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Barasa P, Simoliunas E, Grybas A, Zilinskaite-Tamasauske R, Dasevicius D, Alksne M, Rinkunaite I, Buivydas A, Baltrukonyte E, Tamulyte R, Megur A, Verkauskas G, Baltriukiene D, Bukelskiene V. Development of multilayered artificial urethra graft for urethroplasty. J Biomed Mater Res A 2024. [PMID: 39268589 DOI: 10.1002/jbm.a.37796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 08/11/2024] [Accepted: 09/03/2024] [Indexed: 09/17/2024]
Abstract
To enhance the treatment of patients' urethral defects, such as strictures and hypospadias, we investigated the potential of using artificial urethral tissue. Our study aimed to generate this tissue and assess its effectiveness in a rabbit model. Two types of bioprinted grafts, based on methacrylated gelatin-silk fibroin (GelMA-SF) hydrogels, were produced: acellular, as well as loaded with autologous rabbit stem cells. Rabbit adipose stem cells (RASC) were differentiated toward smooth muscle in the GelMA-SF hydrogel, while rabbit buccal mucosa stem cells (RBMC), differentiated toward the epithelium, were seeded on its surface, forming two layers of the cell-laden tissue. The constructs were then reinforced with polycaprolactone-polylactic acid meshes to create implantable multilayered artificial urethral grafts. In vivo experiments showed that the cell-laden tissue integrated into the urethra with less fibrosis and inflammation compared to its acellular counterpart. Staining to trace the implanted cells confirmed integration into the host organism 3 months postsurgery.
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Affiliation(s)
- Povilas Barasa
- Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Egidijus Simoliunas
- Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Aivaras Grybas
- Urology Center, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Ramune Zilinskaite-Tamasauske
- Children's Surgery, Orthopaedic and Traumatology Centre, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Darius Dasevicius
- Centre of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Milda Alksne
- Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Ieva Rinkunaite
- Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Andrius Buivydas
- Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Emilija Baltrukonyte
- Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Rimgaile Tamulyte
- Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | | | - Gilvydas Verkauskas
- Children's Surgery, Orthopaedic and Traumatology Centre, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Daiva Baltriukiene
- Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Virginija Bukelskiene
- Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
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Xie QG, Xue TT, Chen XR, Li ZY, Xu Z, Li ZQ, Luo P. Application of the modified Byars staged procedure for severe hypospadias repair. Asian J Androl 2024:00129336-990000000-00239. [PMID: 39238320 DOI: 10.4103/aja202470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 07/01/2024] [Indexed: 09/07/2024] Open
Abstract
This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias. We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) between October 2012 and October 2022. In total, 31 patients underwent the conventional Byars procedure (conventional group), and 45 patients underwent the modified Byars staged procedure (modified group). Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage. Notably, there were no statistically significant differences in the preoperative baseline characteristics, duration of surgery, amount of blood loss, or occurrence of postoperative complications, including urethral fistula, stricture and diverticulum, or penile curvature, between the conventional and modified groups. However, there was a significantly lower incidence of coronal sulcus fistula (0 vs 16.1%, P = 0.02) and glans dehiscence (0 vs 12.9%, P = 0.02) in the surgical group than that in the conventional group. In addition, the modified group exhibited a notably greater rate of normotopic urethral opening (100.0% vs 83.9%, P = 0.01) and a higher mean score on the Hypospadias Objective Penile Evaluation (HOPE; mean ± standard error of mean: 8.6 ± 0.2 vs 7.9 ± 0.3, P = 0.02) than did the conventional group. In conclusion, the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula. Consequently, it offers a promising approach for achieving favorable penile esthetics, thereby providing a reliable therapeutic option for severe hypospadias.
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Affiliation(s)
- Qi-Gen Xie
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Ting-Ting Xue
- Department of Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510620, China
| | - Xu-Ren Chen
- Reproductive Medicine Center, The Key Laboratory for Reproductive Medicine of Guangdong Province, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Zhao-Ying Li
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Zhe Xu
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Zuo-Qing Li
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Peng Luo
- Reproductive Medicine Center, The Key Laboratory for Reproductive Medicine of Guangdong Province, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
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Anttila A, Lahdes-Vasama T, Pakkasjärvi N, Taskinen S. Cumulative re-operation rates during follow-up after hypospadias repair. BJU Int 2024. [PMID: 39224939 DOI: 10.1111/bju.16519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To assess the cumulative rates of re-operations after hypospadias repair and evaluate long-term surgical outcomes at a tertiary paediatric urology centre. PATIENTS AND METHODS Retrospective analysis of 293 boys born between 1991 and 2003 undergoing hypospadias surgery was conducted. The study included 274 patients: 165 with distal, 34 with midshaft, and 75 with proximal hypospadias. Kaplan-Meier methods were used to evaluate the re-operation data. RESULTS The median age at primary surgery was 1.3 years, with a median follow-up of 14.4 years. The overall re-operation rate was 48.2%, with approximately half of the problems detected within the first 3 months after surgery. The risk of re-operation was correlated with hypospadias severity, with 5- and 15-year re-operation risks at 39.3% and 51.8%, respectively. Limitations of the study include its retrospective nature and variations in surgical techniques from current standards. CONCLUSION There is a significant risk of unplanned re-operations following hypospadias repair, increasing with the severity of the original condition. This underscores the need for extended follow-up and effective communication with patients and their families about the likelihood of requiring multiple surgeries for optimal outcomes.
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Affiliation(s)
- Annaleena Anttila
- Department of Pediatric Surgery, Section of Pediatric Urology, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
- Department of Pediatric Surgery, Tampere University Hospital, Tampere, Finland
| | - Tuija Lahdes-Vasama
- Department of Pediatric Surgery, Tampere University Hospital, Tampere, Finland
| | - Niklas Pakkasjärvi
- Department of Pediatric Surgery, Section of Pediatric Urology, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Seppo Taskinen
- Department of Pediatric Surgery, Section of Pediatric Urology, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
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Zhou G, Jiang M, Liu X, Yin J, yang Z, Li S, Chen J. Effect of Prolonging the Duration of Stenting on Urethral Stricture in Proximal Hypospadias with Severe Curvature Repair: A Prospective Cohort Study. Eur J Pediatr Surg 2024; 34:363-367. [PMID: 37336243 PMCID: PMC11226329 DOI: 10.1055/s-0043-1769797] [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: 03/01/2023] [Accepted: 05/04/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate whether prolonged stenting reduces the risk of urethral stricture after proximal hypospadias (PH) with severe curvature (SC) repair. MATERIALS AND METHODS We prospectively studied a cohort of patients with PH with SC repair who underwent urethral plate transection and urethroplasty between January 2010 and December 2020. According to the duration of stenting, the patients were divided into 2-, 4-, and 6-week groups. Postoperative complications and time of urethral stricture occurrence were analyzed. RESULTS In total, 665 patients were included in the analysis. The overall incidence of complications was 26.6% (n = 177), including 42 cases of urethral strictures: 27 (64.3%) cases of urethral stricture occurred between 4 and 6 weeks after urethroplasty, 7 cases occurred between 7 weeks and 6 months after urethroplasty, 7 cases occurred more than 6 months after urethroplasty, and 1 case occurred at 3 weeks after urethroplasty. The incidence of urethral stricture in the 6-week group (1.8%) was significantly lower than that in the 4- (5.8%) and 2-week groups (10.9%) (p < 0.05). CONCLUSION Prolonged stenting reduces the risk of urethral stricture in PH with SC repair. Four to six weeks after PH with SC repair may be the key period for the formation of early urethral strictures.
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Affiliation(s)
- Guanglun Zhou
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Man Jiang
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, China
| | - Xiaodong Liu
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Jianchun Yin
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Zhilin yang
- Department of Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Shouln Li
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Guangdong, Shenzhen, China
| | - Jinjun Chen
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Guangdong, Shenzhen, China
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Lavoie C, Do C, Baker Z, Trabold M, Han J, Thaker H, Chang A. Human umbilical cord allograft associated with higher pediatric urethrocutaneous fistula repair success rates. J Pediatr Urol 2024; 20:692.e1-692.e6. [PMID: 38951046 DOI: 10.1016/j.jpurol.2024.06.013] [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: 12/06/2023] [Revised: 05/02/2024] [Accepted: 06/11/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Urethrocutaneous fistula (UCF) formation is a known complication following hypospadias repair, affecting between 5 and 70% of cases. Moreover, approximately 30% of patients experience refistulization after UCF repair. The use of extracellular matrices, such as AmnioCord, a dehydrated human umbilical cord allograft manufactured by MiMedx®, may mitigate high rates of refistulization. OBJECTIVE To determine whether the use of AmnioCord during UCF repair is associated with reduced incidence of subsequent UCFs among pediatric patients. DESIGN, SETTING, AND PARTICIPANTS Electronic medical records were retrospectively reviewed among 60 patients who underwent at least one UCF repair at a pediatric hospital in a large urban setting in the U.S. between January 2012-June 2018. Patients were followed through January 2024. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Adjusted generalized estimating equation regression models were used to assess the association between AmnioCord use and rates of refistulization, while controlling for confounding variables. RESULTS The number of fistula presentations per patient ranged from one to four; 53.3% had one fistula, 30.0% had two, and 16.6% had three or more. Overall fistula repair success rate was 56.8% but significantly differed by AmnioCord use in adjusted modelling; 69.4% of cases that received AmnioCord were successfully repaired, compared to 47.2% of cases that did not receive AmnioCord. In adjusted models, patients who received AmnioCord had 2.66 times greater odds of surgical success than patients who did not receive AmnioCord (95% CI:1.13-6.24; p = 0.02). CONCLUSIONS This study demonstrates a positive association between AmnioCord use and successful UCF closure among pediatric patients.
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Affiliation(s)
- Callum Lavoie
- Division of Urology, Children's Hospital Los Angeles, USC Institute of Urology, Keck School of Medicine of USC, Los Angeles, CA, USA.
| | - Christine Do
- Division of Urology, Children's Hospital Los Angeles, USC Institute of Urology, Keck School of Medicine of USC, Los Angeles, CA, USA.
| | - Zoë Baker
- Division of Urology, Children's Hospital Los Angeles, USC Institute of Urology, Keck School of Medicine of USC, Los Angeles, CA, USA.
| | - Melissa Trabold
- Division of Urology, Children's Hospital Los Angeles, USC Institute of Urology, Keck School of Medicine of USC, Los Angeles, CA, USA.
| | - Jullet Han
- Division of Urology, Children's Hospital Los Angeles, USC Institute of Urology, Keck School of Medicine of USC, Los Angeles, CA, USA.
| | | | - Andy Chang
- Division of Urology, Children's Hospital Los Angeles, USC Institute of Urology, Keck School of Medicine of USC, Los Angeles, CA, USA.
