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Zhang B, Bi Y, Ruan S. Reconstructing forked corpus spongiosum to correct glans droop in distal/midshaft hypospadias repair. J Int Med Res 2021; 48:300060520925698. [PMID: 32459109 PMCID: PMC7278107 DOI: 10.1177/0300060520925698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose We reviewed our experience and efficacy of reconstruction of a forked corpus spongiosum
(FCS) to correct glans droop in distal/midshaft hypospadias repair. Methods Eighty-five consecutive patients who underwent distal/midshaft hypospadias repair by
the same surgeon in our center from October 2015 to June 2018 were retrospectively
analyzed. All cases were accompanied by different degrees of glans droop, which we
corrected by cutting off and reconstructing the FCS along the plate. We recorded the
degrees of glans droop, development of the FCS, and postoperative complications
including residual chordee, fistula, diverticulum, glans dehiscence, meatus stenosis,
and urethral stricture. Results The follow-up period ranged from 5 to 37 months (mean, 19.7 months). Two patients
(2.3%) developed a coronal fistula and underwent a second repair. Two patients (2.3%)
developed a mild urethral diverticulum and underwent continued observation. One patient
(1.2%) developed a meatus stenosis that resolved after 1 month of meatus expansion
combined with external mometasone furoate. No patients developed postoperative residual
chordee or urethral stricture. Conclusions The degree of glans droop is closely associated with the development of an FCS.
Reconstructing the FCS to correct the glans droop can yield satisfactory outcomes and
should be popularized in distal/midshaft hypospadias repair.
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Affiliation(s)
- Bin Zhang
- Department of Pediatric Urology, Children's Hospital of Fudan University, Shanghai, China
| | - Yunli Bi
- Department of Pediatric Urology, Children's Hospital of Fudan University, Shanghai, China
| | - Shuangsui Ruan
- Department of Pediatric Urology, Children's Hospital of Fudan University, Shanghai, China
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Zhang B, Bi YL, Ruan SS. Application and efficacy of reconstructing forked corpus spongiosum in distal/midshaft hypospadias repair. Asian J Androl 2021; 23:47-51. [PMID: 32859871 PMCID: PMC7831843 DOI: 10.4103/aja.aja_42_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We reviewed our experience in reconstructing forked corpus spongiosum (FCS) in distal/midshaft hypospadias repair and analyzed the efficacy of this surgical technique. From August 2013 to December 2018, 137 consecutive cases of distal/midshaft hypospadias operated by the same surgeon in Urology Department, Children's Hospital of Fudan University (Shanghai, China), were retrospectively analyzed. Sixty-four patients who underwent routine tubularized incised plate (TIP) or onlay island flap (ONLAY) surgery were included in the nonreconstructing group, and 73 patients who underwent reconstructing FCS during TIP or ONLAY surgery were included as the reconstructing group. Thirty-eight cases underwent TIP, and 26 underwent ONLAY in the nonreconstructing group, with a median follow-up of 44 (range: 30–70) months. Twenty-seven cases underwent TIP, and 46 underwent ONLAY in the reconstructing group, with a median follow-up of 15 (range: 6–27) months. In the nonreconstructing/reconstructing groups, the mean age at the time of surgery was 37.55 (standard deviation [s.d.]: 29.65)/35.23 (s.d.: 31.27) months, the mean operation duration was 91.95 (s.d.: 12.17)/93.84 (s.d.: 14.91) min, the mean neourethral length was 1.88 (s.d.: 0.53)/1.94 (s.d.: 0.53) cm, and the mean glans width was 11.83 (s.d.: 1.32)/11.56 (s.d.: 1.83) mm. Twelve (18.8%)/5 (6.8%) postoperative complications occurred in the nonreconstructing/reconstructing groups. These included fistula (5/2), glans dehiscence (3/0), diverticulum (1/2), residual chordee (3/0), and meatus stenosis (0/1) in each group. There was a significant difference in the overall rate of complications (P = 0.035). These results indicate that the technique of reconstructing FCS provides excellent outcomes with fewer complications in distal/midshaft hypospadias repair.
