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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 2023. [PMID: 37336243 DOI: 10.1055/s-0043-1769797] [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: 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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Kumar A, Ram Dhayal I. A Comparative Study on the Outcomes of Hypospadias Surgery Following Early Versus Late Bladder Catheter Removal. Cureus 2022; 14:e26104. [PMID: 35875280 PMCID: PMC9297234 DOI: 10.7759/cureus.26104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/20/2022] Open
Abstract
Background Hypospadias is the most common penile malformation affecting up to one in 300 live male births. In general, a urinary diversion (urethral stent or bladder catheter) is maintained in situ for two to seven days or more after hypospadias repair. Because of the low level of evidence, the latest guidelines of the European Association of Urology and the European Society of Paediatric Urology provide no recommendations concerning the timing of catheter removal after hypospadias surgery. In this study, we aimed to compare the outcomes of hypospadias surgery (tubularized incised plate urethroplasty, TIPU) following early versus late bladder catheter removal. Methodology In total, 62 patients were included in this study. All patients underwent TIPU by the same team of surgeons. All patients were divided into the following two groups: group A (32 patients) had their catheter removed on or before the fifth postoperative day, and group B (30 patients) had their catheter removed after the fifth postoperative day. All patients were scheduled for an outpatient assessment after two weeks, at one month, after three months, and at six months if necessary. Results The mean age of patients in group A was five years (three to seven years) and in group B was five years (four to 7.25 years) with a p-value of 0.378. Among the early complications of the surgery, the occurrence of wound infections, urinary tract infections, and urinary retention was comparable among the two groups. The rate of bladder spasms (0% versus 13.3%, p = 0.033) was significantly higher in group B than in group A. The rate of urinary retention (12.5% versus 0%, p = 0.045) was significantly higher in group A than in group B. Superficial wound infection occurred in two out of 32 patients in group A (6.3%) and two out of 30 patients in group B (6.7%) (p = 0.94). Both groups had similar incidences of wound complications. Urinary tract infections also had a similar incidence in both early and late catheter removal groups, i.e., one out of 32 patients in group A (3.1%) and three out of 30 patients (10%) in group B (p = 0.271). Urinary extravasation following hypospadias repair occurred in two out of 32 patients (6.3%). No extravasation was noted in the late catheter removal group. However, the difference was not clinically significant (p = 0.164). Two patients in both groups developed urethrocutaneous fistula (6.3% in group A versus 6.7% in group B). However, the difference was not clinically significant. Meatal stenosis developed in three out of 32 patients in group A and two out of 30 patients in group B (9.4% versus 6.7%; p = 0.696). One patient in the early catheter removal group developed urethral stricture as a late complication. None of the patients in the late catheter removal group developed this complication. Conclusions The occurrence of long-term complications of TIP hypospadias repair was not affected by the early removal of the bladder catheter. The shortcomings of our study were its descriptive nature and the small sample size. Further prospective randomized controlled trials are needed to ascertain the safety of early catheter removal and improvement in quality of life in the immediate postoperative period.
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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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Burki T, Al Hams AW, Nazer A, Mojallid A, Abasher A, Jamalalail Y, Al Modhen F, Al Shammari A. Outcome of stented versus unstented mid-shaft to distal hypospadias repair. Urol Ann 2022; 14:147-151. [PMID: 35711489 PMCID: PMC9197002 DOI: 10.4103/ua.ua_168_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/21/2020] [Indexed: 12/02/2022] Open
Abstract
Aims We compared the outcomes of unstented repair (UR) versus stented repair (SR) in patients with mid-shaft to coronal hypospadias (HS) to elucidate if SR has any advantage over the UR. Materials and Methods: We retrospectively studied our mid-shaft to coronal HS repair patients between January 2013 and January 2018. We recorded variables such as degree of HS, age at repair, surgeon, type of repair, suture used, stent usage, and standard early and late complications. Relative risk (RR) was calculated and P < 0.05 was considered significant. Results: We included 120 patients (63 UR, 57 SR). There was no statistically significant difference in any parameters in both the groups. All had either tubularized incised plate or Thiersch–Duplay procedure. Urethroplasty was done with PDS 6/0 in all cases. Trainees performed two-third of the repairs under variable supervision. Early complications included one UR patient having urinary retention needing insertion of urethral catheter, five SR patients having bleeding/swelling, and three UR having dysuria. All were managed conservatively. For late complications, 98 patients were available (UR: 51, SR: 47) with fistula in 17 (17.3%), UR 8 (15.6%) versus SR 9 (19.1%) (P = 0.5, RR = 1.2) meatal stenosis in 3, UR 3 versus SR 0 (P = 0.06, RR = 6.4) and glanular dehiscence 6, UR 4 versus SR 2 (P = 0.25, RR = 1.8). Conclusion: There were no statistically significant differences in the short-term complications between UR and SR for HS. In the long term, RR for meatal stenosis is higher in UR.
