1
|
Gabra A, Beyari BM, AlNuwaiser SJ, Allaf SM, Alghanmi R, Alrayiqi R, Mosaad F, Kurdi M. Outcomes of Hypospadias Repair Based on Surgical Techniques: A 4-Year Retrospective Study. Res Rep Urol 2024; 16:79-87. [PMID: 38558857 PMCID: PMC10981871 DOI: 10.2147/rru.s451552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose This study aimed to report the outcomes of hypospadias repair performed at a tertiary-level hospital during 2018 to 2021. Methods A retrospective chart review of 119 patients was performed. Results The most frequent coronal hypospadias cases were distal. However, the most common scrotal hypospadias cases were proximal. The average age at the time of the first surgery was 2.4 years (standard deviation, ±2.3 years). The tubularised incised plate technique was performed for 57 of these 119 patients. Urethral fistula was the most common complication associated with distal and proximal cases (23.96% and 30.43%, respectively). No significant correlation was observed between any complication and the surgical technique. Based on the logistic regression model, the duration of urethral stenting was statistically significant (p=0.025), indicating that a urinary catheter duration of more than 5 days resulted in a 2.9-times increased risk of postoperative urethral fistula. Conclusion Prolonged urethral stenting for more than 5 days may result in subsequent urethral fistula development. Neither the severity of hypospadias nor the surgical technique seems to affect postoperative complications.
Collapse
Affiliation(s)
- Aisha Gabra
- Division of Pediatric Surgery, Department of Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Badr Mohammed Beyari
- Faculty of Medicine and Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Sara Jamal AlNuwaiser
- Faculty of Medicine and Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Sarah Mamdouh Allaf
- Faculty of Medicine and Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Reem Alghanmi
- Faculty of Medicine and Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Rahaf Alrayiqi
- Faculty of Medicine and Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Faisal Mosaad
- Division of Pediatric Surgery, Department of Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Mazen Kurdi
- Division of Pediatric Surgery, Department of Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| |
Collapse
|
2
|
Cousin I, Basmaison C, Cousin E, Lebonvallet N, Germouty I, Leven C, De Vries P. Complication rates of proximal hypospadias: meta-analyses of four surgical repairs. J Pediatr Urol 2022; 18:587-597. [PMID: 36058812 DOI: 10.1016/j.jpurol.2022.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/28/2022] [Accepted: 08/12/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Proximal hypospadias surgery is impacted by a high complication rate. The goal of this work was to assess the overall composite complication rate, fistula rate and stenosis rate following proximal hypospadias surgery realized according to onlay urethroplasty, Duckett, Koyanagi and Bracka techniques. METHODS The databases MEDLINE, EMBASE, SCOPUS, Cochrane Library, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (CENTRAL) and Sciencedirect were searched. Studies had to report data about the mean age of population, the average duration of patient follow-up and the number of procedures required for surgical treatment of primary and proximal hypospadias. Two independent including one urologist reviewers screened all the articles and selected the articles to be included. RESULTS Overall composite complication rates were 32%, 34%, 49%, and 43%, for Onlay urethroplasty, Duckett's tubularized flaps urethroplasty, Koyanagi repair and Bracka 2 stages repair, respectively. Fistula rates were 13%, 18%, 21% and 23% respectively. The heterogeneity of complication rates reported in the different studies was not moderated by age, country, or patient's continent origin. DISCUSSION The classifications of complications used in articles were disparate and make comparisons between techniques difficult. The report of post-surgical complications in the literature is often poorly coded and follow-up times were often too short. CONCLUSION This meta-analysis attempts to determine to the extent possible, given the serious weaknesses in the hypospadias literature, plausible estimates of complication rates after skin flap urethroplasty. The patched onlay skin flap, the Duckett's tubularized skin flap technique, the Koyanagi's technique, and the Bracka's two-stage urethroplasty procedure lead to very high complication rates. Reported complication rates are comparable across techniques.
Collapse
Affiliation(s)
- Ianis Cousin
- Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire de Brest, Hôpital Augustin Morvan, 4 Avenue Foch, 29200 Brest, France; Laboratoire Intéraction épithéliums Neurones, Université de Bretagne Occidentale, 6 Rue Colbert, 29200 Brest, France.
