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Ye ZH, Wang C, Zhang ZC, Chen HS, Wang X, Liu X, Wei GH. Risk factors and timing of complication presentation following primary hypospadias repair in adolescents. Int J Urol 2024; 31:245-251. [PMID: 37986214 DOI: 10.1111/iju.15342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES To evaluate the risk factors for postoperative complications in adolescents who undergo primary hypospadias repair and determine the time required for complication detection. METHODS Our study included patients classified as Tanner stages three to five who underwent primary hypospadias repairs at our hospital from January 2015 to August 2022. The patients' baseline information, clinical characteristics, postoperative complications, and time to complication detection were collected. Cox regression analysis, ROC curves, Kaplan-Meier survival analyses, and the Mann-Whitney U test were used. RESULTS The study comprised 143 patients, with a median age of 12.58 years. Postoperative complications were experienced by 66 patients. The length of the urethral defect was identified as an independent risk factor for postoperative complications. The ROC curve analysis identified 3 cm as the optimal cutoff value for the length of the urethral defect. The median time to complication detection was 30.5 days (IQR 23 to 209.25). 89.4% of the complications were identified within the first year. Patients with a urethral defect of <3 cm experienced a significantly longer time for the detection of urethral fistula compared to those with a urethral defect of ≥3 cm (p = 0.047). CONCLUSIONS Our data indicate that adolescents with a urethral defect ≥3 cm have a higher risk of postoperative complications. Although most complications were identified within the first year, conducting long-term follow-ups for adolescents is recommended to identify potential subsequent complications that may arise from persistent urethral alterations.
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Affiliation(s)
- Zi-Han Ye
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
| | - Chong Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
| | - Zhi-Cheng Zhang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
| | - Hong-Song Chen
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
| | - Xiao Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
| | - Xing Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
| | - Guang-Hui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
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Ye ZH, Wang C, Zhang ZC, Chen HS, Wang X, Wang YX, Liu X, Wei GH. Efficacy of Body Wash and Povidone-Iodine in Skin Preparation in Reducing Surgical Site Infections After Hypospadias Repair Among Adolescents: A Prospective Cohort Study With Retrospective Controls. Surg Infect (Larchmt) 2023; 24:823-829. [PMID: 37944080 DOI: 10.1089/sur.2023.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Background: Surgical site infections (SSIs) that occur after hypospadias repair frequently result in incision healing complications, especially during puberty. This study aimed to evaluate the efficacy of twice-daily pre-operative skin preparation using body wash and povidone-iodine within 48 hours before hypospadias repair with regard to infection rates in adolescents. Patients and Methods: Prospective recruitment included patients in Tanner stages 3 to 5 undergoing hypospadias repair from January 2015 to January 2021. The experimental group comprised patients who performed twice-daily skin preparation with body wash and povidone-iodine within 48 hours before surgery. Surgeons selected either 0.5% or 5% povidone-iodine for skin preparation. The control group comprised a retrospective cohort of hypospadias repair conducted in the preceding five years, where patients performed pre-surgery evening showers using a body wash. Complications were collected over a six-month follow-up period. Results: The study included 90 patients in the 0.5% povidone-iodine group, 92 patients in the 5% povidone-iodine group, and 84 patients in the control group. Differences were observed among the groups in terms of SSI (p = 0.030) and urethral fistula (p = 0.019). In post hoc tests, only the 5% povidone-iodine group demonstrated a diminished incidence of SSI (p = 0.009) and urethral fistula (p = 0.005) in comparison to the control group. Conclusions: Using body wash and 5% povidone-iodine for skin preparation was associated with a reduction in the incidence of SSI and urethral fistula following hypospadias repair in adolescents and may be considered to improve outcomes.
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Affiliation(s)
- Zi-Han Ye
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
| | - Chong Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
| | - Zhi-Cheng Zhang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
| | - Hong-Song Chen
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
| | - Xiao Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
| | - Yan-Xi Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
| | - Xing Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
| | - Guang-Hui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, PR China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, PR China
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Ernst M, Klamer B, Thompson N, Alpert S, Dajusta D, Fuchs M, McLeod D, Jayanthi R, Ching C. Caregiver disclosure of common early childhood pediatric urologic surgeries. J Pediatr Urol 2023; 19:522.e1-522.e8. [PMID: 36898864 DOI: 10.1016/j.jpurol.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Certain pediatric urologic diagnoses can have serious long-term adverse health outcomes. As a result, it is important for a child to be aware of their diagnosis and a prior surgery. When children have surgery prior to the age of memory formation, it is incumbent upon their caregiver to disclose this surgery. When and how to disclose this information and even if this occurs, is not clear. OBJECTIVE We developed a survey to assess caregiver plans to disclose early childhood pediatric urologic surgery and evaluate for predictors of disclosure and resources needed. METHODS A questionnaire was distributed to caregivers of male children ≤4 years old undergoing single stage repair of hypospadias, inguinal hernia, chordee, or cryptorchidism as part of an IRB approved research study. These surgeries were chosen due to being outpatient surgeries with potential long-term complications and impact. The age criteria was chosen due to likely being before patient memory formation and thus reliance on caregiver disclosure of prior surgery. Surveys were collected the day of surgery and contained information on caregiver demographics, validated health literacy screening, and plans to disclose surgery. RESULTS 120 survey responses were collected (Summary Table). The majority of caregivers responded affirmatively to planning to disclose their child's surgery (108; 90%). There was no impact of caregiver age, gender, race, marital status, education level, health literacy, or personal surgical history on plans to disclose surgery (p ≥ 0.05). Plan to disclose was also not different across urologic surgery type. Race was significantly associated with being "concerned or nervous about disclosing the surgery to the patient". The median patient age for planned disclosure was 10 years (IQR: 7-13). Only 17 respondents (14%) stated they received any information about how to discuss this surgery with the patient, however 83 (69%) felt this information would be helpful. CONCLUSIONS Our study suggests that most caregivers plan to discuss early childhood urologic surgeries with children, however want further guidance in how to talk to their child. While no specific surgery or demographic factor was found to be significantly associated with plans to disclose surgery, it is concerning that one in ten patients will potentially never learn about impactful surgery they had as a child. There is an opportunity for us to better counsel our patients' families about surgical disclosure and fill this gap with quality improvement efforts.
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Affiliation(s)
- Michael Ernst
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Brett Klamer
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Nora Thompson
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Seth Alpert
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Daniel Dajusta
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Molly Fuchs
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Daryl McLeod
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Rama Jayanthi
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Christina Ching
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
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Age-dependent early complications of hypospadias repair: a single institutional experience. Pediatr Surg Int 2023; 39:115. [PMID: 36773206 PMCID: PMC9918807 DOI: 10.1007/s00383-023-05388-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE To correlate age at hypospadias repair with early post-operative complications and highlight need for adaptation to post-operative care in older children. METHODS Anecdotal evidence suggests boys with delayed surgery for hypospadias suffer increased rates of early post-operative complication. Hence, a retrospective analysis was conducted of all patients undergoing hypospadias repair between March 2019 and 2022. RESULTS Ninety eight patients were divided into Group A (< 2years of age at first surgery) or Group B (> 2years). While patients in Group A encountered no early post-operative complications, seven in Group B (11%) suffered a range of complications including dislodged stents (3/7), significant spasmodic pain requiring prolonged hospital stay (2/7) and urinary retention (2/7). More than half of these children required emergency supra-pubic catheter insertion. CONCLUSION Significantly more children undergoing hypospadias surgery after the age of 2 years suffered complications within the early post-operative period. This resulted in prolonged hospital stays and a number returning to theatre for insertion of a supra-pubic catheter. We recommend a tailored approach to the post-operative care of older children undergoing hypospadias repair, including strict parental education regarding dressing/stent care and medication compliance, as well as efforts to enhance robustness of dressings and stent anchorage in children likely to pull at stents.
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Choudhry DK, Heredia L, Brenn BR, Brown M, Carvalho NF, Whaley MC, Shaik SS, Hagerty JA, Bani Hani A. Nerve stimulation guided bilateral pudendal nerve block versus landmark-based caudal block for hypospadias repair in young children: a prospective, randomized, pragmatic trial. Reg Anesth Pain Med 2022; 47:744-748. [DOI: 10.1136/rapm-2022-103680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/20/2022] [Indexed: 11/03/2022]
Abstract
IntroductionCaudal block is frequently performed to provide analgesia for hypospadias repair. Literature suggests that pudendal block provides prolonged postoperative analgesia as compared with caudal block in children between 2 and 5 years. We compared the efficacy of pudendal and caudal blocks in children less than 2 years.Methods60 children scheduled for hypospadias repair received standard general anesthesia along with either pudendal or caudal block (groups of 30 each). Variables collected were demographic data, block time, operating room time, intraoperative pain medication need, pain assessment score and medication need in the recovery room and pain assessment at home.ResultGroups were demographically similar. No differences were observed in the following recorded times (minutes): block procedure (caudal: 9.5±4.0, pudendal: 10.6±4.1, p=0.30), anesthesia (caudal: 17.3±5.3, pudendal: 17.7±4.3, p=0.75), total OR (caudal: 171±35, pudendal: 172±41; p=0.95) and postanesthesia care unit (PACU) stay (caudal: 88±37, pudendal: 86±42; p=0.80). Additionally, no differences were observed in rescue pain medication need in the operating room (caudal: 0, pudendal: 2 (p=0.49), in PACU (caudal: 4, pudendal: 4, p=0.99), pain assessed at home, time to pain level 2 (caudal: 13.93±8.9, pudendal: 15.17±8.7), average pain scores (p=0.67) and total pain free epochs (pain level of zero) (p=0.80) in the first 24 hours.DiscussionIn children less than 2 years, both blocks provide comparable intraoperative and postoperative pain relief in the first 24 hours after hypospadias surgery.Trial registration numberNCT03145415.