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Karabulut R, Turkyilmaz Z, Atan A, Kaya C, Sonmez K. What are the factors affecting glanular dehiscence after hypospadias surgery? Actas Urol Esp 2021; 46:4-15. [PMID: 34838491 DOI: 10.1016/j.acuroe.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/29/2020] [Indexed: 10/19/2022]
Abstract
BACKGROUND Glanular dehiscence (GD) is one of the main complications after hypospadias surgery. There is a limited number of publications regarding GD in the literature. OBJECTIVE The aim of this work is to reveal the factors that affect GD after a literature review. EVIDENCE ACQUISITION A literature search for relevant articles was performed in database using the search term glans dehiscence without setting date range limit or any other limits. All articles related to GD after hypospadias surgery were included in this study. After collecting the information from full text articles, 71 articles were included in this systematic review. In these studies, localization of hypospadic meatus, type of surgery, and other clinical data which were thought to behave as risk factors for GD were obtained. Chi-Square test was used to evaluate the differences between the parameters, where p < 0.05 was taken as statistically significant. RESULTS After evaluating the 71 articles that met the inclusion criteria, 309 cases (3.48%) of GD after 8858 hypospadias repairs were obtained in this review. GD rates were found significantly high for proximal hypospadias (5%), two-stage hypospadia repairs (5%) and re-do hypospadias repair (8.75%) (p = 0.002, 0.022, and 0.004, respectively). Glans width <14 mm, urethral plate (UP) width <7 mm, hypospadias surgeries performed before 6 months of age and after puberty, and caudal block anesthesia increased the rate of GD. CONCLUSIONS The rate of GD increases after proximal, cripple and staged hypospadias surgeries, a glans width <15 mm and UP width <8 mm, postpubertal surgeries, and caudal anesthesia use during surgery.
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Affiliation(s)
- Ramazan Karabulut
- Gazi University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey.
| | - Z Turkyilmaz
- Gazi University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - A Atan
- Gazi University, Faculty of Medicine, Department of Urology, Ankara, Turkey
| | - C Kaya
- Gazi University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - K Sonmez
- Gazi University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
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Scarpa MG, Codrich D, Iaquinto M, Guida E, Cerrina A, Schleef J. Medium-term outcome after stented and un-stented distal urethroplasty: A retrospective analysis on redo-urethroplasty need and cosmetic results. Actas Urol Esp 2021; 45:642-647. [PMID: 34764052 DOI: 10.1016/j.acuroe.2020.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/26/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Long-term complication rates after distal hypospadias repair can be close to 20%. There are no available guidelines regarding the need for a catheter in distal urethroplasty. We report a retrospective analysis on medium-term redo-urethroplasty rate and cosmetic results after a two-years pilot study on stented/un-stented distal urethroplasties. MATERIALS AND METHODS A total of 11 stented (Group A) and 17 un-stented (Group B) Snodgrass-procedures were performed by the same pediatric surgeon at our Institution (2011-2013). The median age at surgery was 2.1 years (range 1-8.5). Inclusion criteria were primitive distal defect, same surgeon in both interventions, catheter-free discharge. The median follow-up was 6.4 years (range 1.5-8.1). All patients received at least one post-operative clinical-cosmetic examination (HOSE). The aim of our study was to compare medium-term complications and redo-urethroplasty rates before starting a randomized study. A retrospective analysis was performed. We used Fisher's exact-test (P < 0.05) for statistical analysis. RESULTS Of 28 complications, 5 required redo-surgery: 2/11 stented-cases, 3/17 un-stented. Cosmetic results were satisfactory in both groups. These results were not statistically significant (P = 1.000). CONCLUSION Long-term follow-up is mandatory to know redo-urethroplasty rate and cosmetic outcome after distal stented/un-stented repair. Further studies are needed to evaluate the role of catheter placement and the definitive outcome in distal urethroplasty.