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Affiliation(s)
- Bin Zhang
- Department of Pediatric Urology, Children's Hospital of Fudan University, Shanghai 201102,, China
| | - Yun-Li Bi
- Department of Pediatric Urology, Children's Hospital of Fudan University, Shanghai 201102,, China
| | - Shuang-Sui Ruan
- Department of Pediatric Urology, Children's Hospital of Fudan University, Shanghai 201102,, China
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Yuri P, Gunadi, Lestari RP, Fardilla FP, Setyaningsih WAW, Arfian N, Dachlan I. The impact of COL1A1 and COL6A1 expression on hypospadias and penile curvature severity. BMC Urol 2020; 20:189. [PMID: 33261612 PMCID: PMC7709398 DOI: 10.1186/s12894-020-00760-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypospadias, the most frequent congenital male external genitalia abnormality, is usually associated with curvature of the ventral penis, i.e. chordee. Abnormality of darto tissue has been suggested as the pathophysiology of chordees. Collagen is one of the most abundant fibrous proteins within the extracellular matrix. In this study, we determined the expression of collagen 1 (COL1A1) and COL6A1 in patients with hypospadias and associated them with the severity of penile curvature. METHODS We included 60 children < 18 years old, consisting of 20 distal hypospadias, 20 proximal hypospadias patients, and 20 controls in our institution from 2017 - 2020. The expression of COL1A1 and COL6A1 in darto tissue was determined by reverse-transcriptase polymerase chain reaction (qPCR). The penile curvature severity was classified as mild (< 30 degrees), moderate (30-60 degrees), and severe (> 60 degrees). RESULTS qPCR showed that COL1A1 and COL6A1 expression was significantly downregulated in the distal (0.88 (0.38-2.53) and 0.54 (0.16-4.35), respectively) and proximal 0.76 (0.33-2.57) and 0.57 (0.18-1.38), respectively) hypospadias groups compared to controls (1.85 (0.24-4.61) and 0.93 (0.17-4.06), respectively) with p-values of 0.024 and 0.018, respectively. Furthermore, there was a moderate correlation between COL1A1 and COL6A1 expression (r = 0.458, p < 0.0001). Interestingly, COL1A1 and COL6A1 were also significantly downregulated in the moderate and severe chordee groups compared to the mild chordee groups, with p-values of 0.003 and 0.037, respectively. CONCLUSIONS Aberrant COL1A1 and COL6A1 expression might affect abnormalities in darto tissue and penile curvature severity in hypospadias patients.
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Affiliation(s)
- Prahara Yuri
- Division of Urology, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No.1, Yogyakarta, 55281, Indonesia.
| | - Gunadi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Rahmadani Puji Lestari
- Division of Urology, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No.1, Yogyakarta, 55281, Indonesia
| | - Firly Putri Fardilla
- Division of Urology, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No.1, Yogyakarta, 55281, Indonesia
| | | | - Nur Arfian
- Department of Anatomy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ishandono Dachlan
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine,Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
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Duan S, Jiang X, Zhang X, Ou W, Fu M, Chen K, Li J, Ma S. Megameatus intact prepuce treated with urethral plate-preserving surgery: a retrospective study of an unusual hypospadias variant. Transl Androl Urol 2019; 8:583-590. [PMID: 32038954 PMCID: PMC6987599 DOI: 10.21037/tau.2019.10.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/29/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Megameatus intact prepuce (MIP) is a unique variant of hypospadias and is a clinically rare condition. Due to the anatomical characteristics of the MIP hypospadias variant presenting a unique challenge to surgeons, no single urethroplasty method provides a universal solution for all patients. The purpose of this study was to evaluate the outcomes of hypospadias after MIP repair by urethral plate-preserving urethroplasty. METHODS A retrospective study was performed on 25 coronal or distal MIP patients, with a median age of 8, with most deficiencies being discovered during their first hospital visit for phimosis. Correction with urethroplasty was performed for all patients; 5 underwent the Mathieu procedure, 13 underwent the tubularized incised plate (TIP) procedure, and 7 underwent the Duplay procedure. The 25 patients were followed up for 6 to 36 months to evaluate the surgical outcomes. RESULTS There were no significant differences in intraoperative bleeding, hospital stays, postoperative analgesia rate, and cure rate among the three surgical procedures. The operative time for the Mathieu procedure was longer than that for the TIP and Duplay procedures, which did not differ. Complications occurred in 4 of the 25 patients (16.0%), and the overall complication-free survival rate at 1 year after surgery was 80.5%. The age at the time of surgery, urethral plate width, urethroplasty length, surgical procedures, or meatal location (coronal or distal penis) were not independently predictive of complications. CONCLUSIONS The clinical manifestations of MIP are often concealed and then accidentally discovered during hospital visits for phimosis; thus, the actual incidence of MIP might be higher. The urethral plate should be preserved during MIP-correcting treatment, especially for coronal or distal MIP. The same satisfactory outcomes can be obtained with Mathieu, TIP, or Duplay urethroplasty.