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Zhuang J, Su X, Jia Y, Zheng Q, Wei Q, Zhang Z, Hu J, Yuan L, Chai H. Evaluation of postoperative complications of hypospadias using high-frequency ultrasound imaging. BMC Urol 2024; 24:121. [PMID: 38862925 PMCID: PMC11165801 DOI: 10.1186/s12894-024-01491-y] [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] [Received: 10/26/2023] [Accepted: 04/24/2024] [Indexed: 06/13/2024] Open
Abstract
PURPOSE Various complications following hypospadias surgery present distinct manifestations when examined with ultrasound. Utilizing high-frequency ultrasound, clinicians can promptly identify these complications and initiate appropriate treatment. The aim of this study is to catalogue the ultrasonographic presentations of various postoperative complications following hypospadias surgery, thereby providing a reference for ultrasonographic diagnosis. METHODS Ultrasonic images of post-hypospadias surgery from October 1, 2015, to June 30, 2023, recorded at the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences, serve as the basis for this investigation. Drawing on patient clinical diagnoses, this study compiles and selects representative ultrasound images of diverse complications. RESULTS The study encompassed a total of 121 subjects; 26 demonstrated urethral stricture on ultrasonic images, two presented local urethral dilation, six showed intraurethral hair-like structures, 17 revealed intraurethral septum, two exhibited intraurethral fold, one had urethral calculus, one displayed urethral calcification, 12 indicated intraurethral urine accumulation, and two showed urethral diverticulum. CONCLUSION Ultrasound examination is helpful for postoperative diagnosis following hypospadias, detecting complications such as urethral stricture, urethral hair growth, and urethral diverticulum, which can help doctors choose appropriate clinical treatment strategies.
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Affiliation(s)
- Jun Zhuang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xueshang Su
- Department of Cosmetic Injection Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Jia
- Ultrasonography Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Thirty-three Badachu Road, Shijingshan District, Beijing, P.R. China
| | - Qiaoyuan Zheng
- College of Clinical Medicine, Fudan University, No. 130 Dong'an Road, Xuhui District, Shanghai, 200433, People's Republic of China
| | - Qingqian Wei
- Department of Cosmetic Injection Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ziming Zhang
- Department of Cosmetic Injection Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jintian Hu
- Department of Cosmetic Injection Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Yuan
- Ultrasonography Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Thirty-three Badachu Road, Shijingshan District, Beijing, P.R. China.
| | - Hongli Chai
- Ultrasonography Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Thirty-three Badachu Road, Shijingshan District, Beijing, P.R. China.
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Thanneeru SK, Gupta A, Chanchlani R, Sharma PK, Babu R, Ahmad R, Agrawal A. Preoperative topical estrogen application in the management of hypospadias: a systematic review. Pediatr Surg Int 2024; 40:132. [PMID: 38739164 DOI: 10.1007/s00383-024-05708-x] [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] [Accepted: 04/21/2024] [Indexed: 05/14/2024]
Abstract
Local estrogen therapy has been explored as an alternative to conventional testosterone therapy in children requiring urethroplasty for hypospadias. Our objective is to evaluate if preoperative estrogen stimulation reduces post-urethroplasty complications and enhances penile dimensions. A systematic search was conducted on various databases, selecting only randomized controlled trials (RCTs) that tested estrogen on hypospadias patients under 18 years. Articles underwent sorting following PRISMA guidelines and bias risk was assessed using the JBI clinical appraisal tool for RCTs. Out of 607 screened records, 10 underwent full-text review, and 4 randomized controlled trials (RCTs) were selected for analysis. The total patient cohort across studies was 387 with 174 in the estrogen group. All studies utilized topical estrogen, but in different formulations and timings. Prudence is necessary for interpreting results due to variations in formulation, timing, and hypospadias type across studies. Limited by a small number of studies and outcome presentation non-uniformity, the review suggests no change in penile dimensions or postoperative complications with topical estrogen. Further research is needed to explore wound-healing properties of estrogen in hypospadias through animal and human studies.Registration and protocol: Registered in Prospero CRD42024502183.
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Affiliation(s)
| | - Amit Gupta
- All India Institute of Medical Sciences, Bhopal, India
| | | | | | - Ramesh Babu
- Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Reyaz Ahmad
- All India Institute of Medical Sciences, Bhopal, India.
| | - Amit Agrawal
- All India Institute of Medical Sciences, Bhopal, India
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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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Hammouda HM, Shahat AA, Safwat AS, Taha TM. The long-term consequences of the hypospadias salvage repair issue. BMC Pediatr 2024; 24:58. [PMID: 38243172 PMCID: PMC10797878 DOI: 10.1186/s12887-024-04534-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/03/2024] [Indexed: 01/21/2024] Open
Abstract
PURPOSE To present the long-term results of redo-hypospadias at our tertiary referral center following a failed prior repair. METHODS One hundred sixty-four individuals with a history of unsuccessful repairs qualified for our retrospective cohort study. Our inclusion criteria were as follows: pre-operative data that was accessible, redo-hypospadias that was successfully repaired, and at least three years of follow-up at the last hospital visit. RESULTS The mean patient age was 91.3 ± 21.1 months. The mean follow-up after successful repair was 41.3 ± 3.1 months. Ninety-two (group A) had one prior repair, and 72 (group B) had 2 or 3 repairs. Group A underwent six primary techniques: 32 underwent Onlay Island Flap (OIF), 10 underwent Mathieu, 12 underwent Tubularized Incised Plate Urethroplasty (TIPU), 8 underwent Urethral Mobilization (UM), and 34 underwent Buccal Mucosal Graft (BMG) { dorsal inlay Graft Urethroplasty (DIGU) in 4 and staged BMG in 30 patients}. In group B, four procedures were used: TIPU in 4, UM in 6, and BMG in 62 (staged BMG in 50 cases and DIGU in 12). CONCLUSIONS The selected type of repair will depend on many factors, like residual healthy local skin and expertise. Safe techniques for repair of redo hypospadias after its 1st failure include TIPU, Mathieu, UM, OIF, and DIGU for distal varieties. After 2nd or 3rd repair DIGU, UM, and TIPU can be performed in distal types, while staged BMG can be applied for proximal ones.
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Affiliation(s)
- Hisham M Hammouda
- Pediatric Urology Division, Urology Department, Assiut University, Assiut, Egypt.
| | - Ahmed A Shahat
- Pediatric Urology Division, Urology Department, Assiut University, Assiut, Egypt
| | - Ahmed S Safwat
- Pediatric Urology Division, Urology Department, Assiut University, Assiut, Egypt
| | - Taha M Taha
- Pediatric Urology Division, Urology Department, Assiut University, Assiut, Egypt
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Yuan Y, Wang YW, Liang YN, Wang YY, Ho JJ, Peng TY, Zhao Z, Deng N. A meta-analysis: single or double dartos flap layer in tubularized incised plate urethroplasty to prevent urethrocutaneous fistula? Front Pediatr 2023; 11:1091242. [PMID: 37360362 PMCID: PMC10286861 DOI: 10.3389/fped.2023.1091242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 04/17/2023] [Indexed: 06/28/2023] Open
Abstract
Backgrounds Urethrocutaneous fistula is one of the most common complications after urethroplasty. This meta-analysis aims to evaluate the superiority of double dartos flap to single dartos flap in preventing fistula during tubularized incised plate urethroplasty (TIPU), which is one of the most frequently used operations for hypospadias. Methods We extracted clinical trials under the following included criteria: (1) children with TIPU; (2) a comparison of single and double flap layer; and (3) record of complications with the following excluded criteria: (1) non-comparison and (2) lack of data. Finally, 13 studies from PubMed, Cochrane Library, Scopus, and Embase have been investigated, with a total of 1,185 patients from 2005 to 2022. The quality assessment was conducted according to the Cochrane handbook and the Newcastle-Ottawa scale. A mixed-effect model was utilized to weigh the risk of fistula, phallic rotation, meatal stenosis, and wound dehiscence by the Review Manager V.5.4 software. Results The double dartos flap layer group excels in descending the risk of postoperative fistula [odds ratio (OR) = 9.56; 95% confidence interval (CI) (4.76, 19.22); P < 0.00001] and phallic rotation [OR = 31.26; 95% CI (9.60, 101.84); P < 0.00001], while there are no differences in the rate of meatal stenosis [OR = 1.49; 95% CI (0.73, 2.70); P = 0.31] and wound dehiscence [OR = 2.30; 95% CI (0.80, 6.63); P = 0.12]. Conclusions The routine utility of a double dartos flap layer is recommended as a potential treatment during the tubularized incised plate urethroplasty. Systematic Review Registration identifier PROSPERO CRD42022366294.