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Affiliation(s)
- M G Scarpa
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy.
| | - D Codrich
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - M Iaquinto
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - E Guida
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - A Cerrina
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - J Schleef
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
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Scarpa MG, Codrich D, Iaquinto M, Guida E, Cerrina A, Schleef J. Medium-term outcome after stented and un-stented distal urethroplasty: A retrospective analysis on redo-urethroplasty need and cosmetic results. Actas Urol Esp 2021; 45:S0210-4806(21)00105-4. [PMID: 34332810 DOI: 10.1016/j.acuro.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/26/2020] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Long-term complication rates after distal hypospadias repair can be close to 20%. There are no available guidelines regarding the need of a catheter in distal urethroplasty. We report a retrospective analysis on medium-term redo-urethroplasty rate and cosmetic results after a two-year pilot study on stented/un-stented distal urethroplasties. MATERIALS AND METHODS A total of 11 stented (Group A) and 17 un-stented (Group B) Snodgrass-procedures were performed by one pediatric surgeon at our Institution (2011-2013). The median age at surgery was 2.1 years (range 1-8.5). Inclusion criteria were primitive distal defect, same surgeon in both interventions, catheter-free discharge. The median follow-up was 6.4 years (range 1.5-8.1). All patients received at least one post-operative clinical-cosmetic examination (HOSE). The aim of our study was to compare medium-term complications and redo-urethroplasty rates before starting a randomized study. A retrospective analysis was performed. We used Fisher's exact-test (P<0.05) for statistical analysis. RESULTS Of 28 complications, 5 required redo-surgery: 2/11 stented-cases, 3/17 un-stented. Cosmetic results were satisfactory in both groups. These results were not statistically significant (P=1.000). CONCLUSION Long-term follow-up is mandatory to know redo-urethroplasty rate and cosmetic outcome after distal stented/un-stented repair. Further studies are needed to evaluate the role of catheter placement and the definitive outcome in distal urethroplasty.
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Affiliation(s)
- M G Scarpa
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italia.
| | - D Codrich
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italia
| | - M Iaquinto
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italia
| | - E Guida
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italia
| | - A Cerrina
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italia
| | - J Schleef
- Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italia
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Bhatia VP, Mittal AG, Austin PF, Hilliard ME. The hypospadias-specific health-related quality of life conceptual framework: a scoping review of the literature. Qual Life Res 2021; 30:1537-1546. [PMID: 33559860 DOI: 10.1007/s11136-021-02773-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Health-related quality of life (HRQoL) is an important yet understudied construct for individuals with hypospadias (HS). An important barrier towards understanding HRQoL and integrating it into research and clinical care for people with HS is the absence of an underlying conceptual framework to illustrate this construct. We propose a conceptual framework for HS-specific HRQoL based upon a scoping review of the HS literature. METHODS/MATERIALS We conducted a literature review of articles published between 1989 and 2019. Our search in Embase and Pubmed used the keyword "hypospadias" in combination with "quality of life" and "patient-reported outcomes." We used thematic analysis of the resulting publications to identify core HRQOL domains. From these results and review of HRQoL literature in other pediatric populations, we developed a conceptual framework representing HS-specific HRQoL. RESULTS We identified five domains of HRQOL previously studied in research with youth and adults with HS: penile appearance, voiding, social interaction, sexual health, and psychological or behavioral function. We propose a model of HS-specific HRQoL comprised of these domains and their areas of overlap, based upon the findings and conceptual mapping of our literature review. CONCLUSION This novel conceptual framework provides a foundation for understanding disease-specific HRQoL in individuals with HS and may serve as a guide for the conduct of future qualitative studies of the HS population. The overlapping biopsychosocial domains illustrate the possible effects of HS on day-to-day life. This framework may guide future surgical, clinical, and behavioral interventions that aim to improve medical care and quality of life outcomes for HS patients.