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Affiliation(s)
- Shouxing Duan
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
- epartment of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
| | - Xuewu Jiang
- Department of Pediatric Surgery, Woman’s and Children’s Hospital, Shenzhen University and Pingshan District, Shenzhen 518122, China
| | - Xuan Zhang
- Department of Pediatric Surgery, Woman’s and Children’s Hospital, Shenzhen University and Pingshan District, Shenzhen 518122, China
| | - Wenhui Ou
- epartment of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
| | - Maxian Fu
- epartment of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
| | - Kaihong Chen
- epartment of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
| | - Jianhong Li
- epartment of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
| | - Shuhua Ma
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
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Omar RG, Khalil MM, Sherif H, Elezaby H. Pedicled preputial island flap for double functions in hypospadias surgery. Turk J Urol 2018; 44:423-427. [PMID: 29799409 DOI: 10.5152/tud.2018.49035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 01/19/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To use the prepuce for double functions one as a second layer for the neourethra to decrease the incidence of urethrocutaneous fistula and the second as a skin covering for the ventral aspect of the penis. MATERIAL AND METHODS From January 2013 to December 2016, 37 cases of hypospadias with mild to moderate chordee were included in this study. The cases with ventral penile skin defect were managed by tubularized incised plate urethroplasty (TIPU) using pedicled preputial flap. Recurrent cases, cases with severe chordee which necessitated division of the urethral plate, and cases with penoscrotal hypospadias were excluded from this study. RESULTS Thirty-seven cases of hypospadias aged 9-60 months with a mean age of 24.8 months were included in this study. Coronal (n= 9 cases; 24.3%), distal penile (n=11; 29.9%), and midpenile hypospadias (n= 17; 45.9%) were detected in respective number of patients. Postoperative complications consisted of external meatal stenosis (n=2; 8.1%), and one case with urethrocutaneous fistula. Skin necrosis was not reported in this study. Follow-up visits were performed at 1, 3 and 6 months which showed good cosmetic appearance that was accepted by their parents. CONCLUSION This technique was beneficial in decreasing the rate of skin necrosis, as it keeps the blood supply to the preputial skin intact, and decreases the incidence of urethrocutaneous fistula.