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Yu J, Sun N, Song H, Li M, Li L, Gong C, Zhang W. Analysis in the influence factors of urethroplasty in DSD. BMC Urol 2022; 22:124. [PMID: 35948888 PMCID: PMC9367162 DOI: 10.1186/s12894-022-01080-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/28/2022] [Indexed: 11/28/2022] Open
Abstract
Background At present, there is no specific research on the factors affecting the success rate of urethroplasty in patients with DSD. The purpose of this study is to explore the factors affecting the success of urethroplasty in DSD patients, and to provide some reference for the surgical treatment of DSD patients undergoing urethroplasty.
Method We reviewed patients with DSD who underwent urethroplasty from January 2016 to December 2019 retrospectively. Patients were divided into four groups: the successful group, the urethrocutaneous fistula group, the urethral diverticulum group, and the urethral stricture group. Risk factors were determined from the following data included the DSD classification, the age of first operation, length of urethral defect, degree of hypospadias, cryptorchidism, micropenis, gonad type, hormone therapy before operation, transposition of penis and scrotum, surgical strategy, urethral covering material, and postoperative catheter removal time. We explored the difference of each factor between four groups through the comparative study of single factor and multifactor logistic regression analysis of related factors. Result 122 cases were enrolled in this group (n = 122), 12 cases were lost to follow-up. Median follow-up was 28 months (12–55 months).We found the success rate of operation decreased with longer urethral defect (B = − 0.473, P = 0.005). The success rate of operation was higher in staged operation and TPIT (TPIT = Transverse Preputial Island Tube operation)-related operation than primary operation (B = 1.238, P = 0.006) and TPIT-nonrelated operation (B = 2.293, P = 0.001). Although there was a significant difference between the age of the first operation and the occurrence of urethrocutaneous fistula (P = 0.006 < 0.05), there was no significant difference in logistic regression analysis (P = 0.161 > 0.05). The incidence of urethrocutaneous fistula was lower in TPIT-related operation than in TPIT-nonrelated operation (B = − 2.507, P = 0.000). The incidence of postoperative urethral diverticulum was lower in staged operation than in primary operation (B = − 1.737, P = 0.015). Conclusion For patients with disorder of sex development undergoing urethroplasty, the length of urethral defect is an independent risk factor affecting both the success rate of operation and the urethrocutaneous fistula. The age of the first operation has a statistically significant effect on the occurrence of postoperative urethrocutaneous fistula, but it is not an independent factor. Urethrocutaneous fistula is less found in TPIT-related operation in the study. Staged operation is an independent protective factor for postoperative urethral diverticulum compared with one-stage operation but isn’t related to urethrocutaneous fistula.
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Affiliation(s)
- Jing Yu
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, 100045, China
| | - Ning Sun
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, 100045, China
| | - Hongcheng Song
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, 100045, China
| | - Minglei Li
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, 100045, China
| | - Lele Li
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, 100045, China
| | - Chunxiu Gong
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, 100045, China.
| | - Weiping Zhang
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, 100045, China.
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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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Radhakrishnan CN, Radhakrishna V. The tunica-vaginalis flap to prevent postoperative fistula following severe hypospadias repair: Has the search for Holy Grail ended? Actas Urol Esp 2021; 45:552-556. [PMID: 34531163 DOI: 10.1016/j.acuroe.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/07/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Fistula following hypospadias repair remains a bane of the hypospadiologist resulting in the evolution of various techniques. Despite all these, the incidence of postoperative fistula varies from 10 to 30% and it increases with the severity of the hypospadias. Hence, a study was conducted to evaluate the efficacy of tunica vaginalis flap in preventing fistula formation following severe hypospadias repair. MATERIALS AND METHODS An observational study was carried out in a tertiary center between 2008 and 2017. The study included children with severe hypospadias (Proximal penile, Penoscrotal, scrotal, and Perineal). In all the patients, a Tunica-Vaginalis flap was used to buttress the urethroplasty. All the patients were followed up for at least a year after the completion of treatment. RESULTS A total of 210 patients were included in the study. Bracka's two-stage repair was performed in 180 patients who had either Penoscrotal hypospadias or a meatus even more proximal. The rest 30 patients with proximal penile hypospadias underwent a single-stage Snodgrass repair. Four (2%) patients developed a fistula, all following two-stage repairs, and half of them required surgical repair. Two (1%) patients had a partial breakdown of repair and underwent a residual repair after six months. CONCLUSION The Tunica-Vaginalis flap is an excellent buttress in severe hypospadias repair. It is readily available, easy to harvest, with its good vascularity helps to significantly reduce the incidence of postoperative fistula.
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Affiliation(s)
- C N Radhakrishnan
- Department of Paediatric Surgery, Manipal Hospital, Bengaluru, India
| | - V Radhakrishna
- Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, India.
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Radhakrishnan CN, Radhakrishna V. The tunica-vaginalis flap to prevent postoperative fistula following severe hypospadias repair: Has the search for Holy Grail ended? Actas Urol Esp 2021; 45:S0210-4806(20)30273-4. [PMID: 33965283 DOI: 10.1016/j.acuro.2020.06.015] [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: 04/17/2020] [Revised: 05/11/2020] [Accepted: 06/07/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Fistula following hypospadias repair remains a bane for the hypospadiologist resulting in the evolution of various techniques. Despite all these, the incidence of postoperative fistula varies between 10 to 30% and it increases with the severity of the hypospadias. Hence, a study was conducted to evaluate the efficacy of tunica vaginalis flap in preventing fistula formation following severe hypospadias repair. MATERIALS AND METHODS An observational study was carried out in a tertiary center between 2008 and 2017. The study included children with severe hypospadias (proximal penile, penoscrotal, scrotal, and perineal). In all the patients, a tunica-vaginalis flap was used to buttress the urethroplasty. All the patients were followed up for at least a year after the completion of treatment. RESULTS A total of 210 patients were included in the study. Bracka's 2-stage repair was performed in 180 patients who had either penoscrotal hypospadias or a meatus even more proximal. The rest 30 patients with proximal penile hypospadias underwent a single-stage Snodgrass repair. Four (2%) patients developed a fistula, all following 2-stage repairs, and half of them required surgical repair. Two (1%) patients had a partial breakdown of repair and underwent a residual repair after 6 months. CONCLUSION The tunica-vaginalis flap is an excellent buttress in severe hypospadias repair. It is readily available, easy to harvest, with its good vascularity helps to significantly reduce the incidence of postoperative fistula.
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Affiliation(s)
- C N Radhakrishnan
- Department of Paediatric Surgery, Manipal Hospital, Bangalore, India
| | - V Radhakrishna
- Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bangalore, India.
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Zhang J, Zhu S, Zhang L, Fu W, Hu J, Zhang Z, Jia W. The association between caudal block and urethroplasty complications of distal tubularized incised plate repair: experience from a South China National Children's Medical Center. Transl Androl Urol 2021; 10:2084-2090. [PMID: 34159089 PMCID: PMC8185679 DOI: 10.21037/tau-21-355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background The effect of caudal block (CB) on the incidence of urethroplasty complications in hypospadias repair remains controversial. The evidence is conflicting, and some confounding bias issues need to be addressed. We sought to study a more homogenous group of distal hypospadias patients undergoing primary tubularized incised plate (TIP) repair by a senior pediatric urology surgeon in the past 2 years to examine the relationship between urethroplasty complications and the use of CB. Methods We reviewed our database to identify consecutive patients who had undergone hypospadias repairs by a senior director surgeon at our Center between January 2018 and November 2020. To be eligible to participate in the study, patients had to meet the following inclusion criteria: (I) have distal hypospadias; (II) have undergone a primary TIP repair; and (III) have attended follow-up appointments for a minimum period of 6 months. The primary outcome was the development of urethroplasty complications during the follow-up period. The principal variable of interest was whether or not CB was used perioperatively. The patients were categorized into a CB group (general anesthesia combined with CB) or a control group (general anesthesia only). Other potential risk factors were analyzed, including patient age at operation, patient weight, glans width, and the length of the urethral plate defect. Results Thirty (12.2%) of the distal patients developed postoperative surgical complications. The postoperative surgical complication rates were similar between the different anesthesia groups. Weight, the length of the urethral plate length, and glans width did not contribute to the risk. Age was the only independent risk factor for postoperative surgical complications, and the complication rates increased in older patients. Conclusions Our data from consecutive TIP repairs in distal hypospadias patients indicated no association between the use of CB anesthesia and the postoperative urethroplasty complication rate. Patients who were older in age when they underwent surgery had a higher risk of complications.