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Affiliation(s)
- V P Bhatia
- Division of Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA. .,Scott Department of Urology, Baylor College of Medicine, 6701 Fannin Street, MS 3340, Houston, TX, 77030, USA.
| | - A G Mittal
- Division of Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA.,Scott Department of Urology, Baylor College of Medicine, 6701 Fannin Street, MS 3340, Houston, TX, 77030, USA
| | - P F Austin
- Division of Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA.,Scott Department of Urology, Baylor College of Medicine, 6701 Fannin Street, MS 3340, Houston, TX, 77030, USA
| | - M E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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Nonstented Tubularized Incised Plate Distal Hypospadias Repair: A Single Center 5 Years' Experience. Urology 2020; 146:207-210. [PMID: 32822686 DOI: 10.1016/j.urology.2020.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/01/2020] [Accepted: 08/09/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To report our immediate and delayed outcomes of nonstented tubularized incised plate (TIP) distal hypospadias repair. METHODS We retrospectively reviewed all charts of children who underwent distal hypospadias repair in a single children's hospital from 2013 to 2018. Patients' demographics, hypospadias characteristics, operative technique, and immediate and delayed outcomes were recorded. RESULTS Of 280 consecutive distal hypospadias repairs that were identified, 74 were excluded due to the use of a repair other than TIP. Eleven stented TIP repairs were excluded as well. Of 195 nonstented repairs, immediate postoperative voiding complications were recorded in 11 (5.6%) and included multiple/split stream in 6 (3%), dysuria and voiding difficulty in 2 (1%), urinary retention in 2 (1%), and gross hematuria that spontaneously resolved in 1 (0.5%). Late follow up was recorded in 142 of 195 (72.8%) repairs. Delayed urethroplasty/glansplasty complications were recorded in 12 (8.5%) and included urethrocutaneous fistula in 10 (7.0%), meatal stenosis in 6 (4.2%) and glans/urethroplasty dehiscence in 2 (1.4%). CONCLUSION Avoiding postoperative urethral stents in distal hypospadias TIP repair reduces the morbidity associated with the stent and is a feasible option that carries acceptable immediate and delayed complication rates. Avoiding the stent eliminates stent-related bladder spasms, the need for other medications, and the short-term office visit for stent removal, therefore reducing parental anxiety, patient discomfort, and reducing cost.
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Doğan G, İpek H. The evolution of hypospadias publications: A bibliometric approach. Rev Int Androl 2020; 19:224-233. [PMID: 32563586 DOI: 10.1016/j.androl.2020.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/29/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND/OBJECTIVE Although the increasing prevalence of hypospadias has been reported in many countries, there is a lack of bibliometric studies that make a holistic assessment of the publications about this issue. This study aims to make a holistic evaluation, latest developments, and trend topics about hypospadias publications between 1980 and 2018 through bibliometric analysis. METHODS All the publications about hypospadias published in the Web of Science index between 1980 and 2018 were downloaded and analyzed using bibliometric methods. The Spearman's correlation coefficient was utilized to analyze the correlations between economic productivity and performance of the countries on hypospadias. Linear regression analysis was performed to estimate the number of publications for the following years. RESULTS Bibliometric analyses were performed with 1940 articles. With 527 (27.2%) publications, the USA was the country that made the most contribution to the literature. The top active 3 journals were the Journal of Urology, Journal of Pediatric Urology, and Urology. A high correlation was detected between hypospadias publication productivity and GDP (r=0.791, p<0.001). The regression analysis results showed that the expected number of articles to be produced was 95 (75-116) for 2019 and 106 (47-164) for 2024. CONCLUSIONS This study provides a holistic evaluation of the articles about hypospadias, which is an anomaly that should be repaired and treated with surgery due to its potential problems for the children at kindergarten and school age. Increasing the collaboration between especially developing countries and research in different countries with samples from different communities through multidisciplinary studies are recommended.
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Affiliation(s)
- Gül Doğan
- Hitit University, Faculty of Medicine, Department of Pediatric Surgery, Çorum, Turkey.