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Affiliation(s)
- Rabea G Omar
- Department of Urology, Benha University School of Medicine, Egypt
| | - Mostafa M Khalil
- Department of Urology, Benha University School of Medicine, Egypt
| | - Hammouda Sherif
- Department of Urology, Benha University School of Medicine, Egypt
| | - Hesham Elezaby
- Department of Urology, Benha University School of Medicine, Egypt
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Dason S, Wong N, Braga LH. The contemporary role of 1 vs. 2-stage repair for proximal hypospadias. Transl Androl Urol 2016; 3:347-58. [PMID: 26813851 PMCID: PMC4708137 DOI: 10.3978/j.issn.2223-4683.2014.11.04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This review discusses the most commonly employed techniques in the repair of proximal hypospadias, highlighting the advantages and disadvantages of single versus staged surgical techniques. Hypospadias can have a spectrum of severity with a urethral meatus ranging from the perineum to the glans. Associated abnormalities are commonly found with proximal hypospadias and encompass a large spectrum, including ventral curvature (VC) up to 50 degrees or more, ventral skin deficiency, a flattened glans, penile torsion and penoscrotal transposition. Our contemporary understanding of hypospadiology is comprised of a foundation built by experts who have described a number of techniques and their outcomes, combined with survey data detailing practice patterns. The two largest components of hypospadias repair include repair of VC and urethroplasty. VC greater than 20 degrees is considered clinically relevant to warrant surgical correction. To repair VC, the penis is first degloved-a procedure that may reduce or remove curvature by itself in some cases. Residual curvature is then repaired with dorsal plication techniques, transection of the urethral plate, and/or ventral lengthening techniques. Urethroplasty takes the form of 1- or 2-stage repairs. One-stage options include the tubularized incised urethroplasty (TIP) or various graft or flap-based techniques. Two-stage options also include grafts or flaps, including oral mucosal and preputial skin grafting. One stage repairs are an attractive option in that they may reduce cost, hospital stay, anesthetic risks, and time to the final result. The downside is that these repairs require mastery of multiple techniques may be more complex, and-depending on technique-have higher complication rates. Two-stage repairs are preferred by the majority of surveyed hypospadiologists. The 2-stage repair is versatile and has satisfactory outcomes, but necessitates a second procedure. Given the lack of clear high-quality evidence supporting the superiority of one approach over the others, hypospadiologists should develop their own algorithm, which gives them the best outcomes.
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Affiliation(s)
- Shawn Dason
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Nathan Wong
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Luis H Braga
- Division of Urology, McMaster University, Hamilton, ON, Canada
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7
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Craig JR, Wallis C, Brant WO, Hotaling JM, Myers JB. Management of adults with prior failed hypospadias surgery. Transl Androl Urol 2016; 3:196-204. [PMID: 26816767 PMCID: PMC4708161 DOI: 10.3978/j.issn.2223-4683.2014.04.03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Hypospadias is one of the most prevalent anomalies of the male genitalia. Contemporary hypospadias repair is very successful, but patients that have the surgery fail often require multiple surgeries throughout their life. Complications from failed hypospadias repairs have a significant impact on patients both psychologically and physically. Failed hypospadias repair encompasses a spectrum of problems that include hypospadias recurrence with an ectopic meatus, urethral fistula, urethral stricture, and ventral penile curvature. Repairs of hypospadias complications can be challenging due to the poor quality of surrounding tissue from disruption of normal vasculature in the re-operative field associated with the underlying disorder. One of the most challenging issues is dealing with urethral strictures. There have been multiple methods described at repairs of these in both a single stage and multiple staged procedures. Particular attention has been directed towards applications of grafts due to worse outcomes with flaps. Buccal mucosa has emerged as the leading graft material in staged repairs. When counseling patients with failed hypospadias it is important to discuss the expected outcome as repairs directed towards a terminally positioned meatus with a straight phallus may require multiple surgeries due to post-operative complications as well as the necessity of proceeding in a staged approach.
