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Abdullateef KS, Elbarbary M, Kaddah S, Elezaby BM, Ragab AS, Mohamed W. Modified versus Classical Tubularised Incised Plate Urethroplasty in Hypospadias: A Comparative Study. Afr J Paediatr Surg 2024; 21:111-116. [PMID: 38546249 PMCID: PMC11003566 DOI: 10.4103/ajps.ajps_107_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/03/2022] [Accepted: 01/02/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Hypospadias is a wide-world congenital malformation that accounts for 1 of 300 live male births. Many procedures were considered for its management. As the tubularised incised plate (TIP) urethroplasty, the most prevalent technique, caused many complications, several modifications were applied to the original operation to improve the outcomes and alleviate complications. The aim of this study was to compare the outcome of the ordinary TIP urethroplasty with the technique modified without dissection of the glans penis. MATERIALS AND METHODS A total of 82 patients with a mean age of 18.8 (±14.8) months, were randomly assigned to undergo TIP with either complete glans wings mobilisation (Group A, n = 42 patients) or without glans dissection (Group B, n = 40 patients). To evaluate the effect of modified TIP urethroplasty without glanular dissection for treatment of distal hypospadias in contrast to classical TIP repair. RESULTS Both techniques showed similar outcomes regarding functional repair, with good to excellent results between 88% and 90% after 6 months of follow-up. Most confronted post-operative complications were wound infection, oedema, urethrocutaneous fistulas and meatal stenosis. Less frequently haematoma, post-operative bleeding and glans dehiscence were encountered. The differences in complication rates between the two studied groups were statistically insignificant except for oedema (P = 0.04), and need for urethral dilatation (P = 0.002) that were more prevalent among patients who were treated with classic TIP repair with complete glans wings mobilisation. CONCLUSION From our point of view, it seems that TIP without glanular dissection technique does not outweigh TIP with complete glans wings mobilisation regarding functional outcomes and post-operative complications.
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Affiliation(s)
- Khaled S. Abdullateef
- Department of Pediatric Surgery, Cairo University Children Specialized Hospital, Cairo, Egypt
| | - Mohamed Elbarbary
- Department of Pediatric Surgery, Cairo University Children Specialized Hospital, Cairo, Egypt
| | - Sherif Kaddah
- Department of Pediatric Surgery, Cairo University Children Specialized Hospital, Cairo, Egypt
| | - Belal Mosaad Elezaby
- Department of Pediatric Surgery, Cairo University Children Specialized Hospital, Cairo, Egypt
| | - Ahmed S. Ragab
- Department of Pediatric Surgery, Port Said University, Port Fuad, Egypt
| | - Wesam Mohamed
- Department of Pediatric Surgery, Cairo University Children Specialized Hospital, Cairo, Egypt
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Ramaswamy R, Hegab SM, Fawsy H, Ghalib SS, Shawky M, Mukattash G. Hypospadias with Intact Prepuce: A Spectrum of Anomalies and their Reconstruction. J Indian Assoc Pediatr Surg 2024; 29:129-136. [PMID: 38616827 PMCID: PMC11014174 DOI: 10.4103/jiaps.jiaps_172_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/12/2023] [Accepted: 11/28/2023] [Indexed: 04/16/2024] Open
Abstract
Aims The aim of the study was to perform a detailed analysis of the clinical characteristics of megameatus with intact prepuce (MIP) and to audit our results of reconstructive surgeries on MIP. Materials and Methods Design: Retrospective analysis. Setting: Pediatric surgery department of tertiary level. Subjects, methods: Hospital records and pictures of MIP operated over a 9-year period. Age, size of penis, circumcised or not, shape of glans, external urethral meatus (EUM), urethral plate (UP), chordee, distal urethra, reconstructive surgery, and complications were analyzed. Postoperative result was objectively assessed by Hypospadias Objective Scoring Evaluation (HOSE). Results Twelve of 254 hypospadias were MIP (incidence = 4.72%). The mean age at operation was 38.25 months (12-87 m). Patients sought circumcision or surgical correction of anomaly. Two patients were precircumcised. MIP was coronal 7, subcoronal 3, and glanular 2. Meatus was wide in 10 and normal in 2. Glans penis was wide in 9 and conical in 3. UP was wide (9), moderately wide (2), or narrow and shallow (1). In two cases of wide deep UP, distal septum was present. Distal urethra was nondilated in all but 1, which had megalourethra. Reconstructive surgery was Tubularized Urethral Plate Urethroplasty (7 cases) or classical Snodgrass (Tubularised incised plate urethroplasty (TIPU), with superimposed vascular dartos flap (5 cases). The megalourethra underwent partial excision and TIPU. Distal UP-septum was incised. Urethral injury (2 cases) and UP injury (1 case) were intraoperative complications. One postoperative complication (ventral glans necrosis) resulted. The mean follow-up period was 4.79 months (1-12 m). In the postoperative follow-up, 11 (92%) had HOSE score 14-16, whereas one had HOSE 13. Conclusion Some hypospadias cases which have intact prepuce have no megameatus; hence, they cannot be termed MIP. All cases of hypospadias having intact prepuce can be covered by the umbrella term "Hypospadias with Intact Prepuce (HIP);" MIP is a large subgroup under HIP. HIP presents with a spectrum of anomalies of glans, EUM, and UP. Repair by tubularization of UP without or with midline incision gives excellent results.
