21 urologists, who rated the outcome with a questionnaire comprising items on the penile meatus, glans, shaft skin and general appearance. Each item was rated with a 4-point Likert scale. The Penile Perception Score is a sum score of all items. Patients were asked to provide a self-assessment with the same instrument. RESULTS When calculated with the ICC and the rank correlation using Kendall W, concordance among urologist scores was fair and good (0.46 and 0.64, respectively, p <0.001). Instrument stability was 0.78, indicating good reproducibility. Using the Spearman rank correlation coefficient general appearance correlated well with single items, including the meatus (r = 0.93, p = 0.000), glans (r = 0.92, p = 0.000) and shaft skin (r = 0.89, p = 0.000). No significant differences were found between patient and urologist Penile Perception Scores. CONCLUSIONS The Penile Perception Score is a reliable instrument for urologist assessment and self-assessment of postpubertal genitalia after hypospadias repair. The instrument can be recommended for all age groups because it was previously validated for the pediatric population.
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Affiliation(s)
- Daniel Max Weber
- Division of Pediatric Urology, Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
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Abstract
PURPOSE OF REVIEW Hypospadias surgery has been in continuous evolution for many years with steadily improving reported results. Despite this many unanswered questions on its cause, management and outcomes remain. Recent research has done little to clarify most matters. RECENT FINDINGS There is increasing evidence of a balance of genetic and developmental factors in the development of hypospadias, but there is doubt whether the incidence of hypospadias is increasing or not. Many technical aspects of hypospadias repair and variations of perioperative management seem to have little effect on outcome, whereas the age at which surgery is performed may. Although efforts are being made to relate anatomical findings to outcome, a lack of objective assessment and standardization is a handicap. Severe hypospadias, particularly that associated with significant chordee, remains challenging although strategies for management are being developed. The future may lie in development of autologous tissue culture for these severe cases. SUMMARY Further development of hypospadias surgery would benefit from objective, standardized methods of describing anatomy and outcome measures to facilitate effective comparison of techniques and procedures.
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Seibold J, Werther M, Alloussi S, Gakis G, Schilling D, Colleselli D, Stenzl A, Schwentner C. Objective long-term evaluation after distal hypospadias repair using the meatal mobilization technique. ACTA ACUST UNITED AC 2010; 44:298-303. [PMID: 20450394 DOI: 10.3109/00365599.2010.482944] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Meatal mobilization (MEMO) by distal urethral preparation has been demonstrated to be an efficient surgical technique for the correction of distal hypospadias offering excellent short-term success rates. This study objectively evaluates individual patient satisfaction using a validated score in the long term. MATERIAL AND METHODS A total of 218 patients who underwent hypospadias repair using the MEMO technique was identified. Of these, 104 (mean age at time of surgery 4.9 years, range 2-28 years) had a minimum follow-up of 5 years and were eligible for the study. They were investigated by physical examination and self-assessment. An objective evaluation using the validated Hypospadias Objective Scoring Evaluation (HOSE) was done in all patients. RESULTS Mean follow-up was 6.3 (range 5-8) years. Ninety-nine patients participated in the investigation, an overall survey response rate of 95.2%. One urethrocutaneous fistula occurred, but no cases of stenosis were noted. One patient developed a mild penile deviation during the postoperative follow-up. Ninety-three out of 99 patients reached the maximum of 16 points (median 15, range 12-16) on the HOSE symptom score. CONCLUSION The MEMO technique demonstrates a surgical success rate of 97% after 2 years. Even in the long-term follow-up of a mean 6.3 years objective outcome data and individual patient satisfaction were excellent. MEMO is a reliable and versatile method for distal hypospadias repair, as reflected by high patient satisfaction.
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Affiliation(s)
- Joerg Seibold
- Department of Urology, Eberhard-Karls University, Tuebingen, Germany
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