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Affiliation(s)
- James R Craig
- The Center for Reconstructive Urology and Men's Health, Department of Surgery, University of Utah, Salt Lake City, Utah, USA ; Primary Children's Medical Center, Salt Lake City, Utah, USA
| | - Chad Wallis
- The Center for Reconstructive Urology and Men's Health, Department of Surgery, University of Utah, Salt Lake City, Utah, USA ; Primary Children's Medical Center, Salt Lake City, Utah, USA
| | - William O Brant
- The Center for Reconstructive Urology and Men's Health, Department of Surgery, University of Utah, Salt Lake City, Utah, USA ; Primary Children's Medical Center, Salt Lake City, Utah, USA
| | - James M Hotaling
- The Center for Reconstructive Urology and Men's Health, Department of Surgery, University of Utah, Salt Lake City, Utah, USA ; Primary Children's Medical Center, Salt Lake City, Utah, USA
| | - Jeremy B Myers
- The Center for Reconstructive Urology and Men's Health, Department of Surgery, University of Utah, Salt Lake City, Utah, USA ; Primary Children's Medical Center, Salt Lake City, Utah, USA
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Weber BA, Braga LHP, Patel P, Pippi Salle JL, Bägli DJ, Khoury AE, Lorenzo AJ. Impact of penile degloving and proximal ventral dissection on curvature correction in children with proximal hypospadias. Can Urol Assoc J 2015; 8:424-7. [PMID: 25553156 DOI: 10.5489/cuaj.2337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Penile degloving is an important step in orthoplasty. Although its role in correcting mild curvature in distal and midshaft hypospadias has been previously reported, its impact on ventral curvature (VC) correction in proximal defects warrants further investigation. Therefore, we sought to document the effect of degloving and proximal urethral dissection on VC correction in children with proximal hypospadias. METHODS We retrospectively reviewed the records of 137 patients who underwent proximal hypospadias repair between 1998 and 2006. VC, defined as mild (<30%), moderate (30%-45%), and severe (>45%), was recorded before penile degloving and after erection test. Percent improvement in VC and need for further treatment (beyond degloving and proximal dissection) based on preoperative degree of curvature were assessed. ANOVA test was used to compare improvement among the 3 groups. RESULTS Mean age at repair was 14 months (range: 6-24). Penile degloving associated with proximal urethral dissection when necessary was responsible for the improvement in the degree of curvature in 7 of 9 (77%) patients with mild VC, 23 of 44 (52%) with moderate and 35 of 84 (40%) with severe VC. Additionally, degloving alone was sufficient for VC correction in 7 of 9 (77%) mild cases, 14 of 44 (30%) moderate and only 2 of 84 (2%) severe cases. The difference among these 3 groups was statistically significant (p < 0.001). CONCLUSIONS Penile degloving alone can correct VC. The percentage of improvement depends on the preoperative degree of curvature, with severe VC cases showing the least improvement.
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Affiliation(s)
- Bryce A Weber
- Division of Urology, University of Calgary, Calgary, AB
| | | | - Premal Patel
- Section of Urology, University of Manitoba, Winnipeg, MB
| | | | - Darius J Bägli
- Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON
| | - Antoine E Khoury
- Department of Urology, University of California at Irvine, Irvine, CA
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON
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Al-Adl AM, El-Karamany TM, Bassiouny AS. Distal extension of the midline urethral-plate incision in the Snodgrass hypospadias repair: An objective assessment of the functional and cosmetic outcomes. Arab J Urol 2014; 12:116-26. [PMID: 26019935 PMCID: PMC4435762 DOI: 10.1016/j.aju.2014.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 02/01/2014] [Accepted: 02/05/2014] [Indexed: 11/25/2022] Open
Abstract
Objectives To objectively assess the functional and cosmetic outcomes of a modified tubularised incised-plate (TIP) urethroplasty (Snodgrass) technique, with particular attention to the uroflowmetry study and Hypospadias Objective Scoring Evaluation (HOSE) score. Patients and methods In a prospective case-series study, 43 consecutive patients with primary distal hypospadias were evaluated. The modified Snodgrass technique included an extension of the midline relaxing incision of the urethral plate from within the hypospadiac meatus to the very tip of the glans. The neourethra was tubularised starting at the neomeatus and proceeding proximally. The neourethra was covered with either a single or double dartos flap. In toilet-trained boys, at least 3 months after surgery, the flow pattern, maximum (Qmax), and mean urinary flow rate (Qave) were recorded, and the results plotted against a recently published