| | - Camille Basmaison
- Laboratoire Intéraction épithéliums Neurones, Université de Bretagne Occidentale, 6 Rue Colbert, 29200 Brest, France
| | - Elie Cousin
- Department of Pediatry, Centre Hospitalier Universitaire de Rennes, 16 Boulevard de Bulgarie 35200 Rennes, France
| | - Nicolas Lebonvallet
- Laboratoire Intéraction épithéliums Neurones, Université de Bretagne Occidentale, 6 Rue Colbert, 29200 Brest, France
| | - Isabelle Germouty
- Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire de Brest, Hôpital Augustin Morvan, 4 Avenue Foch, 29200 Brest, France
| | - Cyril Leven
- Department of Pharmacology, Centre Hospitalier Régional Universitaire de Brest, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Philine De Vries
- Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire de Brest, Hôpital Augustin Morvan, 4 Avenue Foch, 29200 Brest, France; Laboratoire Intéraction épithéliums Neurones, Université de Bretagne Occidentale, 6 Rue Colbert, 29200 Brest, France
| |
Collapse
|
3
|
Vu TH, Viet Nguyen H, Quy Hong Q, Quang Pham H, Thanh Pham T, Hai Do Đ, Đo Truong T. Results of the one-stage proximal hypospadias repair with modified Koyanagi technique: A prospective cohort study in a single Vietnam centre. Ann Med Surg (Lond) 2021; 71:103012. [PMID: 34840761 PMCID: PMC8606834 DOI: 10.1016/j.amsu.2021.103012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 10/30/2021] [Accepted: 10/31/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Proximal hypospadias is the most severe type of hypospadias. Our approach to Koyanagi technique for proximal hypospadias aims to improve the blood supply to the neourethral flaps and reduce meatal complications. Methods Our prospective study included 75 patients who were operated for proximal hypospadias by our Koyanagi technique at Viet Duc hospital between January 2019 and December 2020. The clinical information obtained included a detailed medical history; preoperative, intraoperative, and postoperative data; short-term outcomes by the HOSE score were evaluated by a different physician. Results The mean (range) age was 3.59 ± 2.41 years (1.5–14), 86.7% under 5 years old. There are 31 penoscrotal, 31 scrotal, and 13 perineal hypospadias. The length of the neourethra ranged from 3.5 to 8 cm, mean 5.02 ± 0.88 cm. Evaluation of the surgeon at 6 months after surgery: primary success 81.3%. Complications occurred in 14 cases (18.7%), included 10 urethrocutaneous fistula and 4 dehiscence of the urethra. No cases of meatal stenosis or recession, urethral stricture, urethral diverticula. The mean HOSE score was found to be 14.47 ± 1.35, ranged 11 to 16. 57 patients (76%) had a total HOSE 14 and above and 18 patients had score below 14 (24%) Conclusion Our modified Koyanagi technique give us a good result for one-stage reconstruction of proximal hypospadias. Applying the HOSE score makes postoperative evaluation of hypospadias more objective and reliable. Proximal hypospadias is one of the most challenging conditions. Modified Koyanagi techniques improve the blood supply to the neourethral flaps. The HOSE score is an objective appraisal of the outcome of hypospadias repair.
Collapse
Affiliation(s)
- Tuan Hong Vu
- Department of Pediatric Surgery, Viet Duc Hospital, 40 TrangThi, Hoankiem, Hanoi, Viet Nam
- Department of General Surgery, Hanoi Medical University, Viet Nam
- Corresponding author. Department of Pediatric surgery, Viet Duc hospital, No. 40, Trangthi street, Hoankiem district, Hanoi, 100000, Viet Nam. Tel.: +84916123602.