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Affiliation(s)
- Jingqi Zhang
- Department of Pediatric Urology, Provincial Key Laboratory of Research in Structure Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Shibo Zhu
- Department of Pediatric Urology, Provincial Key Laboratory of Research in Structure Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Liyu Zhang
- Department of Pediatric Urology, Provincial Key Laboratory of Research in Structure Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wen Fu
- Department of Pediatric Urology, Provincial Key Laboratory of Research in Structure Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jinhua Hu
- Department of Pediatric Urology, Provincial Key Laboratory of Research in Structure Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhao Zhang
- Department of Pediatric Urology, Provincial Key Laboratory of Research in Structure Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wei Jia
- Department of Pediatric Urology, Provincial Key Laboratory of Research in Structure Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Sandlas G, Tiwari C, Bothra J, Jadhav B, Shah H. Stentless hypospadias repair: The way forward. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415820931266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Stentless repair of hypospadias has been previously described in the literature for distal penile hypospadias repair. This was a prospective non-randomized study with the aim of assessing the efficacy of stentless repair in our health-care system. Methods: A total of 104 patients managed prospectively for hypospadias over a 30-month period who met the inclusion criteria were included in the study and underwent a stentless modified tubularized incised plate (TIP) urethroplasty repair (with a slight modification described subsequently) by three surgeons and were followed up for a minimum period of six months. Results: The median age at surgery was eight months. The site of meatus was glanular in 20 patients, coronal in 36 patients, sub-coronal in 38 patients and mid-penile in 10 patients. The median operative time was 47 minutes (range 32–76 minutes). The median time to first micturition was 140 minutes (range 10–300 minutes). Voiding difficulty was encountered in two patients, requiring catheterization. Three patients had superficial surgical site infections which were conservatively managed. All patients were discharged on the second postoperative day, except for the three patients with surgical site infection. On follow-up, two patients had a fistula. Conclusion: Stentless repair of hypospadias is the future and the new standard of care and should be used in every case where a modified TIP repair is feasible. This decreases complications from urethral stenting and decreases the duration of hospital stay. Both patient and parents are comfortable with this procedure. Level of evidence Level 2.
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Affiliation(s)
- Gursev Sandlas
- Consultant Paediatric Surgeon, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
- Department of Paediatric Surgery, TNMC and BYL Nair Hospital, Mumbai, India
| | - Charu Tiwari
- Department of Paediatric Surgery, TNMC and BYL Nair Hospital, Mumbai, India
| | - Jyoti Bothra
- Department of Paediatric Surgery, TNMC and BYL Nair Hospital, Mumbai, India
| | - Bhushan Jadhav
- Paediatric Surgery, Clinical Associate, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Hemanshi Shah
- Department of Paediatric Surgery, TNMC and BYL Nair Hospital, Mumbai, India
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13
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Ji F, Tang H, Wu C, Chen L, Wang H, Yan B. Predictive Value of C-Reactive Protein for Early Postoperative Complications in Children After Hypospadias Surgery. Front Pediatr 2021; 9:690863. [PMID: 34589449 PMCID: PMC8474872 DOI: 10.3389/fped.2021.690863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study explored the predictive value of postoperative C-reactive protein in children with hypospadias for postoperative complications and the risk factors. Methods: The clinical and follow-up data of 106 children with hypospadias who were treated with operations at Kunming Children's Hospital in 2020 were, respectively, analyzed. According to the occurrence of postoperative complications, the patients were divided into two groups: 25 patients with postoperative complications were the complications group, and 81 without postoperative complications were the control group. The baseline data, clinical characteristics, laboratory test indexes, and outcome of the two groups were collected. Receiver operating characteristic (ROC) was used to calculate the optimal cutoff value of C-reaction protein (CRP). Logistic regression was used to analyze the risk factors of hypospadias after surgery. A probability value (P) < 0.05 was considered statistically significant. Results: According to the result of the ROC curve, the optimal cutoff value of CRP was 11.7 mg/L. Logistic regression showed that the length of urethral defect, the urethral material, the operative produce, and the postoperative CRP level were related to the occurrence of postoperative complications of patients with DCC. The length of the urethral defect and the CRP level were the independent risk factors of the prognosis of hypospadias patients. The CRP level was related to the occurrence of postoperative complications and fistula. Conclusions: Postoperative CRP level can be used as a reliable marker for predicting the prognosis of hypospadias patients.
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Affiliation(s)
- Fengming Ji
- Yunnan Key Laboratory of Children's Major Disease Research, Urology Department, Kunming Children's Hospital, Kunming, China
| | - Haoyu Tang
- Yunnan Key Laboratory of Children's Major Disease Research, Urology Department, Kunming Children's Hospital, Kunming, China
| | - Chengchuang Wu
- Yunnan Key Laboratory of Children's Major Disease Research, Urology Department, Kunming Children's Hospital, Kunming, China
| | - Li Chen
- Yunnan Key Laboratory of Children's Major Disease Research, Department of General Surgery, Kunming Children's Hospital, Kunming, China
| | - Huake Wang
- Yunnan Key Laboratory of Children's Major Disease Research, Urology Department, Kunming Children's Hospital, Kunming, China
| | - Bing Yan
- Yunnan Key Laboratory of Children's Major Disease Research, Urology Department, Kunming Children's Hospital, Kunming, China
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Alaraby SOMA, Abdeljaleel IA, Hamza AA, Elhassan AEE. A comparative study of polydioxanone (PDS) and polyglactin (Vicryl) in hypospadias repair. Afr J Paediatr Surg 2021; 18:53-57. [PMID: 33595543 PMCID: PMC8109750 DOI: 10.4103/ajps.ajps_90_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/17/2020] [Accepted: 09/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hypospadias is a fairly common problem, and it is the most common genital congenital anomaly. OBJECTIVE This study was carried out to compare polyglactin and polydioxanone in hypospadias repair by assessing the rate of complications, especially urethrocutaneous fistula (UCF) formation. PATIENTS AND METHODS This is a prospective observational cross-sectional hospital-based study carried out at the Department of Paediatric Surgery, Ribat University Hospital, from June 2015 to November 2016. In Group A, there were 55 patients who underwent repair using polyglactin, and in Group B, there were 50 patients who underwent repair using polydioxanone. All patients were operated by the same surgeon. RESULTS The mean age of Group A was 5.7 ± 4.3 years and 5.1 ± 3.9 years in Group B. Meatal advancement and glanuloplasty incorporated operation was done in 47.6%, Tubularized incised plate urethroplasty in (31.4%), Theirsch-Duplay in 20% and Mathieu's repair in 1%. The complication rate was 34% in Group A and 10.9% in Group B. The most frequent complication was UCF, as 19 patients (18.1%) of the study candidates developed UCF; most of them were in Group A (14 patients) and 5 patients in Group B. Another significant complication was meatal stenosis, which occurred in 11 patients (10.5%): 9 in Group A and 2 in Group B. CONCLUSION Polydioxanone (PDS) is satisfactory in hypospadias repair as it is associated with better outcome, especially UCF, which is most common and most difficult to treat complication.
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15
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Abdullaev Z, Agzamkhodjaev S, Chung JM, Lee SD. Risk factors for fistula recurrence after urethrocutaneous fistulectomy in children with hypospadias. Turk J Urol 2020; 47:237-241. [PMID: 33263516 DOI: 10.5152/tud.2020.20323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/10/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to investigate the risk factors of fistula recurrence after primary urethrocutaneous fistulectomy in children with hypospadias. MATERIAL AND METHODS The study included 63 children who underwent fistulectomy for urethrocutaneous fistula (UCFs) that occurred after urethroplasty for hypospadias, between February 2009 and December 2018. The patients were divided into 2 groups: successful group 1 and failed group 2. For data analysis, we included the demographics of the patients, the details of the previous urethroplasty (the type of hypospadias and the location of the meatus after complete chordectomy), the presence of meatal stenosis or urethral stricture after urethroplasty, and the size of the UCFs. The Student t-test and the chi-square test were performed to analyze the data using the Statistical Package for Social Sciences software. RESULTS The overall success rate of primary urethrocutaneous fistulectomy was 81.0% (51/63 children). The most common location of a secondary fistula was the penoscrotal area 5 (41.6%). There were no statistically significant differences in age (p=0.501), weight (p=0.063), body mass index (p=0.924), history of low birth weight (p=0.454), and history of prematurity (p=0.381). The type of hypospadias (p=0.007) and urethral defect length (p=0.021) were identified as independent risk factors for failed urethrocutaneous fistulectomy. There were no statistically significant differences in meatal stenosis (p=0.431), postoperative stricture (p=0.587), fistula location (p=0.173), multiplicity (p=0.588), and fistula size (p=0.530). CONCLUSION The type of hypospadias and the length of the urethral defect are the significant risk factors for secondary fistula recurrence after primary urethrocutaneous fistulectomy.
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Affiliation(s)
- Zafar Abdullaev
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Pediatric Urology, National Children's Medical Center, Tashkent, Uzbekistan
| | - Saidanvar Agzamkhodjaev
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Pediatric Urology, National Children's Medical Center, Tashkent, Uzbekistan
| | - Jae Min Chung
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Urology, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Don Lee
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Urology, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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16
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Yang H, Xuan XX, Hu DL, Zhang H, Shu Q, Guo XD, Fu JF. Comparison of effect between dartos fascia and tunica vaginalis fascia in TIP urethroplasty: a meta-analysis of comparative studies. BMC Urol 2020; 20:161. [PMID: 33059661 PMCID: PMC7559339 DOI: 10.1186/s12894-020-00737-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 10/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background Tubularized incised plate (TIP) urethroplasty is the most commonly performed procedure for hypospadias. Several flap procedures have been recommended to decrease the postoperative complication rate in TIP repair, but no single flap procedure is ideal. This study aimed to compare the outcomes of dartos fascia (DF) and tunica vaginalis fascia (TVF) as intermediate layers in TIP urethroplasty. Methods We searched PubMed, EMBASE, the Cochrane Library, Web of Science, clinicaltrials.gov, and other sources for comparative studies up to April 16, 2020. Studies were selected by the predesigned inclusion criteria. The primary outcomes were postoperative complications. The secondary outcomes were functional and cosmetic outcomes. Results The pooled RR with 95% CI were calculated. We extracted the relevant information from the included studies. Only 6 comparative studies were included. No secondary outcomes were reported. The RR of the total complications rate for DF was 2.41 (95% CI 1.42–4.07, P = 0.0001) compared with TVF in TIP repair. For each postoperative complication, the RRs were 6.48 (2.20–19.12, P = 0.0007), 5.95 (1.13–31.30, P = 0.04), 0.62 (0.25–1.52, P = 0.29), and 0.75 (0.23–2.46, P = 0.64) for urethrocutaneous fistula, prepuce-related complications, meatal/urethral stenosis, and wound-related complications, respectively. Conclusions This meta-analysis reveals that compared to DF, TVF is a better option in TIP repair in terms of decreasing the incidence of the total postoperative complications, urethrocutaneous fistula, and prepuce-related complications. However there is limited evidence for functional and cosmetic outcomes. Overall, larger prospective studies and long-term follow-up data are required to further demonstrate the superiority of TVF over DF. Trial registration PROSPERO CRD42019148554.