flow-rate nomogram from normal children. The postvoid residual urine volume was measured using ultrasonography. The cosmetic outcome was assessed using the HOSE system. Results The native meatus was coronal in 11 (26%), subcoronal in 23 (53%) and distal penile in nine (21%) of the patients. The median (range) age was 4.2 (0.5–14) years. The neourethra was covered by a single dorsal dartos flap in 25 and a double dartos flap in 18 patients. At a median (range) follow-up of 6 (3–24) months, the uroflowmetry findings in 26 uncomplicated toilet-trained boys with a median (range) age of 5.2 (3.3–14) years showed an abnormal Qmax below the fifth percentile in four (15%), with the Qave above the fifth percentile in all. The flow pattern was bell-shaped in nine boys (35%), interrupted/intermittent in five (19%), slightly flattened in 10 (39%) and a plateau in two (8%). A vertical slit-like meatus located at the distal glans was created in 39 (91%) boys, and at the proximal glans in four (9%). The urinary stream was single and straight in 39 and angled in four patients. A straight erection was observed in 42 (98%) boys. Four patients had preoperative mild penile torsion of <45°, that was corrected by surgery. The mean (SD, range) HOSE score was 15.8 (0.6, 13–16). Two patients had a small, single subcoronal fistula. Conclusion Extending the midline urethral plate-incision in the modified Snodgrass repair to the apical part of the glans can be done safely with a high rate of locating the neomeatus at the glans tip, with no resultant meatal stenosis. The functional and cosmetic results of the procedure are good, but long-term data and comparative studies are required to confirm these results.
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Abstract
Purpose Recognition the urethral plate comprises tissues that normally should have created the urethra was an important milestone in hypospadias surgery, giving rise to new operative repairs - most notably the tubularized incised plate technique. This article reviews the current state of the art for hypospadias repair using tubularized, incised plate (TIP). Materials and Methods Personal experience and literature reports were reviewed to summarize use of TIP urethroplasty for distal, proximal, and re-operative hypospadias repairs. Results The TIP can be used to correct all distal and most proximal hypospadias. The major contraindication is ventral curvature that leads to urethral plate transection for straightening, which is only necessary in some proximal cases. Reoperations can also be performed using TIP provided the urethral plate has been maintained and is not grossly scarred. Complication rates are comparable to previously used techniques, while cosmetic appearance after TIP is considered superior to other available procedures. Conclusions Recognition of the urethral plate and its incorporation into the neourethra has revolutionized hypospadias repair. The most commonly used operative procedure today is TIP.
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Affiliation(s)
- Warren T Snodgrass
- Department of Urology, Pediatric Urology Section, Children's Medical Center and the University of Texas Southwestern Medical Center, 2350 Stemmons Freeway Suite F4300 Dallas, Texas 75207, USA
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11
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The comparison of Belt-Fuqua and "TIPU" techniques in proximal penile hypospadias cases: retrospective analysis of 65 cases. Int Urol Nephrol 2009; 41:755-9. [PMID: 19280361 DOI: 10.1007/s11255-009-9546-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Accepted: 02/16/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We have compared our success and complication rates using the single-step "TIPU" (tubularized incised plate urethroplasty) and two-step Belt-Fuqua techniques in patients with proximal penile hypospadias. PATIENTS AND METHODS Sixty-five patients with proximal penile hypospadias were operated on in our clinic between 1998 and 2008: 31 by the "TIPU" technique and 34 by the Belt-Fuqua technique. The correction of the chordee was accomplished with dorsal plication and corporal body grafting in 18 patients in the "TIPU" group and at the first stage in all patients in the Belt-Fuqua group. RESULTS The mean age of the patients was 6.2 years in the "TIPU" group and 6.6 years in the Belt-Fuqua group. The mean follow-up duration was 9.2 and 7.9 months, respectively. The overall complication rate was 22.6% in the "TIPU" group and 11.8% in the Belt-Fuqua group. In both groups, the cosmetic appearance of a natural vertical slit glanular meatus situated at the normal position on the glans was achieved. CONCLUSION The two-step Belt-Fuqua technique is accepted as a good alternative treatment modality because of low complication rates and good results in selected cases with proximal penile hypospadias.