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Affiliation(s)
- Yi Yuan
- Department of Urology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yu-wen Wang
- Department of Urology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yan-nei Liang
- Department of Urology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yu-ying Wang
- Department of Urology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jun-jie Ho
- Department of Urology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tong-yu Peng
- The First Clinical College, Chongqing Medical University, Chongqing, China
| | - Zhang Zhao
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou, China
| | - Nan Deng
- Department of Urology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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11
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Wang J, Xu X, Bao Z, Liu Z, Li G, He F. Lateral incision 1-stage urethroplasty with oral mucosal graft for patients with penile urethral stricture after hypospadias repair-a preliminary report. BMC Urol 2023; 23:75. [PMID: 37118771 PMCID: PMC10148384 DOI: 10.1186/s12894-023-01250-5] [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] [Received: 08/28/2022] [Accepted: 04/17/2023] [Indexed: 04/30/2023] Open
Abstract
PURPOSE To report our early experience of a novel surgical approach for penile urethral strictures after hypospadias repair, using a lateral incision to keep the ventral tissue and vasculature of the penis intact and to avoid the need for tissue interposition. PATIENTS AND METHODS A total of 21 patients underwent lateral incision 1-stage urethroplasty with oral mucosal graft. The median age of the patients was 21 years old (range, 13-47). The median number of prior procedures for hypospadias repair was 3 (range, 1-9) with 18 of 21 patients (85.7%) undergoing greater than 1 prior reconstructive procedure. The mean length of the penile urethral strictures was 4.5 ± 1.7 cm, with a range of 1.0 to 8.0 cm. Selection criteria for lateral incision 1-stage urethroplasty include: non-obliterative stricture, no or mild penile curvature and no urethrocutaneous fistula. RESULTS Median follow-up was 30 months (range, 6-73). Success was achieved in 17 of 21 patients (80.9%). The 4 (19.0%) patients with treatment failure developed recurrent urethral strictures. Of the 4 men with recurrent strictures, 3 were ultimately treated successfully by DVIU (2) or two-stage urethroplasty (1), and one patient chose repeated dilation. CONCLUSIONS For patients with penile urethral stricture after hypospadias repair with non-obliterative stricture, no significant penile curvature and no urethrocutaneous fistula, a lateral approach with oral mucosal graft is a simple technique that avoids the need for tissue interposition and keeps the penile ventral tissue and vasculature intact, resulting in a low risk of complications.
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Affiliation(s)
- Jianwei Wang
- Department of Urology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, No.68 Huinanbei Road, Changping District, Beijing, China
| | - Xiao Xu
- Department of Urology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, No.68 Huinanbei Road, Changping District, Beijing, China
| | - Zhengqing Bao
- Department of Urology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, No.68 Huinanbei Road, Changping District, Beijing, China
| | - Zhenhua Liu
- Department of Urology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, No.68 Huinanbei Road, Changping District, Beijing, China
| | - Guizhong Li
- Department of Urology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, No.68 Huinanbei Road, Changping District, Beijing, China
| | - Feng He
- Department of Urology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, No.68 Huinanbei Road, Changping District, Beijing, China
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12
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Durante L, Ghidini F, Panchieri F, Bovolenta E, Bagnara V, Esposito C, Castagnetti M. Glans dehiscence after severe hypospadias repair. Is it a real complication? Clues from a study in post-pubertal patients. Pediatr Surg Int 2023; 39:101. [PMID: 36737577 PMCID: PMC9898378 DOI: 10.1007/s00383-023-05387-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Glans dehiscence (GD) is reportedly a common complication after proximal hypospadias repairs. However, the need for surgical correction is controversial. The aim of this study was to assess awareness, risk factors, and outcome of GD in post-pubertal patients. The agreement with surgeon assessment was also evaluated. METHODS The design was retrospective. All consecutive patients treated for proximal hypospadias between 2000 and 2011 were included. The presence of GD was self-reported, and the participants could optionally upload a photograph for surgeon assessment. Cosmetic and functional outcomes were assessed by validated questionnaires (HOSE, PPPS, KINDL®, IIEF-5). Results were compared between patients with and without GD. RESULTS Of 219 patients, 34 (16%) participated. Fourteen of them (41%) self-reported GD. Eighteen patients (8%) also uploaded a photograph and, in ten of them (56%), the surgeon noted the presence of GD with poor agreement [k = - 0.444 (95 CI - 0.856 to - 0.033)] with patient report. Patients self-reporting GD had had more frequently a penile curvature at diagnosis (12/14 = 86%, p = 0.01), and had undergone a single-staged repair (100% vs. 65%, p = 0.03). No difference was found in cosmetic and functional outcomes. Results were similar also comparing groups with and without GD as assessed by the surgeon. CONCLUSION GD was a common finding after severe hypospadias repair. It was more common in case of surgeon assessment with poor agreement between patients and surgeons. GD did not prove to have clear clinical implications. Therefore, in our opinion, surgical repair of GD should be recommended only on patients request.
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Affiliation(s)
- Ludovica Durante
- Paediatric Urology Unit, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padua, Italy
| | - Filippo Ghidini
- Paediatric Urology Unit, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padua, Italy
| | - Francesco Panchieri
- Paediatric Urology Unit, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padua, Italy
| | - Eleonora Bovolenta
- Paediatric Urology Unit, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padua, Italy
| | - Vincenzo Bagnara
- Pediatric Surgery Unit, Policlinico "G.B. Morgagni", Catania, Italy
| | - Ciro Esposito
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
| | - Marco Castagnetti
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Via VIII Febbraio, 2, Padua, Italy.
- Pediatric Urology Unit, Bambino Gesù Children Hospital and Research Center, Rome, Italy.
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13
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Di H, Wen Y, Li Y. Preoperative hormone therapy in single-stage repair of hypospadias: A comprehensive systematic review. J Pediatr Urol 2023:S1477-5131(23)00021-9. [PMID: 36746717 DOI: 10.1016/j.jpurol.2023.01.013] [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: 08/15/2022] [Revised: 01/08/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Preoperative hormone therapy (PHT) holds promise for obtaining better surgical conditions for patients undergoing hypospadias correction and increasing the success rate. However, the application and effects of PHT remain uncertain owing to a lack of comprehensive evaluation, thus limiting treatment strategies and development of standardized guidelines. This study aimed to review the following (ⅰ) the criteria and regimens of PHT (ⅱ) its impact on penile growth, postoperative complications, and side effects (ⅲ) and sources of inconsistent clinical outcomes. METHODS This systematic review was registered at PROSPERO (CRD42022346924) and conducted and reported following international recommendations, including the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. We searched the databases over the last two decades to identify eligible studies. This systematic review included literature regarding the use of PHT in the treatment of children with single stage hypospadias repair. Risk of Bias (RoB) was measured using two different tools: randomized controlled trials using a modified version of the RoB Assessment Tool and non-randomized studies of interventions using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I). The R-3.6.3 software was used for the analysis. RESULTS In total, 25 studies involving 4094 patients were included in the systematic review. The surgeons' criteria for using PHT varied, with short penile length being the most important. The most frequently reported regimens for intramuscular (IM) testosterone were either 2 mg/kg or empiric 25 mg monthly, and the duration was 2-3 months preoperatively. Androgens were significantly effective in improving penile development, and the changes commonly peaked at 2-3 months. The effects of PHT on complications and side effects are controversial, and the potential causes include hormone sensitivity, degree of hypospadias, surgical techniques, and dosing regimens. CONCLUSIONS This systematic review evaluated PHT in children with hypospadias. Building on previous studies, this review provides a more specific attitude and possible aspects for resolving the controversies. Future studies should identify the applicable subgroups of patients and standardize the dose and mode of delivery for the best clinical results.
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Affiliation(s)
- Huajie Di
- Pediatrics, Xuzhou Medical University, Xuzhou 221004, China
| | - Yi Wen
- Pediatrics, Xuzhou Medical University, Xuzhou 221004, China
| | - Yuan Li
- Department of Pediatric Urology, Affiliated Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou 221002, China.
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14
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Tian G, Guo B, Zhang L. Analysis of influencing factors of multiple urethrocutaneous fistula after urethroplasty in children with hypospadias. Front Pediatr 2023; 11:1103200. [PMID: 37025285 PMCID: PMC10072279 DOI: 10.3389/fped.2023.1103200] [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: 11/20/2022] [Accepted: 03/01/2023] [Indexed: 04/08/2023] Open
Abstract
Objective The objective of this study was to investigate the influencing factors of multiple urethrocutaneous fistula (UF) after urethroplasty in children with hypospadias. Methods The clinical data of 195 children with UF after urethroplasty treated surgically in the Third Affiliated Hospital of Zhengzhou University from August 2015 to August 2022 were retrospectively analyzed and divided into the single UF group (n = 134) and the multiple UF group (n = 61) according to whether multiple UF occurred after urethroplasty. The possible correlated factors were collected and compared between the two groups, including hypospadias degree, length of formed urethra, time of urethroplasty, pre-urethroplasty weight, age at urethroplasty, urethroplasty style, season of urethroplasty, the first fistula repair method, season of the first fistula repair, diameter of the largest fistula of the first fistula repair, time of the first fistula repair surgery, and other 13 factors. Results By univariate analysis, statistically significant differences were found between the two groups in age at urethroplasty, length of the formed urethra, method of urinary drainage after urethroplasty, whether or not purulent urethral drainage after first fistula repair was present, the first fistula repair method, and diameter of the largest fistula of the first fistula repair (P < 0.05). After multifactorial analysis, the independent risk factors associated with multiple UF after urethroplasty were determined to be use of a vesicostomy tube as the urinary drainage method after urethroplasty (P < 0.05, OR = 6.574, 95% CI: 2.720-15.891) and the presence of purulent urethral drainage after first fistula repair (P < 0.05, OR = 2.723, 95% CI: 1.214-6.109). Conclusions A catheter as the drainage method after urethroplasty is an independent protective factor for multiple urethrocutaneous fistula, and the existence of purulent urethral secretions after the first fistula repair is an independent risk factor.