| | - Hülya İpek
- Hitit University, Faculty of Medicine, Department of Pediatric Surgery, Çorum, Turkey
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A Critical Analysis of Stented and Unstented Tubularized Incised Plate Urethroplasty Through a Prospective Randomized Study and Assessment of Factors Influencing the Functional and Cosmetic Outcomes. Urology 2017. [DOI: 10.1016/j.urology.2017.04.056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mir M, Mir SA, Shahdhar M, Wani M, Moheen HA, Bhat JA. Comparative study of Mirs(') (Mushtaq and Shabir) technique of prepuce preserving minimally invasive urethroplasty with Snodgrass urethroplasty for repair of distal hypospadias without chordee…A prospective study. Indian J Plast Surg 2015; 48:48-53. [PMID: 25991886 PMCID: PMC4413490 DOI: 10.4103/0970-0358.155269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: There is no single, universally applicable technique for hypospadias repair and numerous techniques have been practised from time to time. We compare the results of our new technique (Mirs’ technique also called Mush & Shab's technique) to Snodgross urethroplasty. Mirs’ technique is a modified version of Thiersch-Duplay urethroplasty. Material and Methods: This prospective comparative study was carried out in a tertiary care hospital of Northern India over a period of 3 years from March 2010 to March 2013 and included 120 patients of anterior (distal penile, subcoronal, coronal and glanular) hypospadias without chordee. They underwent either Mirs’ technique (group 1 n = 60) or Snodgrass technique (group 2 n = 60). Follow-up was at 1-week, 1-month, 3 months and 6 months. Results: The mean operative time was 55 min (range: 43-70 min) in group 1 and 71.9 min (range: 60-81 min) in group 2 (P < 0.001). Urethrocutaneous fistula developed in two and four patients in group 1 and 2, respectively. Fistula closure was done at least 3 months postoperatively, and there was no significant difference in success rate between the two groups. Three cases of glanular dehiscence were detected (one in group 1 and two in group 2); the patient from group 1 had a successful repair using the already preserved prepuce. Conclusion: Mirs’ modification of Thiersch-Duplay technique for distal hypospadias is a time saving procedure with a lower overall complication rate. Valuable local tissue is preserved to deal with any complication that may occur. Analgesic requirement was significantly lower in this minimally traumatic technique. As it is less time consuming, simple and easy to learn with a short learning curve, this technique deserves application in cases of distal hypospadias.
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Affiliation(s)
- Mushtaq Mir
- Department of Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Shabir Ahmad Mir
- Department of Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Muddassir Shahdhar
- Department of Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Mumtazdin Wani
- Department of Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India
| | | | - Jahangeer Ahmad Bhat
- Department of Radiodiagonosis, Government Medical College, Srinagar, Jammu and Kashmir, India
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Chalmers DJ, Siparsky GL, Wiedel CA, Wilcox DT. Distal hypospadias repair in infants without a postoperative stent. Pediatr Surg Int 2015; 31:287-90. [PMID: 25475503 DOI: 10.1007/s00383-014-3647-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To review our experience with infants undergoing distal hypospadias repair without a postoperative stent to determine if an unacceptable complication rate might justify its use. METHODS Children <1 year of age who underwent distal hypospadias repair by a single surgeon were identified through a prospectively maintained database. The use of a postoperative urethral stent was recorded for each case. Demographics, meatus position, operative technique and complications were also recorded. Patients older than 1 year or with hypospadias proximal to a subcoronal position were excluded. RESULTS Eighty-nine patients without a stent were identified in addition to 21 patients who had a stent for a minimum of 3 days. At 3 months follow-up, 4/89 (4.49 %) patients in the stentless group required circumcision revision. 1 patient experienced urinary retention. 1/21 (4.76 %) patients with a postoperative stent required reoperation for meatal stenosis. CONCLUSIONS The complication rate for infants undergoing distal hypospadias repair is low, does not appear to be significantly increased by forgoing a postoperative urethral stent. Avoiding a stent likely reduces a variety of associated adverse events and needs for short-term follow-up.
