A new option to prevent fistulas in anterior urethroplasty in patients with kippered urethra: the tunica vaginalis flap

Current perspectives in hypospadias research: A scoping review of articles published in 2021 (Review)

Hundreds of papers are written about hypospadias every year referring to all aspects of the pathology, being one of the most common congenital malformations. The present study conducted a scoping review of articles published in 2021 to present the main issues and summarize current perspectives and achievements in the field. It searched for the keyword 'hypospadias' in the three most popular databases (PubMed, Scopus and Web of Science). After the analysis of the publications, they were categorized into different domains. The present review was performed respecting the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA ScR) guidelines. A total of 284 articles were included. These were published in 142 different journals. The most accessed was the Journal of Paediatric Urology with 54 articles. The main identified domains were related to surgical techniques, postoperative care, complications, anesthesia, anatomical factors, genetics, environmental factors, endocrinology, associated malformations, questionnaires and recommendations, management, biological materials, animal models, retrospective studies of centers, social media, bibliometrics, small gestational age, neoplasm, or fertility. Promising modifications of existing surgical techniques were presented with improved outcomes for both the proximal and distal types of hypospadias. Relevant anatomical and etiological, and also genetic factors were clarified. Aspects of the peri- and postoperative management referring to the antibiotherapy, analgesia, dressing techniques, and the future use of novel bioengineering agents to prevent, reduce or treat the occurring complications were discussed.

Ventral onlay glanuloplasty for treatment of fossa navicularis strictures

Purpose:

Management of fossa navicularis (FN) strictures balances restoring urethral patency with adequate cosmesis. Historically, FN strictures are managed via glans cap or glans wings, and in severe cases, multi-stage procedures. Ventral onlay glanuloplasty (VOG) is an easily reproducible technique that involves a single-stage augmentation with buccal mucosal graft. We have been applying this technique for several years and present early promising outcomes of this novel approach.

Materials and Methods:

We retrospectively reviewed all patients with FN strictures who underwent VOG at our institution. Treatment success was designated by the absence of extravasation on voiding cystourethrogram and no need for further urethral instrumentation on follow up. Glans cosmesis was assessed by patients providing binary (yes/no) response to the satisfaction in their appearance. We also noted stricture length, stricture etiology, demographic characteristics and any post-operative complications and reported median, interquartile range (IQR) and count, frequency (%), accordingly.

Results:

Ten patients underwent VOG and fit our inclusion criteria. Median stricture length was 2.0 cm (IQR 1.6 -2). Success rate was 90% (9/10) with a median follow up of 30 months (IQR 24.3 – 36.8). The one recurrence was treated by dilation combined with triamcinolone injection at 419 days post-op. Stricture etiology included primarily iatrogenic causes such as transurethral prostate resection (4/10), greenlight laser vaporization (2/10), cystolitholapaxy (1/10), and traumatic catheterization (3/10). All patients were satisfied with penile cosmesis.

Conclusion:

VOG is a simple technique for treating FN strictures. Based on our preliminary series, VOG provides sustained distal urethral patency and patients are pleased with the appearance.