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Affiliation(s)
- Hao Yang
- Zhejiang University School of Medicine, Hangzhou, China.,Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiao-Xiao Xuan
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,National Clinical Research Center for Child Health, Hangzhou, China
| | - Dong-Lai Hu
- Department of Pediatric Surgery, Zhejiang University Jinhua Hospital, Jinhua, China
| | - Hang Zhang
- Zhejiang University School of Medicine, Hangzhou, China.,Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,National Clinical Research Center for Child Health, Hangzhou, China
| | - Qiang Shu
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiao-Dong Guo
- Department of Pediatric Surgery, Zhejiang University Jinhua Hospital, Jinhua, China.
| | - Jun-Fen Fu
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China. .,National Clinical Research Center for Child Health, Hangzhou, China.
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Delayed presentation of urethrocutaneous fistulae after hypospadias repair. J Pediatr Surg 2020; 55:2206-2208. [PMID: 32059814 DOI: 10.1016/j.jpedsurg.2019.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/15/2019] [Accepted: 12/26/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Delayed urethrocutaneous fistula (UCF) presentation after hypospadias repair is rarely reported. The aim of this study is to report our experience with delayed UCF presenting more than 5 years after hypospadias repair. METHODS We conducted a retrospective review of patients who underwent UCF repair (CPT codes 54,340 and 54,344) at our institution between 1997 and 2017. Delayed UCF presentation was defined as a single normal urinary stream after initial hypospadias repair and subsequent presentation of a UCF/s urinary stream more than 5 years after initial hypospadias or UCF repair. Demographic and clinical data were reviewed after approval from our institutional review committee. RESULTS We identified 12 patients with delayed UCF. The mean age at hypospadias repair was 12.3 months (Range 6-32). The mean time to delayed UCF presentation was 11.5 years (Range 7.1-15.8). Four patients with delayed UCF (33.3%) required additional surgery for UCF recurrence with a mean time to recurrence of 2.2 years (Range < 1-5.6). CONCLUSIONS Delayed UCF presentation can occur more than 15 years after initial repair. Pubertal penile skin changes and increased genital awareness in older children may be contributing factors as all but one presented at age 10 years or older. LEVEL OF EVIDENCE III.
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18
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Ngoo A, Borzi P, McBride CA, Patel B. Penile nerve block predicts higher revision surgery rate following distal hypospadias repair when compared with caudal epidural block: A consecutive cohort study. J Pediatr Urol 2020; 16:439.e1-439.e6. [PMID: 32636118 DOI: 10.1016/j.jpurol.2020.05.150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/02/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Recent literature has suggested caudal epidural blocks (CEB) may increase revision surgery rates following hypospadias repair. We sought to investigate this using a large, multi-surgeon series. OBJECTIVE The primary objective of this study was to identify the impact of CEB or penile nerve blocks (PNB) on revision surgery rates following distal hypospadias repair at our centre. STUDY DESIGN A prospectively maintained database of consecutive patients undergoing primary hypospadias repairs under the supervision of 8 different paediatric surgeons at our centre between January 2015 and December 2018 was queried for the following potential risk factors: Age at surgery, American Society of Anaesthesiologist's (ASA) grade, hypospadias type, type of surgery, CEB or PNB, and training level of primary surgeon. Revision surgery was defined as reoperation for fistulas, dehiscence, strictures or meatal stenosis. Univariate and Multivariate analysis was performed using logistic regression. RESULTS 188 patients underwent primary distal hypospadias repair over the study time period. Patients were aged between 7 months and 15 years of age. Median age at surgery was 14 months. Revision surgery was performed for 31 patients (16.5%). Indications were urethrocutaneous fistula (n = 17, 9.0%), meatal stenosis or stricture (n = 9, 4.8%) and glans dehiscence (n = 5, 2.7%). 114 (60.6%) received a penile block and 74 (39.4%) a caudal block. On univariate analysis, PNB (HR 2.55 95% CI 1.04-6.27, p = 0.04) was statistically significant for revision surgery. This association remained significant on multivariate analysis (HR 2.74 95% CI 1.09-6.92, p = 0.03). All other prognostic factors examined were not statistically significant for revision surgery. DISCUSSION Our findings suggest PNB are associated with higher revision surgery rates following distal hypospadias repair. This contrasts with the findings of other authors. CONCLUSION Our study is the first to demonstrate an association between PNB and higher revision surgery rates following distal hypospadias repair.
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Affiliation(s)
- Alexander Ngoo
- Department of Paediatric Surgery, Urology and Burns, Queensland Children's Hospital, Queensland, Australia.
| | - Peter Borzi
- Department of Paediatric Surgery, Urology and Burns, Queensland Children's Hospital, Queensland, Australia
| | - Craig A McBride
- Department of Paediatric Surgery, Urology and Burns, Queensland Children's Hospital, Queensland, Australia
| | - Bhaveshkumar Patel
- Department of Paediatric Surgery, Urology and Burns, Queensland Children's Hospital, Queensland, Australia
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Duarsa GWK, Tirtayasa PMW, Daryanto B, Nurhadi P, Renaldo J, Tarmono, Utomo T, Yuri P, Siregar S, Wahyudi I, Situmorang GR, Ansharullah Palinrungi MA, Hutasoit YI, Hutahaean AYA, Zulfiqar Y, Sigumonrong YH, Mirza H, Rodjani A, Kloping YP. Risk factors for urethrocutaneous fistula following hypospadias repair surgery in Indonesia. J Pediatr Urol 2020; 16:317.e1-317.e6. [PMID: 32360223 DOI: 10.1016/j.jpurol.2020.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 03/25/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Hypospadias is one of the most common congenital malformations with a worldwide increasing trend over the years. Despite advancements in hypospadias repair, complications still occur. One of the most common complications of hypospadias repair surgery is Urethrocutaneous fistula. Studies attempting to analyze the association between the complication and risk factors are always beneficial, especially for studies performed in different areas of the world. We hypothesize that several evaluated risk factors among Indonesian hypospadias patients could be associated with the occurrence of urethrocutaneous fistula after the repair procedure. OBJECTIVE To determine the risk factors associated with urethrocutaneous fistula after hypospadias repair surgery by collecting and analyzing data obtained from multiple centers in Indonesia. MATERIALS AND METHODS A nationwide, retrospective study with 12 hospitals in Indonesia of children with a diagnosis of hypospadias was conducted. The collected data, taken from patients admitted in 2018, from each center's medical records consisted of patient identity, repair technique used, neourethra length, percutaneous cystostomy, and splint size as independent variables speculated to be possible risk factors correlated to the presence of urethrocutaneous fistulae. Binomial logistic regression analysis was performed using SPSS 21.0 to determine the relationship between urethrocutaneous fistulae as a post-repair complication and possible risk factors. RESULTS We collected 591 hypospadias cases from 12 centers in 9 cities in Indonesia. Most patients came when they were already at the age of more than four years old (60.4%). The chordee-only and failed urethroplasty groups are excluded from the analysis as they are not classified as true hypospadias. Most repairs were performed by using the Tubular Incised Plate (TIP) with Thiersch-Duplay technique (44.16%). Most of the reconstructed neourethra are 2-3 cm in length (32.13%). The 8 Fr urethral splint (46.41%) was mostly used during the operation. Most surgeons decided not to perform cystostomy throughout the procedure (61.03%) based on personal preferences. Urethrocutaneous fistula was found in 80 patients (15.27%) out of the total patients who underwent the surgery. The binomial logistic regression analysis shows that age (OR = 1.398, p = 0.015), the decision to not perform cystostomy (OR = 2.963, p = 0.014), and splint size (OR = 1.243, p = 0.023) are significantly associated (p < 0.05) with the development of urethrocutaneous fistula. CONCLUSION Age and splint size are significant risk factors for urethrocutaneous fistula after hypospadias repair in Indonesia, whereas performing percutaneous cystostomy during the repair decreases the risk for urethrocutaneous fistula occurrence.