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15
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Winberg H, Arnbjörnsson E, Anderberg M, Stenström P. Hypospadias repair can be associated with a hairy urethra. Reply to a letter to the Editor concerning the publication "Postoperative outcomes in distal hypospadias: a meta-analysis of Mathieu and tubularized incised plate repair methods for the development of urethrocutaneous fistula and urethral stricture". Pediatr Surg Int 2022; 38:777-778. [PMID: 35235012 DOI: 10.1007/s00383-022-05090-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Affiliation(s)
- H Winberg
- Department of Pediatric Surgery, Skåne University Hospital, 221 85, Lund, Sweden.,Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
| | - E Arnbjörnsson
- Department of Pediatric Surgery, Skåne University Hospital, 221 85, Lund, Sweden. .,Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden.
| | - M Anderberg
- Department of Pediatric Surgery, Skåne University Hospital, 221 85, Lund, Sweden.,Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
| | - P Stenström
- Department of Pediatric Surgery, Skåne University Hospital, 221 85, Lund, Sweden.,Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
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16
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Chandrasekharam VVS, Babu R. Letter to the Editor concerning "Postoperative outcomes in distal hypospadias: a meta-analysis of Mathieu and tubularised incised plate repair methods for the development of urethrocutaneous fistula and urethral stricture". Pediatr Surg Int 2022; 38:651. [PMID: 35174402 DOI: 10.1007/s00383-022-05082-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2022] [Indexed: 10/19/2022]
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17
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Koul A, Shukla D, Aggrawal SK, Sethi N. Incidence of urethrocutaneous fistula following distal hypospadias repair with and without caudal epidural block: A randomized pilot study. J Pediatr Urol 2022; 18:58.e1-58.e7. [PMID: 34863622 DOI: 10.1016/j.jpurol.2021.11.006] [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: 05/30/2021] [Revised: 09/19/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Recent investigations have raised a doubt regarding the safety of Caudal epidural block (CEB) administered to children with distal hypospadias undergoing tubularised incised plate (TIP) urethroplasty. The primary objective of the study was to investigate whether there is any association between CEB and the occurrence of urethrocutaneous fistula (UCF) in the postoperative period. METHODS Fifty ASA 1 and 2 children with distal hypospadias aged 0-8 years were randomly allocated to CEB group (GA with CEB, 0.2% ropivacaine 1 ml/kg; n = 25) and Non-CEB group (GA without CEB; n = 25). Penile measurements were taken before and 20 min after administration of CEB to assess penile engorgement. Intraoperative hemodynamics were recorded at 10 min intervals after induction of anaesthesia. Consumption of IV fentanyl intraoperatively and postoperatively in first 24 h was recorded in both the groups. Rescue analgesia was administered for a score >4 on FLACC scale. After surgery children were followed up monthly for first three months and then at 6-months and yearly in paediatric surgery OPD to assess for development of UCF. RESULTS UCF was found to occur in only two children, one from each group on follow up, with an overall incidence of 4%. There was no difference in the incidence of UCF in the patients with and without CEB. A 26.8% increase in penile volume from baseline was recorded in CEB group (P = 0.000). The intraoperative heart rate and mean arterial pressure was significantly lower in the CEB group as compared to non CEB group at various time intervals. No additional intraoperative IV fentanyl supplementation was required in CEB group. Fentanyl consumption was significantly less in CEB group postoperatively in first 24 h (P = 0.000). DISCUSSION Administration of CEB was not found to have any impact on UCF formation. No relationship between the increase in penile volume after CEB block and occurrence of UCF was noticed. CONCLUSION Despite increase in penile volume after CEB, there was no difference between the two groups as regards to the occurrence of post operative UCF. CEB is an effective analgesic modality and can be continued to be used till the results of well powered prospective randomised trials with long follow up are reported.
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Affiliation(s)
- Archna Koul
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India.
| | - Deepali Shukla
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Satish K Aggrawal
- Department of Paediatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Nitin Sethi
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
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18
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Castagnetti M, El-Ghoneimi A. Surgical management of primary severe hypospadias in children: an update focusing on penile curvature. Nat Rev Urol 2022; 19:147-160. [PMID: 35039660 DOI: 10.1038/s41585-021-00555-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 11/09/2022]
Abstract
Over the past two decades, assessment and treatment of associated curvature has emerged as a major issue in treating patients with proximal hypospadias. However, the cut-off for defining a curvature as clinically significant is still unclear, as not all patients are bothered by the same degree of curvature and, although the need for a method to assess the curvature objectively has been emphasized, no standard method yet exists. Curvature is multifactorial. The same degree of curvature can be due to any possible combination of skin and/or subcutaneous dartos tethering, a short urethral plate and an intrinsic corpora disproportion. Different strategies can be used to treat curvature, depending on the underlying cause, surgeon preferences, and the goals of the repair. In the past 10 years, use of urethral plate transection and ventral lengthening procedures has increased, although the lack of long-term follow-up data on ventral lengthening procedures suggests that the use of such procedures should be selective. Furthermore, straightening manoeuvres are influenced by the technique used for subsequent urethroplasty and, in turn, may influence the success rate of the urethroplasty. This Review provides a comprehensive overview of the major developments from the past 10 years in the management of severe proximal hypospadias in children.
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Affiliation(s)
- Marco Castagnetti
- Paediatric Urology Unit, Department of Surgery, Bambino Gesù Children Hospital and Research Institute, Rome, Italy. .,Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padua, Italy.
| | - Alaa El-Ghoneimi
- Department of Paediatric Surgery and Urology, Reference Centre for Rare Urinary Tract Malformations (MARVU), Hôpital Robert Debré, APHP, Université de Paris, Paris, France
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19
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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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20
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Maurizi E, Adamo D, Magrelli FM, Galaverni G, Attico E, Merra A, Maffezzoni MBR, Losi L, Genna VG, Sceberras V, Pellegrini G. Regenerative Medicine of Epithelia: Lessons From the Past and Future Goals. Front Bioeng Biotechnol 2021; 9:652214. [PMID: 33842447 PMCID: PMC8026866 DOI: 10.3389/fbioe.2021.652214] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/23/2021] [Indexed: 12/13/2022] Open
Abstract
This article explores examples of successful and unsuccessful regenerative medicine on human epithelia. To evaluate the applications of the first regenerated tissues, the analysis of the past successes and failures addresses some pending issues and lay the groundwork for developing new therapies. Research should still be encouraged to fill the gap between pathologies, clinical applications and what regenerative medicine can attain with current knowledge.
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Affiliation(s)
| | - Davide Adamo
- Interdepartmental Centre for Regenerative Medicine “Stefano Ferrari”, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Giulia Galaverni
- Interdepartmental Centre for Regenerative Medicine “Stefano Ferrari”, University of Modena and Reggio Emilia, Modena, Italy
| | - Eustachio Attico
- Interdepartmental Centre for Regenerative Medicine “Stefano Ferrari”, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Lorena Losi
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Graziella Pellegrini
- Holostem Terapie Avanzate S.r.l., Modena, Italy
- Interdepartmental Centre for Regenerative Medicine “Stefano Ferrari”, University of Modena and Reggio Emilia, Modena, Italy
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21
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Ru W, Tang D, Wu D, Tao C, Chen G, Wei J, Tian H, Shu Q. Identification of risk factors associated with numerous reoperations following primary hypospadias repair. J Pediatr Urol 2021; 17:61.e1-61.e5. [PMID: 33246830 DOI: 10.1016/j.jpurol.2020.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Complications remain the top evaluation priority subsequent to hypospadias repair. Complications vary in further management, and usually require one or more reoperations. Patients and/or their parents concern not only with the success rate of reoperation, but also with the risk of numerous reoperations. OBJECTIVE To identify the risk factors associated with numerous reoperations following primary hypospadias repair. STUDY DESIGN Data were collected retrospectively from patients who underwent reoperations for complications following primary hypospadias repair at a single institution from August 2008 to October 2017. RESULTS A total of 507 patients required reoperations following 2754 primary hypospadias repairs. Eventually, 486 patients were eligibly included with a median age of 2.2 years. The median follow-up period was 6.5 years. Preserved urethral plate urethroplasty for primary repair (including Snodgrass, Onlay and Mathieu techniques) was performed in 307 (63.2%) patients, Duckett technique was performed in 121 (24.9%) patients, and staged urethroplasty (including staged Duckett, Byars and Bracka techniques) was performed in 58 (11.9%) patients. The complications included 302 fistulas, 108 dehiscence, 50 urethral strictures, 18 meatal stenosis, 38 diverticula, 24 mild recurrent ventral curvature and 23 severe recurrent ventral curvature. A total of 363 (74.7%) patients needed 1 reoperation, 87 (17.9%) needed 2 reoperations, 19 (3.9%) needed 3 reoperations, and 17 (3.5%) needed >3 reoperations. Ordinal logistic regression demonstrated that severe recurrent ventral curvature, urethral stricture, dehiscence and primary staged hypospadias repair increased the risk of numerous reoperations, with odds ratios of 75.991-fold, 36.967-fold, 11.765-fold and 3.074-fold, respectively. In contrast, diverticulum decreased the risk, with an odds ratio of 0.443-fold. DISCUSSION Our data demonstrated significant heterogeneity in the risk of numerous reoperations for each complication. Severe recurrent ventral curvature conferred the highest risk of numerous reoperations, followed by urethral stricture, dehiscence. In additional, our data showed an increased risk of numerous reoperations following primary staged repairs. Identification the risk factors confers advantages in the assessment of postoperative outcomes and anticipation of future reoperations. CONCLUSION Severe recurrent ventral curvature, urethral stricture, dehiscence and primary staged hypospadias repair were associated with numerous reoperations following primary hypospadias repair.