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Kanaroglou N, Wehbi E, Alotay A, Bagli DJ, Koyle MA, Lorenzo AJ, Farhat WA. Is There a Role for Prophylactic Antibiotics after Stented Hypospadias Repair? J Urol 2013; 190:1535-9. [DOI: 10.1016/j.juro.2013.02.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Niki Kanaroglou
- Division of Urology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elias Wehbi
- Division of Urology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Abdulhakim Alotay
- Division of Urology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Darius J. Bagli
- Division of Urology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Martin A. Koyle
- Division of Urology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Armando J. Lorenzo
- Division of Urology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Walid A. Farhat
- Division of Urology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Xu N, Xue XY, Wei Y, Li XD, Zheng QS, Jiang T, Huang JB. Outcome Analysis of Tubularized Incised Plate Repair in Hypospadias: Is a Catheter Necessary? Urol Int 2013; 90:354-7. [DOI: 10.1159/000347127] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 12/24/2012] [Indexed: 11/19/2022]
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Current world literature. Curr Opin Urol 2012; 22:521-8. [PMID: 23034511 DOI: 10.1097/mou.0b013e3283599868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Radwan M, Soliman MG, Tawfik A, Abo-Elenen M, El-Benday M. Does the type of urinary diversion affect the result of distal hypospadias repair? A prospective randomized trial. Ther Adv Urol 2012; 4:161-5. [PMID: 22852026 DOI: 10.1177/1756287212448111] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this review is to evaluate different techniques in urinary diversion and urethral stenting in hypospadias surgery. PATIENTS AND METHODS The surgical procedure included 192 tubularized incised plate (TIP) repairs for distal penile hypospadias. The patients were prospectively randomized into three groups: In group A, a urethral catheter was used as a stent and for diversion of urine (63 patients); in group B we use no urethral stenting (63 patients), only a suprapubic catheter; and in group C we use a suprapubic diversion and we put a small catheter in the anterior urethra only (66 patients). The urethral catheter was removed in group A at the 6th-7th postoperative day and in group C the urethral stent was removed at the 3rd-4th postoperative day. The suprapubic catheter was removed in both groups B and C at the 7th-9th postoperative day. All patients received an injection of antibiotics in the morning of the operation and daily until the day of catheter removal. All of the operations were performed by the same surgeon. RESULTS The mean ages of our patients were 3, 5, and 5 years in groups A, B, and C, respectively. The mean hospital stay was 5 days (3-8). Follow-up ranged from 8 to 48 months (mean of 21.5 ± 10.1 months). Bladder spasm was observed in 33% of our patients in group A while there were no cases of spasm in the other two groups with a statistically significant difference (p < 0.05). Fistula was reported in eight patients (12.7%) of our urethral catheter group A, while it was observed in three patients (2.3%) of our suprapubic diversion groups B and C with a statistically significant difference between the two groups (p < 0.05). Meatal stenosis was reported in eight patients in group B (12.7%; nonstented group) versus three patients of both groups A and C (2.4%; stented groups) with a statistically significant difference (p < 0.05). CONCLUSION Suprapubic diversion is an important step in hypospadias repair as it provides a better success rate with a significantly lower rate of occurrence of fistula. However, the addition of a stent in the anterior urethra to suprapubic diversion avoids the development of meatal stenosis and also avoids the bladder spasm observed with a urethral catheter.
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Affiliation(s)
- Mohamed Radwan
- Urology Department, Faculty of Medicine, Tanta University, Egypyt
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Silay MS, Sirin H, Tepeler A, Karatag T, Armagan A, Horasanli K, Miroglu C. "Snodgraft" technique for the treatment of primary distal hypospadias: pushing the envelope. J Urol 2012; 188:938-42. [PMID: 22819401 DOI: 10.1016/j.juro.2012.04.126] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE "Snodgraft" modification has been proposed to reduce the risk of meatal/neourethral stenosis in distal hypospadias. We applied the Snodgraft technique by using inner preputial graft in primary distal hypospadias repair. MATERIALS AND METHODS A total of 102 consecutive patients undergoing the Snodgraft procedure were prospectively studied between 2006 and 2011. Mean patient age was 7.2 years. Localization of the meatus was glanular in 5 patients, coronal in 49, subcoronal in 45 and mid penile in 3. In all patients the posterior urethral plate was incised, and the graft harvested from the inner prepuce was sutured from the old meatus to the tip of the glans. A neourethra was created over a urethral catheter using 6-zero polyglactin suture. An interpositional flap was laid over the urethra as a second barrier. All patients were followed at 3 to 6-month intervals for cosmetic and functional results. RESULTS At a mean of 2.4 years of followup no patient had meatal stenosis or diverticulum at the inlay graft site. However, urethrocutaneous fistula was observed in 10 patients (9.8%). A slit-like appearance of neomeatus was achieved in all patients. During followup no obstructive urinary flow pattern was detected, and early and long-term maximum urine flow rates were comparable. CONCLUSIONS No meatal/neourethral stenosis was observed in any patient undergoing a Snodgraft procedure. A randomized trial will be needed to prove that the incidence of meatal/neourethral stenosis is lower after Snodgraft repair compared to routine tubularized incised plate repair.
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Affiliation(s)
- Mesrur Selcuk Silay
- Department of Urology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey.
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