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Affiliation(s)
- Gede Wirya Kusuma Duarsa
- Division of Urology, Department of Surgery, Faculty of Medicine Universitas Udayana, Sanglah Hospital, Denpasar, Indonesia.
| | - Pande Made Wisnu Tirtayasa
- Division of Urology, Department of Surgery, Faculty of Medicine Universitas Udayana, Sanglah Hospital, Denpasar, Indonesia
| | - Besut Daryanto
- Department of Urology, Faculty of Medicine Universitas Brawijaya, Saiful Anwar Hospital, Malang, Indonesia
| | - Pradana Nurhadi
- Department of Urology, Faculty of Medicine Universitas Brawijaya, Saiful Anwar Hospital, Malang, Indonesia
| | - Johan Renaldo
- Department of Urology, Faculty of Medicine Universitas Airlangga, Soetomo Hospital, Surabaya, Indonesia
| | - Tarmono
- Department of Urology, Faculty of Medicine Universitas Airlangga, Soetomo Hospital, Surabaya, Indonesia
| | - Trisula Utomo
- Department of Urology, Faculty of Medicine Universitas Gadjah Mada, Sardjito Hospital, Yogyakarta, Indonesia
| | - Prahara Yuri
- Department of Urology, Faculty of Medicine Universitas Gadjah Mada, Sardjito Hospital, Yogyakarta, Indonesia
| | - Safendra Siregar
- Department of Urology, Faculty of Medicine Universitas Padjajaran, Hasan Sadikin Hospital, Bandung, Indonesia
| | - Irfan Wahyudi
- Department of Urology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Gerhard Reinaldi Situmorang
- Department of Urology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Yonas Immanuel Hutasoit
- Department of Urology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Yevri Zulfiqar
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Andalas, M.Djamil Hospital, Padang, Indonesia
| | - Yacobda H Sigumonrong
- Department of Urology, Faculty of Medicine, Universitas Sumatera Utara, Adam Malik Hospital, Medan, Indonesia
| | - Hendy Mirza
- Department of Urology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Arry Rodjani
- Department of Urology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Yudhistira Pradnyan Kloping
- Medical Doctor, General Practitioner, Medical Faculty of Airlangga University, Surabaya, East Java, Indonesia
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Wu Y, Wang J, Zhao T, Wei Y, Han L, Liu X, Lin T, Wei G, Wu S. Complications Following Primary Repair of Non-proximal Hypospadias in Children: A Systematic Review and Meta-Analysis. Front Pediatr 2020; 8:579364. [PMID: 33363061 PMCID: PMC7756017 DOI: 10.3389/fped.2020.579364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/13/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose: The aim of this study was to systematically review the literature on the complications and postoperative outcomes of children with non-proximal hypospadias. Methods: Electronic databases including PubMed, Embase, and Cochrane Library CENTRAL were searched systematically from January 1990 to June 2020 for the literature that reported the postoperative outcomes of patients with non-proximal hypospadias. Non-proximal hypospadias encompassed distal and mid-penile hypospadias. Results: We included 44 studies involving 10,666 subjects. Urethrocutaneous fistula (UCF) was the most common complication with an incidence of 4.0% (95% CI, 3.1-5.0%). Incidence of overall complications was 8.0% (95% CI, 6.3-9.8%). Meta-regression analysis revealed that length of urethral stent indwelling (coefficient 0.006; 95% CI, 0.000-0.011; p = 0.036) and penile dressing (coefficient 0.010; 95% CI, 0.000-0.021; p = 0.048) were two risk factors for UCF. Multivariate meta-regression analysis did not identify any independent risk factors for UCF. No differences were found between stent and stentless groups in non-proximal hypospadias regarding incidences of UCF (OR, 0.589; 95% CI, 0.267-1.297), meatal stenosis (OR, 0.880; 95% CI, 0.318-2.437), and overall complications (OR, 0.695; 95% CI, 0.403-1.199). No differences were found between foreskin preservation and circumcision in terms of complications either. Conclusions: UCF is the most common complication following hypospadias repair with an incidence of 4.0%. Independent risk factors for UCF were not identified in the current research. Distal hypospadias repair without stent indwelling is not likely to compromise the postoperative outcome. Further studies should be designed to explore the differences between different surgical approaches and the potential risk factors for complications following hypospadias repair.
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Affiliation(s)
- Yuhao Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Junke Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Tianxin Zhao
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Yuexin Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Lindong Han
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Xing Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Tao Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Guanghui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Shengde Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
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Duarsa GWK, Pratiwi DA, Tirtayasa PW, Yudiana W, Santosa KB, Oka AAG, Wahyuni S, Mahadewa TGB. Functional and Cosmetic Urethroplasty Outcome, Emotional Stress after Genital Examination, Post Traumatic Stress Disorder, and Ages at the Time of Urethroplasty as Potential Risk Factor Causing Psychosocial Disorder of Hypospadia Children. Open Access Maced J Med Sci 2019; 7:1452-1455. [PMID: 31198453 PMCID: PMC6542407 DOI: 10.3889/oamjms.2019.227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 04/05/2019] [Accepted: 04/06/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Children with hypospadias, being born with congenital abnormalities, having repeated genital examination, hospitalization, and undewent genital surgery, experienced psychological stress that may negatively affect their psychosocial life. Choosing the proper time of surgery as recommended is important, since it may have a positive impact on the psychosocial adaptation. AIM This study aims to find the risk factors causing psychosocial disorders in post-repair surgery on hypospadias children. METHODS This is a case control study, from 203 hypospadias patients underwent urethroplasty from 2009 to 2018. Subjets were screened for psychosocial disorders by Pediatric Symptoms Questionnaire 17 (PSC-17) questionnaire to find those with psychosocial disorders, score 15 or more (case group) and those without psychosocial disorders (control group), score 0-14. We traced back the data retrospectively from both group (history of utrethrocutaneous fistula and meatal stenosis, age upon urethroplasty) and collecting new ones (cosmetic outcome, emotional stress after genital examination, and the existence of PTSD). Fisher's exact test was performed to see the Odds ratio (OR) for each variable. RESULTS Some children with hypospadias show impaired on psychocosial. Functional and cosmetic outcome not significantly different as potensial risk factor psychosocial disorders, genital examination doesn't trigger psychological stress and also none children show PTSD symtomp after surgery. Comparison time of age urethroplasty did not differ significantly between two group. CONCLUSIONS Twenty-nine children post urthroplasty show psychosocial disorders. Functional and cosmetic urethroplasty outcomes, emotional stress after genital examination, post-traumatic stress disorder were not risk factors of pshycosocial disorder of hypospadias patients. Ages at time of surgery did not differ significantly between two group and this is contradict to the previous recommendations.
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Affiliation(s)
- Gede Wirya Kusuma Duarsa
- Department of Urology, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
| | - Dinar Ayu Pratiwi
- Department of Surgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
| | - Pande Wisnu Tirtayasa
- Department of Urology, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
| | - Wayan Yudiana
- Department of Urology, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
| | - Kadek Budi Santosa
- Department of Urology, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
| | - Anak Agung Gde Oka
- Department of Urology, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
| | - Sri Wahyuni
- Department of Psychiatry, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
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Sheng X, Xu D, Wu Y, Yu Y, Chen J, Qi J. The risk factors of Urethrocutaneous fistula after hypospadias surgery in the youth population. BMC Urol 2018; 18:64. [PMID: 30041630 PMCID: PMC6057100 DOI: 10.1186/s12894-018-0366-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 05/16/2018] [Indexed: 11/10/2022] Open
Abstract
Background The current research aims to evaluate the risk factors of urethrocutaneous fistula after hypospadias surgery among the youth in China. Methods One hundred twenty hypospadias patients were enrolled in our study. All of them were defined as Tanner 4 or 5. The information collected from the participants include age, urethral operation history, urinary comorbidities before operation, urine test before operation, body temperature before and after operation, type of surgical repair, chordee degree, urethral defect length and whether received vesicostomy after surgery or not. Independent t test, chi-square test and multivariate logistic regression were performed to evaluate the risk factor of urethrocutaneous fistula. Results Among the enrolled patients, 39 patients (32.5%) developed urethrocutaneous fistula after hypospadias repair. Our result showed significant association between the group with urethrocutaneous fistula and the group without urethrocutaneous fistula with respect to age, pyuria before operation, urethral defect length and the urethral operation history. The following logistic regression showed that urethral defect length and the urethral operation history were the risk factors of urethrocutaneous fistula. Conclusions Urethral defect length and urethral operation history should be taken into consideration before undergoing hypospadias surgery since our study discovered that the risk of developing urethrocutaneous fistula after hypospadias repair is associated with urethral defect length and urethral operation history. Age, surgical procedure, type of surgical repair, chordee degree and other factors were not obviously related to the development of urethrocutaneous fistula. Electronic supplementary material The online version of this article (10.1186/s12894-018-0366-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xujun Sheng
- Department of Urology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, 1665 Kongjiang Rd, XinHua Hospital, Shanghai, 200092, China
| | - Ding Xu
- Department of Urology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, 1665 Kongjiang Rd, XinHua Hospital, Shanghai, 200092, China
| | - Yu Wu
- Department of Urology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, 1665 Kongjiang Rd, XinHua Hospital, Shanghai, 200092, China
| | - Yongjiang Yu
- Department of Urology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, 1665 Kongjiang Rd, XinHua Hospital, Shanghai, 200092, China
| | - Jianhua Chen
- Department of Urology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, 1665 Kongjiang Rd, XinHua Hospital, Shanghai, 200092, China
| | - Jun Qi
- Department of Urology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, 1665 Kongjiang Rd, XinHua Hospital, Shanghai, 200092, China.