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Affiliation(s)
- Wei Ru
- Department of Urology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Daxing Tang
- Department of Urology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Dehua Wu
- Department of Urology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Chang Tao
- Department of Urology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Guangjie Chen
- Department of Urology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jia Wei
- Department of Urology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Hongjuan Tian
- Department of Urology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qiang Shu
- Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
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22
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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: 6] [Impact Index Per Article: 1.5] [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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Dokter EM, van der Zanden LF, Laumer SJ, Vart P, Kortmann BB, de Gier RP, Feitz WF, Roeleveld N, van Rooij IA. Development of a prediction model for postoperative complications after primary hypospadias correction. J Pediatr Surg 2020; 55:2209-2215. [PMID: 32444172 DOI: 10.1016/j.jpedsurg.2020.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 03/20/2020] [Accepted: 03/28/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE To develop a prediction model for postoperative complications after primary one-stage hypospadias correction to improve preoperative parental counseling. MATERIALS AND METHODS In this retrospective cohort study, data were collected from 356 patients with anterior or middle hypospadias who had a one-stage hypospadias correction from 2003 onwards. Potential treatment- and patient-related factors were selected and used to develop a prediction model for postoperative complications within one year (wound-related complications, urinary tract infections, fistulas, stenosis, and prepuce-related complications). Multivariable logistic regression analysis with stepwise backward selection and a p-value of 0.20 was used to select the final model, which was internally validated using the bootstrap procedure. RESULTS Complications within one year postoperatively occurred in 66 patients (19%), of which 13% and 37% were seen in anterior and middle type of hypospadias, respectively. Hypospadias phenotype, surgical technique, chordectomy, and surgeon's experience were included in the final prediction model, whereas none of the patient-related factors were. The final model had a good discriminative ability (bias corrected C statistic 0.70) and calibration. CONCLUSION Using easily obtainable information, this model showed good accuracy in predicting complications within one year after hypospadias surgery. It is a first step towards individualized risk prediction of postoperative complications for anterior and middle hypospadias and can assist in preoperative parental counseling. TYPE OF STUDY Prognostic study. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Elisabeth Mj Dokter
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Loes Fm van der Zanden
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Susanne Jm Laumer
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Priya Vart
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Barbara Bm Kortmann
- Department of Urology, Paediatric Urology, Radboudumc Amalia Children's Hospital, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Robert Pe de Gier
- Department of Urology, Paediatric Urology, Radboudumc Amalia Children's Hospital, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Wout Fj Feitz
- Department of Urology, Paediatric Urology, Radboudumc Amalia Children's Hospital, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Nel Roeleveld
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Iris Alm van Rooij
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
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Upper lip graft (ULG) for redo urethroplasties in children. A step by step video. J Pediatr Urol 2020; 16:510-511. [PMID: 32694089 DOI: 10.1016/j.jpurol.2020.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/17/2020] [Accepted: 06/25/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Lower lip and cheek are commonly used sources of buccal mucosa grafts for urethroplasty. In recent years, aiming to improve the donor site morbidity, our preference changed to the use (ULG). The aim of this video is to illustrate the technical details of the ULG harvesting for children. MATERIAL AND METHODS The inner surface of the upper lip is exposed by two stay sutures. The frenulum is spared, the mucosa to be harvested is marked and local submucosal infiltration is done with a solution of bupivacaine plus epinephrine. The edges are incised ant the submucosa plane created with a scissor. The graft is detached, defatted, and applied with quilting stitches over the recipient site with the standard technique. Hemostasis is secured and the donor site is left open. RESULTS From 2015 to 2018, 25 ULG harvests were done in 24 patients. Only one (5%) presented local pain associated to the procedure in the first 24 h. After minimum 2 months after surgery, none of the patients presented perioral nubmness, difficulty with mouth opening, contraction of the donor site or changes in salivation. CONCLUSIONS ULG harvest is easy and a suitable alternative source of oral mucosa for urethroplasty in children.
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Winberg H, Anderberg M, Arnbjörnsson E, Stenström P. Urinary flow measurement in hypospadias correlated to surgical procedure and risk of development of urethra-cutaneous fistula. J Pediatr Urol 2020; 16:306.e1-306.e8. [PMID: 32295743 DOI: 10.1016/j.jpurol.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/07/2020] [Indexed: 10/24/2022]
Abstract
AIM To explore the correlation between fistula development and urinary flow measurements after hypospadias repair with emphasis on patients with urethrocutaneous fistula complications and to identify risk factors for fistula development. METHODS Urinary flow was examined in boys operated on for hypospadias. Outcome of maximum urinary flow (ml/s) (Qmax), voided volume for age (ml) (Volume), and pathological flow pattern (n) (Curve) was compared between the Byars, Mathieu, and Tubularized Incised Plate (TIP) surgical repair methods and between the groups of those who had and had not developed a fistula. Logistic regression analysis was performed for age at operation, genetics, comorbidity, or urinary flow measurements regarding the development of urethrocutaneous fistula. RESULTS Seventy-three boys underwent hypospadias repair. Overall, the urinary flow measurements differed significantly between the three reconstructive methods, being favorable for the Mathieu procedure regarding Qmax (p < 0.01), volume (p = 0.04), and frequency of pathological voiding curve (p < 0.01; Table). The frequency of urethrocutaneous fistula was 18% (13/73) and did not differ significantly between the three different reconstructive surgery methods (Byar 33%, Mathieu 32%, and TIP 12%; p = 0.22). Urinary flow measurements did not differ between patients with and without fistula complications regarding Qmax 10 ml/s (4-16) vs. 8 ml/s (2-18), voided volume 74 ml (35-171) vs. 71 ml (9-270), or abnormal urinary flow pattern (23% vs. 30%). On logistic regression analysis, age at operation, genetics, comorbidity, and urinary flow measurement parameters did not turn out to be independent risk factors for development of urethrocutaneous fistula after hypospadias repair. DISCUSSIONS The study demonstrated significant differences between the urinary flow measurement results between the three different repair methods, favoring the Mathieu procedure. A low Qmax was a common postoperative finding. Urinary flow measurements did not differ between boys developing fistula and those who did not. No risk factors for fistula development were identified. The study did not support that it would be possible, at an early postoperative stage, to identify those with an upcoming postoperative fistula neither with urinary flow measurements nor through risk factors. No similar reports have studied the possibility of using postoperative urinary flow measurements to determine patients at risk of fistula development after hypospadias repair. CONCLUSIONS Urinary flow measurements were favorable after hypospadias reconstruction with Mathieu compared with Byars and TIP. Furthermore, urinary flow measurements did not differ between reconstructed with and without a fistula complication. No risk factor for fistula development was identified.
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Affiliation(s)
- Hans Winberg
- Department of Pediatric Surgery, Skåne University Hospital, 221 85, Lund, Sweden; Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden.
| | - Magnus Anderberg
- Department of Pediatric Surgery, Skåne University Hospital, 221 85, Lund, Sweden; Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden.
| | - Einar Arnbjörnsson
- Department of Pediatric Surgery, Skåne University Hospital, 221 85, Lund, Sweden; Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden.
| | - Pernilla Stenström
- Department of Pediatric Surgery, Skåne University Hospital, 221 85, Lund, Sweden; Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden.
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Postoperative outcomes in distal hypospadias: a meta-analysis of the Mathieu and tubularized incised plate repair methods for development of urethrocutaneous fistula and urethral stricture. Pediatr Surg Int 2019; 35:1301-1308. [PMID: 31372729 PMCID: PMC6800881 DOI: 10.1007/s00383-019-04523-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the two major complications, namely postoperative urethrocutaneous fistula and urethral stricture, between the Mathieu and tubularized incised plate (TIP) repair methods for distal hypospadias. METHODS In this meta-analysis, electronic databases were searched for comparative studies on the two techniques. The Oxford Centre for Evidence-based Medicine Levels of Evidence was used to evaluate the included studies. The main outcome measure was the frequency of postoperative fistula and urethral stricture. RevMan 5.3 was used for statistical analyses, with P < 0.05 indicating statistical significance. RESULTS A total of 17 studies, which included 1572 patients, met the inclusion criteria. The frequency of urethrocutaneous fistula did not differ between the Mathieu [115 (13%)] and TIP [90 (13%)] methods [odds ratio (OR) 1.1, 95% confidence intervals (CI) 0.6-1.9; P = 0.73)]. Urethral stricture was less frequent after the Mathieu [15 (2%)] method than after the TIP [37 (5%)] method (OR 0.5, 95% CI 0.3-0.8; P < 0.01), even after the subgroup analysis of eight randomized controlled trials was included. Overall, the quality of the included studies was determined to be satisfactory. The levels of evidence on which this review was based ranged from 1b to 2b using the CEBM Levels of Evidence. CONCLUSION Compared with TIP repair, Mathieu repair for hypospadias had a significantly lower risk for urethral stricture; however, the risk for urethrocutaneous fistula was similar.
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Prevalence, assessment and surgical correction of penile curvature in hypospadias patients treated at one European Referral Center: description of the technique and surgical outcomes. World J Urol 2019; 38:2041-2048. [PMID: 31654219 DOI: 10.1007/s00345-019-02961-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/13/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Penile curvature (PC) is a common component of hypospadias, but its presence is inconstantly assessed. We aim to report prevalence of PC in hypospadias patients, as well as to report our method to assess and correct PC, with the associated postoperative outcomes. METHODS We scrutinized 303 pediatric hypospadias patients operated (2013-2018) at our referral center. PC was routinely assessed and eventually corrected with dorsal plications (DP) as one-stage procedure, or ventral tunica attenuations ± DP as two-stage repair. PC severity and surgical treatment of PC were compared between primary and failed hypospadias. Finally, PC severity, failed repair and PC treatment were tested as predictors of perioperative complications. RESULTS PC (> 10°) was identified in 274/303 (90.4%) patients, 86.1% with distal, 91.8% with midshaft, and 100% with proximal hypospadias, respectively. PC was found in 51/64 (79.7%) of failed hypospadias. One-stage and two-stage procedures were adopted in 211/274 (77%) and 63/274 (23%) children, respectively. PC severity (p = 0.1) and PC treatment (p = 0.4) did not differ between primary and failed hypospadias. PC severity (all p > 0.2), failed repair (p = 0.8), and PC treatment (all p > 0.09) were not predictors of perioperative complications. 95.6% of patients achieved a straight penis. CONCLUSION Less than 1/10 patients did not require PC correction. High rate of residual PC in failed hypospadias and similar severity between failed and primary suggest that PC was usually under-corrected. It is possible to correct PC completely and the resulting complication would not be associated with PC severity, failed repair or treatment adopted.