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Braga LHP, Lorenzo AJ, Salle JLP. Tubularized incised plate urethroplasty for distal hypospadias: A literature review. Indian J Urol 2008; 24:219-25. [PMID: 19468401 PMCID: PMC2684277 DOI: 10.4103/0970-1591.40619] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The tubularized incised plate (TIP) urethroplasty or Snodgrass procedure has gained worldwide acceptance for distal hypospadias repair due to its low complication rate, good cosmetic result, and technical simplicity. As a result, several articles have been published concerning various aspects and subtle variations of this procedure. The aim of this review is to critically and systematically analyze the published complication rates of TIP repair for distal hypospadias in children. We also reviewed the surgical modifications that have been introduced to the original technique and discussed the potential impact on the final outcome of the Snodgrass procedure.
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Affiliation(s)
- Luis Henrique P. Braga
- Division of Urology and University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Armando J. Lorenzo
- Division of Urology and University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joao L. Pippi Salle
- Division of Urology and University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
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Martinez Montoya J, Chams Anturi A, Contreras Pérez D. Relación entre algunas técnicas de reparación de hipospadias y complicaciones en el Hospital Universitario San Vicente de Paul 1986- 2005. Actas Urol Esp 2008; 32:332-40. [DOI: 10.1016/s0210-4806(08)73839-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Riccabona M. [Correction of hypospadias by the Snodgrass method. Indications and results]. Urologe A 2007; 46:1664-9. [PMID: 18004540 DOI: 10.1007/s00120-007-1584-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Tubularisation of the urethral plate with a medial incision was popularized by Snodgrass in the late 1990s. Since then this procedure has emerged throughout the world as the method of choice for correction of primary hypospadias. The procedure is applied as the technique of choice for primary correction of hypospadias, regardless of the level of the hypospadic meatus and the width of the original urethral plate, and is also used in various situations for secondary hypospadias surgery.. The complication rate is about 5-10 % in primary cases and between 10% and 20% in revision surgery for hypospadias repair.
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Affiliation(s)
- M Riccabona
- Abteilung für Kinderurologie, Krankenhaus der Barmherzigen Schwestern, Betriebsgesellschaft m.b.H., Seilerstätte 4, Linz, Austria.
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Aslan AR, Yücebaş E, Tekin A, Sengör F, Kogan BA. Short-term catheterization after TIP repair in distal hypospadias: who are the best candidates? Pediatr Surg Int 2007; 23:265-9. [PMID: 17093993 DOI: 10.1007/s00383-006-1830-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Accepted: 10/16/2006] [Indexed: 10/23/2022]
Abstract
Over the last decade, tubularized incised plate (TIP) urethroplasty has become the first choice of surgical technique in patients with distal hypospadias. Despite the excellent cosmetic and functional results, prolonged catheterization (7-14 days) remains the main disadvantage of the TIP repair. In this study, we investigated the outcomes of the short-term catheterization in children with distal hypospadias in order to elucidate any relationship between the length of catheterization and the patients' age, meatal localization and postoperative complication rates. The charts of 183 patients who underwent TIP repair for distal hypospadias in two different centers were reviewed retrospectively. Patients were grouped based on their catheter removal time (before 24 h vs. after 24 h) and the toilet status of children (toilet-trained vs. in-diaper). Children who had at least 6 months of follow-up and regular office visits were included in the study group, and the results were compared to the literature as well as the subgroups were also evaluated in terms of complications and catheterization period. A total of 128 patients with 40.4 months of the mean age (6-180 months) and 22.7 months of the follow-up (6-49 months) were included in the study. For the group 1 patients (n = 99) in whom the urethral catheter was removed before 24 h, the mean age and follow-up were 33.4 months (6-150 months) and 22.3 months (6-48 months), respectively. The catheters of group 2 patients (n = 29) were removed after 24 h, and their mean age and follow-up were 64.4 months (6-180 months) and 24.2 months (6-49 months), respectively. The group 2 patients were significantly older than those of group 1 (P < 0.05). The complications, such as fistula, meatal stenosis, tube dehiscence and buried penis, were seen in 11.1% of the group 1 and 13.8% of the group 2 (11.7% in overall), showing no statistically significant difference. On the other hand, 44% of the patients (n = 56) were toilet-trained at time of surgery. Although the mean age (79 months vs. 10.4 months) and the catheter removal time (64.3% vs. 87.5% before 24 h) of this group were significantly longer than the patients in diaper (P < 0.05), no significant difference was determined in terms of complication (14.2% vs. 9.7%). TIP repair with short-term catheterization has similar outcomes to the patients who conventionally carry their stent 7-14 days. The meatal position and the toileting status of the patients are not important in the use and length of catheterization.