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Risk factors for failed urethrocutaneous fistula repair after transverse preputial island flap urethroplasty in pediatric hypospadias. Int Urol Nephrol 2017; 50:191-195. [PMID: 29282594 DOI: 10.1007/s11255-017-1773-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We review our experience in urethrocutaneous fistula (UCF) repair after transverse preputial island flap urethroplasty (Duckett) in pediatric hypospadias to investigate the risk factors for unsuccessful outcome. METHODS Two hundred and nineteen UCFs repairs conducted in our center from January 2015 to December 2016 after Duckett technique were retrospectively reviewed and 182 had a follow-up for more than 6 months. The age of patients, size, localization and numbers of UCFs, interval time of two operations, length of neourethra, times of UCFs repairs, complications other than UCFs, hospital of primary surgery and postoperative infection were analyzed as potential risk factors. Stratified analysis and assessment of additive interaction were performed to have a better understanding of the relation between the risk factors. Logistic regression analysis was used for multivariate analysis. RESULTS UCF repairs were succeeded in 121 (66.5%) and failed in 61 (33.5%) at first operation. In the univariate analysis, size and numbers of UCFs (P = 0.01 and P = 0.035, respectively), interval time of two operations (P = 0.042) and hospital of primary surgery (P = 0.02) were statistically related with the outcome. In the multivariate analysis, UCF ≥ 2 (OR 2.71, 95%, CI 1.095-6.692, P = 0.031), size ≥ 2 mm (OR 2.45, 95% CI 1.267-4.757, P = 0.08) and primary surgery not at our hospital (OR 2.21, 95% CI 1.094-4.126, P = 0.026) were identified as independent risk factors for unsuccessful outcome. In the stratified analysis, multiplicative interaction between the 3 risk factors was not found. CONCLUSIONS Our study suggested that UCF repairs after transverse preputial island flap urethroplasty were easier to fail if the UCF was ≥ 2 mm, the numbers of UCFs was ≥ 2, or the surgeon had less experience. The age of patients, site of UCFs, interval time of two operations, length of neourethra, times of UCFs repairs, complications other than UCF and postoperative infection were not significantly related to the success rate of UCF repair.
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Comparison of interrupted- and continuous-suture urethroplasty in tubularised incised-plate hypospadias repair: A prospective study. Arab J Urol 2017; 15:312-318. [PMID: 29234534 PMCID: PMC5717464 DOI: 10.1016/j.aju.2017.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/14/2017] [Accepted: 10/18/2017] [Indexed: 12/02/2022] Open
Abstract
Objective To compare the effect of interrupted- and continuous-suture urethroplasty on complication rates in Snodgrass tubularised incised-plate (TIP) hypospadias repair. Patients and methods This was a prospective randomised study comprising 100 boys (age range 1–5 years) with primary subcoronal, distal- and mid-penile hypospadias who underwent repair from October 2010 to March 2015 in a tertiary care hospital. Boys with glanular, recurrent, and proximal hypospadias were excluded from the study. The boys were prospectively randomised into two groups: Group A, comprised 50 boys who underwent interrupted subcuticular suture Snodgrass TIP urethroplasty; and Group B, comprised 50 boys who underwent continuous subcuticular suture Snodgrass TIP urethroplasty. Outcomes were assessed in terms of complication rates and aesthetic appearance during follow-up. Results There was no significant difference in the occurrence of complications between the groups. There were 21 complications, with 10 occurring in Group A and 11 in Group-B. Urethrocutaneous fistula was the most common complication in both groups (six in Group A and seven in Group B), the fistulae were <2 mm in nine patients and 3–5 mm in the remaining four. Partial glans dehiscence occurred in one patient in each group. One patient from each group also had superficial wound infection, meatal stenosis and urethral stricture respectively, all of which were managed conservatively. The resultant urinary stream was single and good in all patients of both groups. Conclusions The type of suture technique had no significant effect on complication rates after Snodgrass hypospadias repair and thus the choice of technique depends on surgeon preference.
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25
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Mozafarpour S, Kajbafzadeh AM, Abbasioun R, Habibi AA, Nabavizadeh B. Ointment Fistulography: Introducing a Novel Technique for Single or Multiple Urethrocutaneous Fistula Diagnosis After Hypospadias Surgery. Urology 2017; 106:231-232. [PMID: 28982617 DOI: 10.1016/j.urology.2017.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVE Hypospadias is a common congenital malformation of the male genital tract. The most frequent complication after hypospadias repair is urethrocutaneous fistula.1 Its incidence has been reported up to 35% worldwide.2 The diagnosis of these fistulas is sometimes challenging particularly with tiny and multiple fistulas. Usually, parents complain of urinary spraying, sprinkling, or passing a single stream of urine from the undersurface of the penis after the surgery. Urethrocutaneous fistulas are not always visible on physical examination. Locating the fistula and status of the surrounding skin is very important in order to choose the surgical repair technique.3 The patency and anatomy of the distal urethra should also be determined before the repair surgery.4 That is why urologists usually use retrograde urethrography or cystoscopy to find the location of fistula. However, these modalities have their own risk for children and are not always helpful. Sometimes the contrast media inserted can clog some fistulas especially near the glans and preclude the diagnosis. We present an easy technique to screen for urethrocutaneous fistulas after hypospadias surgery. TECHNIQUE In this technique (Video 1), an antibiotic ointment is inserted through the meatus while the base of the penis is held; the ointment is then gently pushed through the meatus. As shown in the video, the ointment will protrude through the fistulas anywhere along the shaft. This technique can also be performed reversely as the ointment inserted from the fistulas will protrude from the meatus. For younger children under the age of 3, we exclusively perform this technique under anesthesia on the repair surgery day, whereas in toddlers we perform this technique in the office and once again under anesthesia right before the repair surgery. RESULT This technique shows even tiny and multiple fistulas not detectable on physical examinations. We have used this technique in our clinic and have not missed any fistulas. The diameter of the protruded ointment in reverse fistulography is an indicator of the distal urethral diameter. Therefore, in case of narrow ointment diameter, distal urethral strictures should be suspected as correction of distal obstruction is an important determinant in the success rate of fistula repair surgery.5 CONCLUSION: We suggest this diagnostic technique as a safe, inexpensive, easy, office-based, feasible, and reproducible method. Negative urine culture is not required for this examination. Also, there is no need to insert contrast media as in retrograde urethrography or induce anesthesia as in cystoscopy. We believe this simple technique help urologists around the world to diagnose this common complication of hypospadias surgery without the need for special equipment.
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Affiliation(s)
- Sarah Mozafarpour
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Abbasioun
- Pediatric Urology and Regenerative Medicine Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbar Habibi
- Pediatric Urology and Regenerative Medicine Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Nabavizadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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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: 57] [Impact Index Per Article: 8.1] [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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Garnier S, Maillet O, Cereda B, Ollivier M, Jeandel C, Broussous S, Lopez C, Paris F, Philibert P, Amouroux C, Jeandel C, Coffy A, Gaspari L, Daures JP, Sultan C, Kalfa N. Late surgical correction of hypospadias increases the risk of complications: a series of 501 consecutive patients. BJU Int 2017; 119:942-947. [DOI: 10.1111/bju.13771] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Sarah Garnier
- Department of Paediatric Surgery and Urology; Lapeyronie Hospital; CHU Montpellier; Montpellier France
| | - Olivier Maillet
- Department of Paediatric Surgery and Urology; Lapeyronie Hospital; CHU Montpellier; Montpellier France
| | - Barbara Cereda
- Department of Paediatric Surgery and Urology; Lapeyronie Hospital; CHU Montpellier; Montpellier France
| | - Margot Ollivier
- Department of Paediatric Surgery and Urology; Lapeyronie Hospital; CHU Montpellier; Montpellier France
| | - Clement Jeandel
- Department of Paediatric Surgery and Urology; Lapeyronie Hospital; CHU Montpellier; Montpellier France
| | - Sylvie Broussous
- Department of Paediatric Surgery and Urology; Lapeyronie Hospital; CHU Montpellier; Montpellier France
| | - Christophe Lopez
- Department of Paediatric Surgery and Urology; Lapeyronie Hospital; CHU Montpellier; Montpellier France
| | - Francoise Paris
- Department of Paediatric Endocrinology; Arnaud de Villeneuve Hospital; CHU Montpellier; Montpellier France
- Department of Endocrinology; Lapeyronie Hospital; CHU Montpellier; Montpellier France
| | - Pascal Philibert
- Department of Endocrinology; Lapeyronie Hospital; CHU Montpellier; Montpellier France
| | - Cyril Amouroux
- Department of Paediatric Endocrinology; Arnaud de Villeneuve Hospital; CHU Montpellier; Montpellier France
| | - Claire Jeandel
- Department of Paediatric Endocrinology; Arnaud de Villeneuve Hospital; CHU Montpellier; Montpellier France
| | - Amandine Coffy
- Institute of Clinical Research; University of Montpellier; Montpellier France
| | - Laura Gaspari
- Department of Endocrinology; Lapeyronie Hospital; CHU Montpellier; Montpellier France
| | - Jean Pierre Daures
- Institute of Clinical Research; University of Montpellier; Montpellier France
| | - Charles Sultan
- Department of Paediatric Endocrinology; Arnaud de Villeneuve Hospital; CHU Montpellier; Montpellier France
- Department of Endocrinology; Lapeyronie Hospital; CHU Montpellier; Montpellier France
| | - Nicolas Kalfa
- Department of Paediatric Surgery and Urology; Lapeyronie Hospital; CHU Montpellier; Montpellier France
- Department of Endocrinology; Lapeyronie Hospital; CHU Montpellier; Montpellier France
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Ardelt PU, Cederqvist M, Barth M, Frankenschmidt A. The SIGHT questionnaire: A novel assessment tool for Satisfaction In Genital Hypospadias Treatment. J Pediatr Urol 2017; 13:33.e1-33.e8. [PMID: 27889217 DOI: 10.1016/j.jpurol.2016.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 10/04/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE Psychosexual development is currently underrepresented in hypospadias outcome research. The aim of this study was to develop and validate a questionnaire addressing psychosexual long-term satisfaction, specifically of adolescent patients, after hypospadias repair. MATERIALS AND METHODS In a multistep participative design we identified key interests of adolescent patients with hypospadias. Next, a questionnaire addressing specifically the psychosexual satisfaction of adolescents after hypospadias repair was established. A population of 109 former patients with hypospadias was then assessed using this questionnaire. Furthermore, functional and cosmetic aspects, behavioural anomalies, and sexual activity were investigated. Age-matched patients undergoing circumcision served as control patients. Possible influence factors on patient satisfaction were investigated. Clinical trial registry site: German Registry of Clinical Trials DRKS, Freiburg, Germany (Reference: DRKS00003432). RESULTS Key interests of adolescent patients were "normal appearance of the penis", "normal function of the penis regarding voiding and sexual activity", "no limitations regarding cosmetic appearance to others", "no limitations to sexual activity", and an "unimpaired masculine identity". The "Satisfaction In Genital Hypospadias Treatment" (SIGHT) questionnaire was developed using these items and using previously published evaluation systems. Nine questions address psychosexual aspects and two additional questions address current sexual activity. Internal consistency was high and retest reliability acceptable. The patient population showed a normal strength and difficulties score (SDQ). Overall satisfaction was high and similar to that of the control group. In a Spearman correlation a high SDQ value, erectile problems, and complications correlated negatively with satisfaction. CONCLUSION To date, few studies have examined patients' satisfaction and psychosexuality. To our knowledge, the SIGHT questionnaire is the first to be developed participatively and in a stepwise fashion in collaboration with a paediatric psychologist and an open approach to determine items specifically important for adolescents. The SIGHT questionnaire can thus offer a relevant assessment of patients' psychosexual satisfaction. It is most suitable to supplement current strategies that so far mostly neglect the impact on psychosexual wellbeing.