| | - Hoa Viet Nguyen
- Department of Pediatric Surgery, Viet Duc Hospital, 40 TrangThi, Hoankiem, Hanoi, Viet Nam
| | - Quan Quy Hong
- Department of Pediatric Surgery, Viet Duc Hospital, 40 TrangThi, Hoankiem, Hanoi, Viet Nam
| | - Hung Quang Pham
- Department of Pediatric Surgery, Viet Duc Hospital, 40 TrangThi, Hoankiem, Hanoi, Viet Nam
- Department of General Surgery, Hanoi Medical University, Viet Nam
| | - Tung Thanh Pham
- Department of General Surgery, Hanoi Medical University, Viet Nam
| | - Đang Hai Do
- Department of General Surgery, Hanoi Medical University, Viet Nam
| | - Thanh Đo Truong
- Department of General Surgery, Hanoi Medical University, Viet Nam
- Department of Urology, Viet Duc Hospital, 40 TrangThi, Hoankiem, Hanoi, Viet Nam
| |
Collapse
|
4
|
Koyanagi urethroplasty for proximal hypospadias: A stage procedure? Prog Urol 2021; 32:312-318. [PMID: 34688536 DOI: 10.1016/j.purol.2021.09.008] [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: 03/22/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To report experience and technical refinements with the Koyanagi urethroplasty for proximal hypospadias. METHODS A retrospective study was conducted between 2004 and 2017. Medical records of patients treated by the Koyanagi technique were investigated. The penile ventral skin was closed either with a Byars flap or using an "Ombredanne's chasuble" (OC). The cohort was divided chronologically into two groups of the same number of patients (early -E- and late experience group-LEG-). Demographics, anatomical findings and surgical outcomes were compared between groups using univariate analysis. A logistic regression was performed to assess factors associated with the occurrence of a postoperative urethrocutaneous fistula or urethroplasty dehiscence (UD). RESULTS The Koyanagi urethroplasty was performed in 67 patients, 33 in the EEG and 34 in the LEG. The overall surgical complication rate was 64.2% (n=43), including 42 fistula or UD, higher in the EEG (81.8%) than in the LEG (44.1%, P<0.01). However, in the LEG, patients underwent the surgery older and the use of OC more frequent. After multivariate analyses, factors associated with a postoperative fistula or UD were the year of surgery (OR=0.71 [0.53-0.96] P=0.02), the age at surgery (OR=1.11 [1.01-1.22], P=0.03); contrary to the skin coverage method or the stenting duration (P>0.05). An urethral stenosis occurred in 1 patient (1.5%). At last follow-up, 64.2% of patients required a further procedure and 80.6% of urethral meatus were glandular. CONCLUSION In this study the complication rate, particularly the urethrocutaneous fistula, remained high. Urethral stenosis, were rare but the follow-up was too short to clearly identified them. Considering as a 2 stage procedure koyanagi uretroplasty allows to obtain finally good results. LEVEL OF EVIDENCE III.
Collapse
|
5
|
Youssef SB, Ksia A, Fredj MB, Messaoud M, Laamiri R, Belhassen S, Mosbahi S, Bouzzaffara B, Sahnoun L, Mekki M, Belguith M, Nouri A. Intérêt de la technique de Koyanagi dans le traitement de l’hypospadias posterieur chez l’enfant. AFRICAN JOURNAL OF UROLOGY 2018. [DOI: 10.1016/j.afju.2017.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
6
|
Springer A, Tekgul S, Subramaniam R. An Update of Current Practice in Hypospadias Surgery. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.eursup.2016.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
7
|
A New Modification of the Koyanagi Technique for the One-stage Repair of Severe Hypospadias. Urology 2016; 93:175-9. [PMID: 27041473 DOI: 10.1016/j.urology.2016.03.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 03/09/2016] [Accepted: 03/17/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To describe a new modification of the Koyanagi technique for the one-stage repair of severe hypospadias and its short-term outcomes. PATIENTS AND METHODS Our modified Koyanagi technique was performed in 24 patients with severe hypospadias between February 2012 and January 2015. The age of the patients ranged from 1.9 to 11.9 years (mean = 3.5 years). The flap design was similar to the Koyanagi technique, but our modified technique highlighted the following points: after the chordee was completely corrected, the urethral plate was recreated using foreskin, and then a U-shaped incision was made on the original and recreated urethral plate (as in the Duplay technique); a pedicled flap of the tunica vaginalis or scrotal dartos was used for additional coverage of the neourethra. RESULTS The operation time lasted from 120 to 150 minutes (mean = 140 minutes). There were 5 patients (20.8%) who developed complications: 4 patients (16.7%) developed a fistula and 1 patient (4.2%) developed dehiscence of the urethra. There were no reported urethral strictures, meatal stenosis, or urethral diverticula. The complications in the 5 patients were successfully addressed with secondary repair, and all patients achieved satisfactory cosmetic and urethral functional results. CONCLUSION The modified Koyanagi technique simplified the operation and better preserved the blood supply to the flap. The additional coverage of the neourethra using a pedicled flap of the tunica vaginalis or scrotal dartos significantly decreased the rate of fistula formation. This technique is highly suitable for the one-stage repair of severe hypospadias with penoscrotal transposition.
Collapse
|
8
|
Abstract
Hypospadias is a challenging field of urogenital reconstructive surgery with different techniques being currently used. Modern surgery claims that it is possible to create a functionally and cosmetically normal penis. Continuous re-evaluation and assessment of outcome may have a major impact on future clinical practice. Assessment of outcome includes: complication rate, cosmetic appearance of the penis, functional outcome (micturition, sexuality), and psychological factors such as quality of life and psychosexual life. This article briefly reviews current strategies of outcome assessment. Somehow in the future, we will be able to give an accurate estimation of the long-term consequences of being born with hypospadias.
Collapse
Affiliation(s)
- Alexander Springer
- Department of Pediatric Surgery, Medical University of Vienna , Vienna , Austria
| |
Collapse
|