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Dokter EM, Goosen EE, van der Zanden LF, Kortmann BB, de Gier RP, Roeleveld N, Feitz WF, van Rooij IA. Level of agreement on postoperative complications after one-stage hypospadias correction comparing medical records and parent reports. J Pediatr Surg 2019; 54:1825-1831. [PMID: 30850151 DOI: 10.1016/j.jpedsurg.2019.01.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/10/2019] [Accepted: 01/12/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To analyze agreement on postoperative complications after hypospadias surgery according to medical records and parents' reports. MATERIALS & METHODS In this retrospective cohort study, data were collected from 409 children who received an initial one-stage hypospadias correction in the Radboudumc, The Netherlands. Postoperative complications according to medical records were compared with parent-reported complications in an online questionnaire. Main complications studied were wound-related complications, urinary tract infections, fistulas, stenosis, and prepuce-related complications. Agreement was determined by Cohen's kappa coefficient. RESULTS Slightly less complications were mentioned in medical records (37%) compared to parents' reports (42%). Overall agreement was moderate (κ = 0.50, 95% confidence interval (CI):0.41-0.59), but poor for some specific complications. Agreement was higher for complications that needed reoperation compared to when no reoperation was performed (κ = 0.53, 95% CI: 0.43-0.62 and κ = 0.18, 95% CI: 0.06-0.31) and for patients with recent surgery (<5 years before questionnaire completion) compared to less recent surgeries (κ = 0.69, 95% CI: 0.55-0.84 and κ = 0.43, 95% CI: 0.33-0.54). CONCLUSIONS Agreement on complications according to medical records and parents' reports was poor to moderate, but better after reoperation and more recent surgery. Some complications mentioned in medical records were missing from parents' reports and the other way around. Better agreement will give physicians and parents a more reliable view on postoperative outcome after hypospadias surgery. TYPE OF STUDY Diagnostic test. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Elisabeth Mj Dokter
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Evelina Ec Goosen
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Urology, Pediatric Urology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Loes Fm van der Zanden
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Barbara Bm Kortmann
- Department of Urology, Pediatric Urology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Robert Pe de Gier
- Department of Urology, Pediatric Urology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Nel Roeleveld
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wout Fj Feitz
- Department of Urology, Pediatric Urology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Iris Alm van Rooij
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
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Duarsa GWK, Tirtayasa PMW, Daryanto B, Nurhadi P, Renaldo J, Tarmono T, Utomo T, Yuri P, Siregar S, Wahyudi I, Situmorang GR, Palinrungi MAA, Hutasoit YI, Hutahaean AYA, Zulfiqar Y, Sigumonrong YH, Mirza H, Rodjani A. Common Practice of Hypospadias Management by Pediatric Urologists in Indonesia: A Multi-center Descriptive Study from Referral Hospitals. Open Access Maced J Med Sci 2019; 7:2242-2245. [PMID: 31592011 PMCID: PMC6765069 DOI: 10.3889/oamjms.2019.628] [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: 05/05/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Hypospadias is the second most common congenital anomalies among human congenital disabilities. There are over 300 surgery techniques being introduced to treat hypospadias. The successful of hypospadias repair is assessed by several outcomes as well as complications following surgery. AIM: This study aims to show the multicenter hypospadias data in Indonesia descriptively. METHODS: All the data were compiled based on questionnaires, which were distributed to Indonesian pediatric urologists. The questionnaire includes several questions containing demographic aspect, preferred techniques being used, and complications being found regarding hypospadias repair. RESULTS: Eighteen Indonesian pediatric urologists from 12 centres involved in this study. The data were collected from June – September 2018 based on the surgeon’s experience throughout 2017. From 591 cases based on the returned questionnaire, penile-type hypospadias was the most common type of hypospadias being treated (35.7%) followed by penoscrotal (28.9%) and scrotal-type (12.9%). Moderate severity of chordee was mostly seen among all cases (40.6%). Tubularised incised plate (TIP), + Thiersch Duplay, was the most common technique being used to treat hypospadias (44.3%), followed by onlay island preputial flap (14.9%) and two-stage technique (14%). The incidence of urethrocutaneous fistulae in this study was 13.9%. CONCLUSION: This study showed how Indonesian pediatric urologists dealt with hypospadias cases. TIP + Thiersch Duplay procedure being the preferred technique used by most participants and the rate of urethrocutaneous fistulae as one of the complications was comparable with previous studies.
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Affiliation(s)
- Gede Wirya Kusuma Duarsa
- Divison of Urology, Department of Surgery, Faculty of Medicine Universitas Udayana, Sanglah Hospital, Denpasar, Indonesia
| | - Pande Made Wisnu Tirtayasa
- Divison 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 Tarmono
- Department of Urology, Faculty of Medicine Universitas Airlangga, Soetomo Hospital, Surabaya, Indonesia
| | - Trisulo 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
| | - Muhammad Asykar A Palinrungi
- Division of Urology, Department of Surgery, Faculty of Medicine Universitas Hasannudin, Wahidin Sudirohusodo Hospital, Makassar, 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 Surgery, Persahabatan Hospital, Jakarta, Indonesia
| | - Arry Rodjani
- Department of Urology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Saavedra AA, Rourke KF. Characterization and outcomes of urethroplasty for hypospadias-associated urethral strictures in adults. Can Urol Assoc J 2019; 13:E335-E340. [PMID: 31039108 DOI: 10.5489/cuaj.5863] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Urethral stricture is one of the most commonly encountered complications after hypospadias repair but remains poorly described. The aim of this study is to better characterize hypospadias-associated urethral strictures (HAUS) and treatment outcomes. METHODS We conducted a retrospective analysis of 84 patients who underwent urethroplasty (UP) for HAUS from 2003-2017. Patients were characterized with regard to demographics, stricture length, location, concurrent pathology, previous surgery, type of urethroplasty, 90-day complications, and surgical success defined as the absence of stricture on cystoscopy. Univariate and survival multivariate analysis was performed. RESULTS Overall success was 88.1% at a mean followup of 19 months, with a 90-day complication rate of 9.5%, a 21.4% rate of urethrocutaneous fistula requiring a mean of 1.4 surgeries. Patients were categorized into one of four groups based on stricture length, location, and number of previous procedures: group 1 (66.7%) - previous failed hypospadias repair (HR) with stricture involving the entire repair; group 2 (7.1%) - "junctional stricture" at the junction of the "neourethra" and native urethra; group 3 (11.9%) - isolated bulbar stricture outside the repaired urethra; group 4 (14.3%) - urethral stricture in untreated hypospadias. Despite differing by technique (p<0.0001), stricture length (p=0.02), location (p<0.001), and number of previous repairs (p<0.001), groups did not significantly differ by success (p=0.82), complications (p=0.16), or urethrocutaneous fistula (p=0.19), whereas individual techniques did. CONCLUSIONS UP for HAUS is often successful but patients frequently require more than one operation and have a significant risk of associated complications. Despite a broad spectrum of presentation, patients can often be categorized into one of four groups, which can help direct decision-making and obtain similar outcomes regardless of baseline differences.
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Affiliation(s)
- Alvaro A Saavedra
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Keith F Rourke
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Preoperative Illnesses in Children Do Not Increase the Risk of Complications After Hypospadias Repair. Pediatr Infect Dis J 2019; 38:104-109. [PMID: 29620719 DOI: 10.1097/inf.0000000000002064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preoperative illnesses might induce immunosuppression and subsequently increase morbidity after surgery. Several studies have tried to identify risk factors for complications after hypospadias correction, but effects of illnesses in the weeks just before surgery are unknown. We aimed to determine the associations between preoperative illnesses not severe enough to postpone surgery and short-term complications after hypospadias repair in children. METHODS In this retrospective cohort study, data were collected from 681 children with anterior or middle type hypospadias that had initial 1-stage repair in the period 1983-2012 in the Radboudumc, The Netherlands. The associations between common illnesses, such as common cold, fever and ear infection, within 2 weeks before repair, and postoperative complications, such as urethrocutaneous fistula, wound dehiscence and stenosis, within 2 months and 1 year after surgery, were analyzed using multivariable logistic regression analyses. RESULTS Of the 681 boys, 22% had preoperative illnesses, most often common cold, and 14% had postoperative complications. Children with preoperative illnesses had fewer postoperative complications within 2 months (n = 13, 9%) than children without preoperative illnesses (n = 79, 16%), resulting in a 50% risk reduction (odds ratio: 0.49; 95% confidence interval: 0.26-0.93). Preoperative infections (common cold, fever and ear infection), in particular, reduced the risk of postoperative infections (wound and urinary tract infections; odds ratio: 0.37; 95% confidence interval: 0.14-0.98). Results were similar for complications within 1 year. CONCLUSIONS Common preoperative illnesses not severe enough to postpone surgery did not increase the postoperative complication risk and even seemed to have a protective effect, especially for postoperative infections. Consequently, there is no reason to alter preoperative screening.
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Mammo TN, Negash SA, Negussie T, Getachew H, Dejene B, Tadesse A, Derbew M. Hypospadias Repair in Ethiopia: A Five Year Review. Ethiop J Health Sci 2019; 28:735-740. [PMID: 30607090 PMCID: PMC6308759 DOI: 10.4314/ejhs.v28i6.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Hypospadias repair is one of the problematic issues in pediatric surgery. As a result of the multiple complications following the procedure, a variety of techniques have been used and newer methods continue to emerge. There is still controversy regarding the best method of repair. We aimed to determine the outcome of surgery and factors contributing to unfavorable outcomes in children with hypospadias. Materials and Methods This is a retrospective review undertaken from September 2009 to August 2014. The research was conducted at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. All children who underwent hypospadias repair and had regular follow-up were included in the study. Results A total of 202 boys aged less than 13 years were assessed. Most surgeries (80.3%) were performed in children older than 18 months. Transverse incised plate urethroplasty (TIP) was frequently performed for distal hypospadias (71.2 %), while transverse ventral preputal flap (TVPF) was the most common procedure done for proximal hypospadias (62.8 %). Overall success rate for first surgery was 55.9 %. There was a high rate of major post-operative complications (44.1%) of which urethrocutaneous fistula (UCF) was the most common (31.2%) followed by meatal stenosis and glans breakdown (7.4 % each). These complications were found to be higher in those who were operated at a later age and those with proximal hypospadias (p=0.03 and p=0.01 respectively). There was also a significant difference among the type of procedures with TIP and TVPF having the least complications (p<0.01). Conclusion From our experience, we found TIP a relatively safe and reliable method of repair for distal hypospadias while TVPF single stage repair was superior in the proximal ones. The high rate of complications in our institution was associated with higher burden of severe hypospadias and older age at surgery.