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Affiliation(s)
- Peter U Ardelt
- Department of Urology, University Hospital Basel, Switzerland.
| | - Marco Cederqvist
- Department of Urology and Paediatric Urology, Medical School, Albert-Ludwigs-University of Freiburg, Germany
| | - Michael Barth
- Department of Paediatric Psychology, Medical School, Albert-Ludwigs-University of Freiburg, Germany
| | - Alexander Frankenschmidt
- Department of Urology and Paediatric Urology, Medical School, Albert-Ludwigs-University of Freiburg, Germany
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Elmoghazy H, Hussein MM, Mohamed E, Badawy A, Alsagheer G, Abd Elhamed AM. A novel technique for repair of mid-penile hypospadias using a preputial skin flap: results of 110 patients. Int Urol Nephrol 2016; 48:1943-1949. [PMID: 27623810 DOI: 10.1007/s11255-016-1416-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/01/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several techniques have been used to repair mid-penile hypospadias; however, high failure rates and major complications have been reported. In this study, we describe a novel technique using a well-vascularized flap of the inner and outer preputial skin. METHODS A total of 110 male children with hypospadias underwent repair by our technique between 2008 and 2015. The inclusion criteria were children with mid-penile or slightly more proximal hypospadias, with or without ventral chordae, and an intact prepuce of the cobra eyes variety. Recurrent cases, patients with other preputial types, and circumcised children were excluded from this study. The prepared flap was sutured in its natural longitudinal orientation to the created urethral plate strip to form a neo-urethra over a urethral catheter. Outcome measures included surgical success without the formation of a urethra-cutaneous fistula, no ischaemia of the flaps, glans dehiscence or infection and functional outcome and cosmetic appearance. RESULTS The median follow-up duration was 3.3 years. There were 63 cases of mid-penile hypospadias (57.3 %), and in 47 cases (42.7 %), the meatus was slightly more proximal. The age of the patients ranged from 1.1 to 8.0 years, with a mean age of 4.6 ± 1.2 years. Surgery was successful in 106 (96.4 %) cases. Minor complications occurred in 11 patients (10 %) and included oedema of glans in ten patients and bluish discoloration on the ventral aspect of the glans close to the suture line in three patients. All patients improved within 2 weeks after surgery. Long-term follow-up revealed a properly functioning urethra with a forward, projectile, single, compact, and rifled urinary stream of adequate calibre and cosmetically acceptable repair. No cases of meatal retraction, meatal stenosis, urethral stricture, or acquired urethral diverticulum occurred. DISCUSSION Our technique is different from the split prepuce in situ technique. We create a narrow strip of the urethral plate that facilitates glanular closure, and we use the inner and adjacent outer skin in a vertical manner to preserve excess skin for penile coverage. Prepuce is split at midline to preserve more preputial skin with favourable dartos tissue for penile skin coverage. The glans is closed using a stitch-by-stitch method that has not been described previously. CONCLUSION This study presents a novel technique for mid-penile hypospadias repair using a preputial skin flap with excellent results in terms of short- and long-term outcomes.
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Affiliation(s)
- Hazem Elmoghazy
- Department of Urology, Sohag University Hospital, Alshark District, Sohag, Sohag Governorate, Egypt.
| | - Mohamed M Hussein
- Department of Urology, Sohag University Hospital, Alshark District, Sohag, Sohag Governorate, Egypt
| | - Elnisr Mohamed
- Department of Urology, Sohag University Hospital, Alshark District, Sohag, Sohag Governorate, Egypt
| | - Abdelbasset Badawy
- Department of Urology, Sohag University Hospital, Alshark District, Sohag, Sohag Governorate, Egypt
| | - Gamal Alsagheer
- Department of Urology, South Valley University Hospital, Qena, Egypt
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ZakiEldahshoury M, Gamal W, Salem E, Rashed E, Mamdouh A. Is approximated de-epithelized glanuloplasty beneficial for hypospadiologist? Actas Urol Esp 2016; 40:258-62. [PMID: 26781549 DOI: 10.1016/j.acuro.2015.11.010] [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: 07/19/2015] [Revised: 11/03/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Further evaluation of the cosmetic and functional results of approximated de-epithelized glanuloplasty in different degree of hypospadias. MATERIAL AND METHODS This study included 96 male patients (DPH=68 & MPH=28). Patients selected for repair with glans approximation should have wide urethral plate & grooved glans. All cases were repaired with the classic TIP and glans approximation technique. Follow up was for one year by clinical examination of the meatal shape, size & site, glans shape, skin covering, suture line, urethral catheter, edema & fistula in addition to parent satisfaction. RESULTS Mean operative time was 49±9minutes. As regards the functional and cosmetic outcomes, success was reported in 95.8%, while failure was in 4.16% in the form of glanular disruption in two patients and subcoronal urethrocutaneous fistula in another two patients. CONCLUSION Glans approximation has many advantages, good cosmetic and functional results, short operative time, less blood loss, no need for tourniquet. Study of a large number of cases and comparing glans approximation with the classic TIP technique.
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Abstract
Great controversies and misunderstandings have developed around the relatively recently coined term disorders of sex development (DSD). In this article, we question the wisdom of including XX individuals with congenital adrenal hyperplasia (CAH) in the DSD category and develop arguments against it based on the published literature on the subject. It is clear that females with CAH assigned the female gender before 24 months of age and properly managed retain the female gender identity regardless of the Prader grade. Females with CAH and low Prader grades have the potential for a normal sexual and reproductive life. Those with greater degrees of prenatal androgen exposure (Prader grades IV and V) raised as females also identify themselves as females but experience more male-like behavior in childhood, have a greater rate of homosexuality, and have greater difficulty with vaginal penetration and maintaining pregnancies. Improvement in surgical techniques, better endocrinological, psychological, and surgical follow-up may lessen these problems in the future. Given the fact that the term DSD includes many conditions with problematic gender identity and conflicts with the gender assigned at birth, it may be appropriate to exclude females with CAH from the DSD classification.
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Affiliation(s)
- Ricardo González
- Pediatric Surgery and Urology, Auf der Bult Kinder- und Jugendkrankenhaus , Hannover , Germany
| | - Barbara M Ludwikowski
- Pediatric Surgery and Urology, Auf der Bult Kinder- und Jugendkrankenhaus , Hannover , Germany
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Zaidi RH, Casanova NF, Haydar B, Voepel-Lewis T, Wan JH. Urethrocutaneous fistula following hypospadias repair: regional anesthesia and other factors. Paediatr Anaesth 2015. [PMID: 26201497 DOI: 10.1111/pan.12719] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Urethrocutaneous fistula is a well-known complication of hypospadias surgery. A recent prospective study by Kundra et al. (Pediatr Anesth 2012) has suggested that caudal anesthesia may increase the risk of fistula formation. We sought to evaluate this possible association and determine if any other novel factors may be associated with fistula formation. METHODS Children who underwent primary hypospadias repair between January 1, 1994 and March 31, 2013 at our tertiary care center were included in this study. Reviewed surgical data included repair type, duration of procedure, use of local anesthetic infiltration, and subcutaneous epinephrine. Analgesic factors included use of caudal and/or penile block, opioid usage, postoperative pain scores, and nausea/vomiting. Postoperative surgical complications and estimates of family household median income by zip code were also reviewed. RESULTS Fistula occurrence was not associated with caudal or penile block, severity of postoperative pain, or surgeon experience. A more proximal location of the urethral meatus, longer operating time, and use of subcutaneous epinephrine were significantly more common in patients who developed fistula. As assessed by home address zip code, distance of more than 100 miles and median household income in the bottom 25th percentile of our study population were not associated with fistula, as compared to closer distance or higher income. CONCLUSION In this series, we found no association between the use of caudal regional anesthesia and fistula formation. Location of the starting urethral meatus, prolonged surgical duration, and subcutaneous epinephrine use were associated with fistula formation. Our findings call into question the routine use of epinephrine in hypospadias repair.