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Affiliation(s)
- Ahmet R Aslan
- Division of Urology, Haydarpaşa Numune Research & Education Hospital, Istanbul, Turkey.
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Soygur T, Filiz E, Zumrutbas AE, Arikan N. Results of dorsal midline plication in children with penile curvature and hypospadias. Urology 2004; 64:795-8; discussion 798. [PMID: 15491724 DOI: 10.1016/j.urology.2004.05.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2004] [Accepted: 05/14/2004] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To present our initial results using dorsal midline (12-o'clock position) plication in children with penile curvature and hypospadias. METHODS Twenty-five children with hypospadias and ventral curvature confirmed after artificial erection underwent dorsal midline plication and hypospadias repair. Ventral curvature was corrected by making a 5 to 10-mm-long vertical incision through the tunica albuginea at the dorsal midline and approximating the outer edges of the incision with a monofilament polydioxanone stitch. RESULTS One plication suture was needed in 15 patients. In 8 patients with mid-shaft hypospadias and 2 with proximal penile hypospadias, two and three sutures were needed, respectively. In none of the patients was division of the urethral plate needed, except for one with proximal hypospadias. No complications were encountered during a mean follow-up of 9 months (range 5 to 34). CONCLUSIONS We believe that most cases of penile curvature with hypospadias can be corrected using dorsal midline plication of the tunica albuginea. Although long-term follow-up is necessary after puberty to confirm any erectile or sensory advantage, this approach might be considered whenever plication is to be performed.
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Affiliation(s)
- Tarkan Soygur
- Department of Urology, Division of Pediatric Urology, University of Ankara Faculty of Medicine, Ankara, Turkey
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Taneli F, Ulman C, Genc A, Yilmaz O, Taneli C. Biochemical analysis of urethral collagen content after tubularized incised plate urethroplasty: an experimental study in rabbits. ACTA ACUST UNITED AC 2004; 32:219-22. [PMID: 15205857 DOI: 10.1007/s00240-004-0407-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2003] [Accepted: 02/10/2004] [Indexed: 10/26/2022]
Abstract
The aim of the present study was the biochemical analysis of tissue hydroxyproline levels in incised urethral plates in order to show the total collagen content after the Snodgrass operation in the hypospadiac rabbit model. The study comprised 21 male New Zealand rabbits, (2.2-2.4 kg). The animals were randomly allocated to three groups each containing seven rabbits as follows: group 1, the ventral urethra was completely excised and a model of hypospadias formed. A full-thickness incision was made on the distal dorsal urethra, a feeding tube was placed as an urethral catheter and both urethral wings were sutured ventrally. Group 2, inserting an iris knife into the urethra, the ventral wall was incised mimicking an urethrotome. Group 3 consisted of normal control rabbits to determine the basal tissue hydroxyproline level. A slight increase in the hydroxyproline level was observed in the ventral part of the urethral tissue compared to the dorsal part in both groups 1 and 2; however, these differences were not significant. After the Snodgrass operation in the rabbit model, no significant differences were observed in the hydroxyproline levels of the dorsal and ventral parts of the urethra or between these and of the controls. Further studies are required in order to determine the mechanism underlying urethral healing through normal re-epithelization without excess collagen deposition after incised urethral plate urethroplasty.
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Affiliation(s)
- Fatma Taneli
- Department of Clinical Biochemistry, Faculty of Medicine, Celal Bayar University, 45020 Manisa, Turkey.
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