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Affiliation(s)
| | - Samuel A Negash
- Unit of pediatric of surgery, Department of surgery, Addis Ababa University, Ethiopia
| | - Teamir Negussie
- Unit of pediatric of surgery, Department of surgery, Addis Ababa University, Ethiopia
| | - Hanna Getachew
- Unit of pediatric of surgery, Department of surgery, Addis Ababa University, Ethiopia
| | - Belachew Dejene
- Unit of pediatric of surgery, Department of surgery, Addis Ababa University, Ethiopia
| | - Amezene Tadesse
- Unit of pediatric of surgery, Department of surgery, Addis Ababa University, Ethiopia
| | - Miliard Derbew
- Unit of pediatric of surgery, Department of surgery, Addis Ababa University, Ethiopia
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Dossanova A, Lozovoy V, Manekenova K, Lozovaya Y, Seidakhmetov M, Dossanov B, Omarov T, Botabaeva A, Shakeeva A, Baubekov Z. Histological and morphological characteristics of the prepuce of penis skin structure in different age groups. J Pediatr Urol 2018; 14:280.e1-280.e6. [PMID: 29703688 DOI: 10.1016/j.jpurol.2018.02.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 02/08/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hypospadias is one of the most common congenital abnormalities in childhood. The number of cases has rapidly grown in recent years. OBJECTIVES The purpose of this research was to analyze the histological and morphological differences of the foreskin samples taken from boys in three age groups. STUDY DESIGN A total of 30 Asian patients participated in the research. Clinical materials obtained via biopsy were divided into three age groups. The first group included 10 biopsy materials of preputial skin taken from boys aged <3 years. The second included 10 similar biopsy materials from boys aged 3-5 years. The third included 10 biopsy materials taken from boys aged 5-7 years. The skin areas were taken from the dorsal, two lateral and the ventral surfaces (closer to the bridle) with dimensions of 1.0 × 1.0 cm. All removed foreskins underwent histological examination. RESULTS Obtained results showed that the number of vein clusters in the prepuce and the cases of vessel wall fibrosis grew with age. It is worth noting that no such discoveries were made in younger boys (aged <3 years). Sample analysis showed that the number of nerve, vessel, and collagen fibers increased with age. DISCUSSION It is believed that it is important to continue investigating the prepuce in hypospadias, in order to gain a better understanding of the abnormality depending on type. CONCLUSION Peculiarities of prepuce in hypospadias discovered in different age groups allowed a full understanding of the pathology development processes.
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Affiliation(s)
- A Dossanova
- JCS Astana Medical University, Astana, Kazakhstan.
| | - V Lozovoy
- JCS Astana Medical University, Astana, Kazakhstan
| | - K Manekenova
- JCS Astana Medical University, Astana, Kazakhstan
| | - Y Lozovaya
- JCS Astana Medical University, Astana, Kazakhstan
| | | | - B Dossanov
- JCS Astana Medical University, Astana, Kazakhstan
| | - T Omarov
- JCS Astana Medical University, Astana, Kazakhstan
| | - A Botabaeva
- JCS Astana Medical University, Astana, Kazakhstan
| | - A Shakeeva
- JCS Astana Medical University, Astana, Kazakhstan
| | - Z Baubekov
- West Kazakhstan Medical University, Aktobe, Kazakhstan
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Morrison CD, Cinà DP, Gonzalez CM, Hofer MD. Surgical Approaches and Long-Term Outcomes in Adults with Complex Reoperative Hypospadias Repair. J Urol 2018; 199:1296-1301. [DOI: 10.1016/j.juro.2017.11.078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Christopher D. Morrison
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve Medical School (CMG), Cleveland, Ohio
| | - Davide P. Cinà
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve Medical School (CMG), Cleveland, Ohio
| | - Christopher M. Gonzalez
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve Medical School (CMG), Cleveland, Ohio
| | - Matthias D. Hofer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve Medical School (CMG), Cleveland, Ohio
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Aldamanhori R, Chapple CR. Management of the patient with failed hypospadias surgery presenting in adulthood. F1000Res 2017; 6:1890. [PMID: 29263781 PMCID: PMC5658707 DOI: 10.12688/f1000research.11980.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2017] [Indexed: 01/09/2023] Open
Abstract
The management of patients who have had complications of primary surgery for the resolution of a hypospadiac deformity remains a therapeutic challenge. Adults with complications following childhood hypospadias repairs are undoubtedly a difficult population to treat, as there is usually a cosmetic deformity, lower urinary tract symptoms, and resulting psychosexual consequences. A surgeon's experience has been and still remains an important factor in determining subsequent surgical outcomes, particularly with more severe or complex cases. The purpose of this review is to evaluate the complications of hypospadias repair that present in adults and review published experience in treating them.
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Affiliation(s)
- Reem Aldamanhori
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK.,Department of Urology, University of Dammam, Dammam, Saudi Arabia
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Keays MA, Dave S. Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes. Can Urol Assoc J 2017; 11:S48-S53. [PMID: 28265319 DOI: 10.5489/cuaj.4386] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In this article, we present the current approach to hypospadias, a review of the classification, preoperative evaluation, and factors that enable decision-making during surgery. We will then discuss patient-reported outcomes, evaluating the patients' and parents' perspectives regarding hypospadias repair.
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Affiliation(s)
- Melise A Keays
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Sumit Dave
- Division of Urology, Department of Surgery and Pediatrics, London Health Sciences Centre, London, ON, Canada
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Saavedra-Belaunde JA, Soto-Aviles O, Jorge J, Escudero K, Vazquez-Cruz M, Perez-Brayfield M. Can regional anesthesia have an effect on surgical outcomes in patients undergoing distal hypospadia surgery? J Pediatr Urol 2017; 13:45.e1-45.e4. [PMID: 27956108 DOI: 10.1016/j.jpurol.2016.09.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/24/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND Caudal and penile blocks are the most popular regional anesthetic techniques used in infants and children undergoing urological surgery. A recent report has suggested that penile venous pooling resulting from caudal blocks could affect surgical outcomes after hypospadias operations. OBJECTIVE The aim was to report our experience in patients with distal hypospadias undergoing repair with caudal versus penile block. STUDY DESIGN A retrospective clinical database was constructed for patients who underwent distal hypospadias repair by a single surgeon (M.P.B.) at our sponsoring institutions for the time period 2008-2013 (n = 192). Collected data included hypospadias classification (glanular, coronal, subcoronal), chordee status, perioperative anesthesia (caudal vs. penile), and assessment of postoperative complications (fistula and meatal stenosis). RESULTS Risk ratio (RR) analysis for all distal hypospadias cases revealed that there is a higher risk of developing complications in patients who underwent caudal anesthesia than in patients who underwent penile block RR for a complication was 3.70 (95% CI 1.05-13.03; p < 0.04) (Figure). DISCUSSION Similar to other papers in the literature, we found that patients who underwent caudal anesthesia had more complications than those who underwent penile block. The limitations of this study include not adjusting the results according to the severity of hypospadias. CONCLUSION The main goal of this study was accomplished by demonstrating that, in our series, caudal anesthesia is associated with a higher risk of fistula formation after undergoing distal hypospadias repair than penile block.
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Affiliation(s)
| | - Omar Soto-Aviles
- Department of Urology, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Juan Jorge
- Department of Urology, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | | | | | - Marcos Perez-Brayfield
- Department of Urology, University of Puerto Rico School of Medicine, San Juan, PR, USA; HIMA San Pablo, Bayamon, PR, USA
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Lee JH, Shin SK, Kim MH. Caudal anesthesia safety for hypospadias repair - a reply. Anaesthesia 2016; 71:1247-8. [DOI: 10.1111/anae.13662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J. H. Lee
- Yonsei University College of Medicine; Seoul Korea
| | - S. K. Shin
- Yonsei University College of Medicine; Seoul Korea
| | - M. H. Kim
- Yonsei University College of Medicine; Seoul Korea
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Nozohoor Ekmark A, Arnbjörnsson E, Svensson H, Hansson E. Patient-reported long-term outcome after primary hypospadias repair. J Plast Surg Hand Surg 2016; 51:172-177. [PMID: 27687614 DOI: 10.1080/2000656x.2016.1212713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Long-term evaluation of the surgical outcome after puberty, particularly patient reported outcome is rare in the literature. The aims of this study were to investigation the patients' satisfaction with the long-term results and their views and memories of their childhood surgery and follow-up. METHODS A modified version of previously used questionnaire was sent to 134 patients ages 18 years or older previously primarily repaired due to hypospadias by one of the authors (HS) between 1989 -2009. RESULTS Thirty-nine patients responded. Eighty-two per cent were satisfied with the appearance of their penis, 87% were satisfied with their ability to urinate and their sexual function and 92% were satisfied with the overall surgical results. Ninety per cent of patients were positive to the current duration of our post-pubertal follow-up program or would have preferred an even longer follow-up. CONCLUSIONS The majority of patients were satisfied with the long-term surgical results and the duration of follow-up. Despite having problems patients does not always contact the health care system spontaneously, which warrants long-term follow-up.
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Affiliation(s)
- Ann Nozohoor Ekmark
- a Department of Clinical Sciences in Malmö , Lund University , Lund , Sweden.,b Department of Paediatric Surgery , Skåne University Hospital , Lund , Sweden
| | - Einar Arnbjörnsson
- b Department of Paediatric Surgery , Skåne University Hospital , Lund , Sweden.,c Department of Clinical Sciences Lund , Lund University , Lund , Sweden
| | - Henry Svensson
- a Department of Clinical Sciences in Malmö , Lund University , Lund , Sweden.,d Department of Plastic and Reconstructive Surgery , Skåne University Hospital , Lund , Sweden
| | - Emma Hansson
- a Department of Clinical Sciences in Malmö , Lund University , Lund , Sweden.,d Department of Plastic and Reconstructive Surgery , Skåne University Hospital , Lund , Sweden
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Kim MH, Im YJ, Kil HK, Han SW, Joe YE, Lee JH. Impact of caudal block on postoperative complications in children undergoing tubularised incised plate urethroplasty for hypospadias repair: a retrospective cohort study. Anaesthesia 2016; 71:773-8. [PMID: 27156500 DOI: 10.1111/anae.13463] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2016] [Indexed: 11/26/2022]
Abstract
This study aimed to assess the association between caudal block and postoperative complications after tubularised incised plate urethroplasty. The medical records of 388 paediatric patients who underwent urethroplasty at a tertiary medical centre were analysed retrospectively. Among the 342 patients included, 216 patients received a caudal block and 72 (21.1%) patients suffered surgical complications. The number of patients having surgical complications was significantly greater among patients who received a caudal block than among patients who did not receive a caudal block (53 (24.5%) versus 19 (15.1%), respectively, p = 0.04). Based on multivariate logistic regression analysis, duration of surgery, caudal block and hypospadias types were independent risk factors for the surgical complications. Patients with caudal block had an odds ratio of 2.1 (95% CI, 1.14-3.81, p = 0.018) for the development of postoperative complications compared with patients without caudal block. This analysis demonstrates that caudal block is associated with surgical complications after tubularised incised plate urethroplasty.