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Affiliation(s)
- Raza H Zaidi
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Nina F Casanova
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Bishr Haydar
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Terri Voepel-Lewis
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Julian H Wan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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Daher P, Khoury A, Riachy E, Atallah B. Three-week or one-week bladder catheterization for hypospadias repair? A retrospective-prospective observational study of 189 patients. J Pediatr Surg 2015; 50:1063-6. [PMID: 25863542 DOI: 10.1016/j.jpedsurg.2015.03.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/09/2015] [Accepted: 03/22/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE While there is little scientific evidence over the optimal duration for transurethral bladder catheterization after hypospadias repair, most surgeons leave the catheter for 7-10 days. We herein describe our experience with bladder catheterization for three weeks after hypospadias repair, an approach not previously described in the literature. PATIENTS AND METHODS We reviewed the charts of 189 patients who underwent hypospadias repair by a single pediatric urologist. The study population was divided as follows: group 1 consisted of children operated between March 2007 and September 2010 and whose catheters were left for one week (n=95); group 2 consisted of those operated between September 2010 and July 2013 and whose catheters were left for three weeks (n=94). The primary objective of the study was to compare complication rates between the two groups. Secondary outcomes were evaluation of the effect of age, surgical technique, curvature, and hypospadias degree as potential factors for postoperative complications. RESULTS Median age at hypospadias repair was 18 months (range, 3-100 months) in group 1, and 16 months (range, 2-96 months) in group 2, P=.209. The complication rate was 22.1% (n=21) for group 1 and 7.4% (n=7) for group 2, P=.005. Complications observed in group 1 and 2 were meatal stenosis (n=4 and 2, respectively) and urethro-cutaneous fistulas (n=17 and 5, respectively). Coronal fistulas manifested more frequently in patients in group 1 compared to those in group 2 (13.7% vs. 3.2%, P=.01). Complications were observed in 20 patients out of 139 (11.5%) after Duplay, and in 8 patients out of 15 (53.3%) after Duckett (P<.001). In Duplay cases, complications were significantly associated with one-week bladder catheterization (OR: 5.00; 95% CI: 1.53-16.32; P=.008) and higher age group at operation (OR: 1.88; 95% CI 1.07-3.28; P=.026). In Duckett cases, number of surgeries, age, severity, curvature and catheter duration were not found to be associated with complications. CONCLUSION In cases of Duplay, a three-week instead of one-week catheterization and age below 6 months at hypospadias repair are associated with a better outcome and fewer complications.
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Affiliation(s)
- Paul Daher
- Department of Pediatric Surgery, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Boulevard Alfred Naccache, Achrafieh, P.O. Box: 16, 6830, Beirut, Lebanon.
| | - Antoine Khoury
- Department of Pediatric Surgery, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Boulevard Alfred Naccache, Achrafieh, P.O. Box: 16, 6830, Beirut, Lebanon.
| | - Edward Riachy
- Department of Pediatric Surgery, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Boulevard Alfred Naccache, Achrafieh, P.O. Box: 16, 6830, Beirut, Lebanon.
| | - Bachir Atallah
- Department of Statistics, Hotel-Dieu de France University Hospital, Boulevard Alfred Naccache, Achrafieh, P.O. Box: 16, 6830, Beirut, Lebanon.
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Huang LQ, Ge Z, Tian J, Ma G, Lu RG, Deng YJ, Wang LX, Chen CJ, Zhu HB, Zhu XJ, Guo YF. Retrospective analysis of individual risk factors for urethrocutaneous fistula after onlay hypospadias repair in pediatric patients. Ital J Pediatr 2015; 41:35. [PMID: 25903765 PMCID: PMC4422430 DOI: 10.1186/s13052-015-0140-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To retrospectively identify the individual risk factors for the urethrocutaneous fistula (UCF) in pediatric patients after hypospadias repair (HR) with onlay island flap urethroplasty. METHODS A total of 167 patients who underwent primary HR at Nanjing Medical University Affiliated Children Hospital from January 2009 to December 2012 were enrolled. Clinical data including the patient' age at HR, hypospadias type and urethral defect length were documented. RESULTS Among 167 patients, 12.6% patients (n = 21) developed UCF after HR. Postoperative UCF occurred in 3.9% (3/76) cases at age of 0-2 years, 14.3% (9/63) at 2-4 years, 20.0% (2/10) at 4-6 years and 38.9% (7/18) at 6-12 years. The incidences of UCF were 12.0% (3/25), 11.4% (5/132) and 30.0% (3/10) for distal, middle and proximal types of hypospadias. As to the urethral defect length, the incidences of UCF were 8.2% (5/61) in patients with a length of ≤ 2 cm, 12.8% (9/70) in 2-3 cm, 22.6% (7/31) in 3-4 cm and 0% (0/5) in above 4 cm. Older age at HR was significantly associated with the high incidence of UCF formation (P = 0.004), while the hypospadias type and urethral defect length did not affect it (P = 0.264 and P = 0.312, respectively). CONCLUSIONS The patient' age at HR was a risk factor for the UCF formation after HR, and treatment of HR within two years old might be with the least incidence of UCF.
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Affiliation(s)
- Li-Qu Huang
- Department of Urology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210008, China.
| | - Zheng Ge
- Department of Urology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210008, China.
| | - Jun Tian
- Department of Urology, Beijing Children's Hospital Affiliated Hospital of Capital Medical University, Beijing, 100045, China.
| | - Geng Ma
- Department of Urology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210008, China.
| | - Ru-Gang Lu
- Department of Urology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210008, China.
| | - Yong-Ji Deng
- Department of Urology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210008, China.
| | - Li-Xia Wang
- Department of Urology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210008, China.
| | - Chen-Jun Chen
- Department of Urology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210008, China.
| | - Hao-Bo Zhu
- Department of Urology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210008, China.
| | - Xiao-Jiang Zhu
- Department of Urology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210008, China.
| | - Yun-Fei Guo
- Department of Urology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210008, China.
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Soydan H, Okcelik S, Malkoc E, Ates F, Adayener C, Yilmaz Ö, Senkul T, Karademir K. Tubularized incised plate urethroplasty in adults under local anaesthesia. Rev Int Androl 2015. [DOI: 10.1016/j.androl.2014.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bae SH, Lee JN, Kim HT, Chung SK. Urethroplasty by use of turnover flaps (modified mathieu procedure) for distal hypospadias repair in adolescents: comparison with the tubularized incised plate procedure. Korean J Urol 2014; 55:750-5. [PMID: 25405018 PMCID: PMC4231153 DOI: 10.4111/kju.2014.55.11.750] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/02/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The purpose of this study was to examine whether urethroplasty with a turnover flap, as an alternative method of distal hypospadias repair in adolescents, improves the outcome of surgery. MATERIALS AND METHODS Between January 2004 and December 2013, a total of 38 adolescents (aged 11-17 years) underwent distal hypospadias repair with either the tubularized incised plate (TIP) procedure (n=25) or the turnover flap procedure (n=13). The turnover flap procedure was performed with a proximal, ventral penile flap that was turned over to cover the urethral plate. Patient demographics, perioperative outcomes, complications, and postoperative uroflowmetry in each surgical group were analyzed retrospectively. RESULTS The patient demographics were similar in the two groups. There were no significant differences in perioperative outcomes between the groups, including mean operative time, duration of hospital stay, and urethral catheterization. The number of patients with at least one complication, including wound dehiscence, urethrocutaneous fistula, meatal stenosis, and urethral stricture, was lower in the turnover flap group (1/13, 7.7%) than in the TIP group (11/25, 44%, p=0.030). The incidence of meatal stenosis was lower in the turnover flap group (0/12, 0%) than in the TIP group (6/25, 24%). In postoperative uroflowmetry, the plateau-shaped curve rate was lower in the turnover flap group (1/12, 8.3%) than in the TIP group (5/19, 26.3%); the peak flow was higher (p=0.030). CONCLUSIONS The turnover flap procedure is clinically useful for repairing adolescent distal hypospadias because it offers lower complication rates and better functional outcomes than TIP.
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Affiliation(s)
- Seong Ho Bae
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jun Nyung Lee
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyun Tae Kim
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sung Kwang Chung
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
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Metzler IS, Nguyen HT, Hagander L, Jalloh M, Nguyen T, Gueye SM, deVries CR, Meara JG. Surgical Outcomes and Cultural Perceptions in International Hypospadias Care. J Urol 2014; 192:524-9. [DOI: 10.1016/j.juro.2014.01.101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Ian S. Metzler
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
- Department of Plastic and Oral Surgery, Children's Hospital Boston, Boston, Massachusetts
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Hiep T. Nguyen
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts
- IVUmed, Salt Lake City, Utah
| | - Lars Hagander
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
- Department of Plastic and Oral Surgery, Children's Hospital Boston, Boston, Massachusetts
- Pediatric Surgery and International Pediatrics, Department of Clinical Sciences, Lund Faculty of Medicine, Lund University, Lund, Sweden
| | | | | | | | - Catherine R. deVries
- IVUmed, Salt Lake City, Utah
- Department of Urology, Primary Children's Medical Center, Salt Lake City, Utah
| | - John G. Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
- Department of Plastic and Oral Surgery, Children's Hospital Boston, Boston, Massachusetts
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Soave A, Riechardt S, Engel O, Rink M, Fisch M. Komplikationen bei Hypospadiekorrekturen. Urologe A 2014; 53:1001-5. [DOI: 10.1007/s00120-014-3498-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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