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Affiliation(s)
- M H Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y J Im
- Department of Urology, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - H K Kil
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - S W Han
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y E Joe
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J H Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Ghidini F, Sekulovic S, Castagnetti M. Parental Decisional Regret after Primary Distal Hypospadias Repair: Family and Surgery Variables, and Repair Outcomes. J Urol 2015; 195:720-4. [PMID: 26518112 DOI: 10.1016/j.juro.2015.10.118] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Decisional regret is defined as distress after making a health care choice and can be an issue for parents electing distal hypospadias repair for their sons. We assessed the influence on decisional regret of variables related to the family, surgery and outcomes. MATERIALS AND METHODS Charts for 372 patients undergoing primary distal hypospadias repair between 2005 and 2012 were reviewed, and validated questionnaires, including the Decisional Regret Scale, Pediatric Penile Perception Score and Dysfunctional Voiding and Incontinence Scoring System, were administered to parents. RESULTS Data were available for 172 of 372 families (response rate 46.2%). Of 323 parents 128 (39.6%) presented with moderately strong decisional regret, with good agreement within couples. Predictors of decisional regret included intermediate parental educational level (OR 3.19, 95% CI 1.52-6.69), patient not being the first born (OR 2.01, 95% CI 1.07-3.78), family history of hypospadias (OR 4.42, 95% CI 1.96-9.97), initial desire to avoid surgery (OR 2.07, 95% CI 1.04-4.12), younger age at followup (OR 0.81, 95% CI 0.72-0.91), presence of lower urinary tract symptoms (OR 4.92, 95% CI 1.53-15.81) and lower Pediatric Penile Perception Score (OR 0.86, 95% CI 0.75-0.99). Decisional regret was unrelated to parental desire to avoid circumcision, surgical variables, development of complications and duration of followup. CONCLUSIONS Decisional regret is a problem in a significant proportion of parents electing distal hypospadias repair for their sons. In our experience family variables seemed to be predictors of decisional regret, while surgical variables did not. Predictors of decisional regret included worse parental perception of penile appearance and the presence of lower urinary tract symptoms. However, the latter could be unrelated to surgery. Irrespective of the duration of followup, decisional regret seems decreased in parents of older patients.
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Affiliation(s)
- Filippo Ghidini
- Section of Pediatric Urology, Urology Unit, University Hospital of Padova, Padua, Italy
| | - Sasa Sekulovic
- Section of Pediatric Urology, Urology Unit, University Hospital of Padova, Padua, Italy
| | - Marco Castagnetti
- Section of Pediatric Urology, Urology Unit, University Hospital of Padova, Padua, Italy.
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Nozohoor Ekmark A, Svensson H, Arnbjörnsson E, Hansson E. Failed hypospadias repair: An algorithm for secondary reconstruction using remaining local tissue. J Plast Reconstr Aesthet Surg 2015. [PMID: 26195272 DOI: 10.1016/j.bjps.2015.06.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Salvage hypospadias surgery is performed after failed primary reconstruction. Several treatment strategies have been suggested, all with pros and cons. The aim of this study was to evaluate our treatment algorithm for primary hypospadias repair applied to secondary cases in which a salvage procedure is indicated and, most importantly, local tissue is present. The algorithm was applied to 36 consecutive patients who had undergone a total of 109 surgical procedures before referral. In accordance with the algorithm, 12 patients without ventral curvature achieved a satisfactory result with one procedure by the use of local skin flaps. Six patients with moderate ventral curvature underwent orthoplasty, fistula closure, and/or urethral reconstruction using local skin flaps in one session. Eighteen patients with a severe ventral curvature or a proximal meatus were reconstructed in two stages using Byars' technique. After a median of two salvage procedures (range: 1-4), all patients but one, who awaits splitting of a skin bridge in the meatus, were successfully reconstructed. Two patients in active follow-up have potential problems requiring further surgery. Our findings indicate that failed hypospadias repairs are often due to an underestimation of the ventral curvature at the initial repair. Therefore, reevaluation of the degree of curvature is important. One-stage salvage repairs can be used, provided that none or minimal curvature remains. In cases of marked curvature, however, a meticulous resection of the chordee and ventral scarring is crucial. The subsequent repair of the large ventral defect and the long urethral reconstruction can, in most cases, be safely managed in a two-stage procedure.
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Affiliation(s)
- Ann Nozohoor Ekmark
- Departments of Clinical Sciences in Malmö, Lund University, Lund, Sweden; Paediatric Surgery, Skåne University Hospital, Lund, Sweden.
| | - Henry Svensson
- Departments of Clinical Sciences in Malmö, Lund University, Lund, Sweden; Departments of Plastic and Reconstructive Surgery, Skåne University Hospital, Sweden
| | - Einar Arnbjörnsson
- Clinical Sciences Lund, Lund University, Lund, Sweden; Paediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Emma Hansson
- Departments of Clinical Sciences in Malmö, Lund University, Lund, Sweden; Departments of Plastic and Reconstructive Surgery, Skåne University Hospital, Sweden
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Castagnetti M. Childhood hypospadias repairs--do they stand the test of time? J Urol 2014; 193:756-7. [PMID: 25526997 DOI: 10.1016/j.juro.2014.12.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Marco Castagnetti
- Section of Pediatric Urology, Urology Unit, University Hospital of Padova, Padua, Italy
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Wishart ED, Metcalfe PD. A modification of the TIP procedure for distal hypospadias: The burrowing technique. Can Urol Assoc J 2014; 8:E425-8. [PMID: 25024797 DOI: 10.5489/cuaj.1677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The tubularized incised plate urethroplasty (TIP) hypospadias repair is a commonly performed procedure for hypospadias. Multiple series document excellent cosmetic outcome in conjunction with low complication rates. We describe a modification that we have named the "burrowing technique." We believe that this technique facilitates dissection of the glans, which improves mobility, decreases tension with closure, and potentially improves outcomes. METHODS A retrospective review was performed of 193 coronal or mid-shaft hypospadias repairs by a single surgeon. The first 98 were performed using the TIP procedure, then the burrowing technique was developed and a subsequent 95 were analyzed for outcomes using this modification. Urethral plate characteristics and glandular size did not influence the choice of surgical technique. Cases were selected to allow for a "learning curve," and were consecutively accrued. None of the boys had undergone prior hypospadias surgery. Proximal 2 stage repairs and distal (glanular) repairs were excluded. RESULTS A total of 193 boys underwent repair, 98 with the traditional TIP procedure and 95 using the burrowing modification. In total, 37 (19.2%) patients required re-operation for either fistulas or dehiscence; 23 (23.5%) in the non-burrowing group and 14 (14.7%) in the burrowing group, odds ratio 0.54 (p = 0.10). CONCLUSIONS The TIP procedure has revolutionized the management of distal hypospadias. The burrowing modification increases glandular mobility simplifying the procedure and demonstrates a non-statistically significant trend in reducing reoperation rates.
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Affiliation(s)
- Erin D Wishart
- Department of Surgery, Division of Urology, University of Alberta, Edmonton, AB
| | - Peter D Metcalfe
- Department of Surgery, Division of Urology, University of Alberta, Edmonton, AB
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Chung YG, Tu D, Franck D, Gil ES, Algarrahi K, Adam RM, Kaplan DL, Estrada Jr. CR, Mauney JR. Acellular bi-layer silk fibroin scaffolds support tissue regeneration in a rabbit model of onlay urethroplasty. PLoS One 2014; 9:e91592. [PMID: 24632740 PMCID: PMC3954771 DOI: 10.1371/journal.pone.0091592] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 02/12/2014] [Indexed: 11/23/2022] Open
Abstract
Acellular scaffolds derived from Bombyx mori silk fibroin were investigated for their ability to support functional tissue regeneration in a rabbit model of urethra repair. A bi-layer silk fibroin matrix was fabricated by a solvent-casting/salt leaching process in combination with silk fibroin film casting to generate porous foams buttressed by homogeneous silk fibroin films. Ventral onlay urethroplasty was performed with silk fibroin grafts (Group 1, N = 4) (Width×Length, 1×2 cm2) in adult male rabbits for 3 m of implantation. Parallel control groups consisted of animals receiving small intestinal submucosa (SIS) implants (Group 2, N = 4) or urethrotomy alone (Group 3, N = 3). Animals in all groups exhibited 100% survival prior to scheduled euthanasia and achieved voluntary voiding following 7 d of initial catheterization. Retrograde urethrography of each implant group at 3 m post-op revealed wide urethral calibers and preservation of organ continuity similar to pre-operative and urethrotomy controls with no evidence of contrast extravasation, strictures, fistulas, or stone formation. Histological (hematoxylin and eosin and Masson's trichrome), immunohistochemical, and histomorphometric analyses demonstrated that both silk fibroin and SIS scaffolds promoted similar extents of smooth muscle and epithelial tissue regeneration throughout the original defect sites with prominent contractile protein (α-smooth muscle actin and SM22α) and cytokeratin expression, respectively. De novo innervation and vascularization were also evident in all regenerated tissues indicated by synaptophysin-positive neuronal cells and vessels lined with CD31 expressing endothelial cells. Following 3 m post-op, minimal acute inflammatory reactions were elicited by silk fibroin scaffolds characterized by the presence of eosinophil granulocytes while SIS matrices promoted chronic inflammatory responses indicated by mobilization of mononuclear cell infiltrates. The results of this study demonstrate that bi-layer silk fibroin scaffolds represent promising biomaterials for onlay urethroplasty, capable of promoting similar degrees of tissue regeneration in comparison to conventional SIS scaffolds, but with reduced immunogenicity.
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Affiliation(s)
- Yeun Goo Chung
- Department of Urology, Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, United States of America
| | - Duong Tu
- Department of Urology, Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, United States of America
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Debra Franck
- Department of Urology, Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, United States of America
| | - Eun Seok Gil
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, United States of America
| | - Khalid Algarrahi
- Department of Urology, Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, United States of America
| | - Rosalyn M. Adam
- Department of Urology, Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, United States of America
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, United States of America
| | - David L. Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, United States of America
| | - Carlos R. Estrada Jr.
- Department of Urology, Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, United States of America
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail: (JM); (CE)
| | - Joshua R. Mauney
- Department of Urology, Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, United States of America
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail: (JM); (CE)
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Winberg H, Westbacke G, Ekmark AN, Anderberg M, Arnbjörnsson E. The Complication Rate after Hypospadias Repair and Correlated Preoperative Symptoms*. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/oju.2014.412027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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