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Affiliation(s)
- Rajendran Ramaswamy
- Department of Pediatric Surgery, Maternity and Children’s Hospital (Under Ministry of Health), Najran, Saudi Arabia
| | - Samir Morsi Hegab
- Department of Pediatric Surgery, Maternity and Children’s Hospital (Under Ministry of Health), Najran, Saudi Arabia
| | - Hany Fawsy
- Department of Pediatric Surgery, Maternity and Children’s Hospital (Under Ministry of Health), Najran, Saudi Arabia
| | - Saif Saeed Ghalib
- Department of Pediatric Surgery, Maternity and Children’s Hospital (Under Ministry of Health), Najran, Saudi Arabia
| | - Mohamed Shawky
- Department of Pediatric Surgery, Maternity and Children’s Hospital (Under Ministry of Health), Najran, Saudi Arabia
| | - Ghazi Mukattash
- Department of Pediatric Surgery, Maternity and Children’s Hospital (Under Ministry of Health), Najran, Saudi Arabia
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Herzberg H, Ben-David R, Mendelson T, Dubi-Sobol A, Bashi T, Savin Z, Ben-Chaim J, Bar-Yosef Y. Megameatus intact prepuce variant reconstruction: Long-term outcomes and comparison to post-circumcision hypospadias repair. J Pediatr Urol 2024; 20:38.e1-38.e6. [PMID: 37891026 DOI: 10.1016/j.jpurol.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/17/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Megameatus intact prepuce (MIP) variant is considered a surgical challenge with associated high complication rates. It is usually diagnosed and corrected only after neonatal circumcision, which is discouraged in non-MIP hypospadias. OBJECTIVE In order to determine whether the features of the MIP variant or the performance of a secondary reconstruction following circumcision comprise the cause of higher complication rates, we now compared the results of post-circumcision MIP hypospadias repair to the results of children who underwent repair of non-MIP hypospadias following neonatal circumcision. STUDY DESIGN Reoperation rates of children operated for hypospadias repair following neonatal circumcision between 1999 and 2020 were compared between those with MIP and those with classic non-MIP hypospadias. RESULTS In total, 139 patients who had undergone neonatal circumcision underwent surgical reconstruction at a mean age of 13 months. Sixty-nine had classic hypospadias and 70 had the MIP variant. The median follow-up was 10 years (interquartile range 6,13). The classic group had a higher rate of meatal location below the corona compared to the MIP variant group (53 % vs. 28 %, respectively, p = 0.002). The reoperation rate was comparable for the two groups (32 % vs. 27 %, p = 0.58, Table). Univariate analysis for the MIP hypospadias group showed no association between reoperation and the initial patient characteristics, while a higher probability of reoperation was demonstrated in the presence of ventral curvature (odds ratio 3.5, p = 0.02), and a higher grade of hypospadias (odds ratio 3.3, p = 0.03 for meatal location lower than the coronal sulcus) in the non-MIP group. DISCUSSION The limitations of our work include its retrospective design wherein the patients' characteristics, including classification as MIP vs. non-MIP, are derived from medical records. More patients in the non-MIP group were documented to have penile curvature. The non-MIP group was composed of more patients with meatal location under the coronal sulcus, a factor which may increase the rates for reoperation in that group. Still, with the comparison of the largest reported cohort of circumcised MIP with circumcised non-MIP patients together with an extended follow-up period, we believe that we present strong evidence of the possible role of previous circumcision in the surgical challenge of reconstructing MIP hypospadias. CONCLUSIONS Reoperation rates in MIP hypospadias are high but similar to those of classic hypospadias, both following circumcision, suggesting that circumcision, rather than the unique features of the variant, is the cause for complications.
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Affiliation(s)
- Haim Herzberg
- Department of Urology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Reuben Ben-David
- Department of Urology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tomer Mendelson
- Department of Urology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Adit Dubi-Sobol
- Department of Urology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tomer Bashi
- Department of Urology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ziv Savin
- Department of Urology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacob Ben-Chaim
- Department of Urology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yuval Bar-Yosef
- Department of Urology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Zu J, Chen Y, Liu Y, He T, Wang Y, Zu Y, Peng X. Neomodified Koyanagi technique for severe hypospadias with one-stage sealed Y-shaped penis foreskin vascular protection surgery. Clin Case Rep 2022; 10:e05575. [PMID: 35340636 PMCID: PMC8929279 DOI: 10.1002/ccr3.5575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 11/06/2022] Open
Abstract
Proximal hypospadias defects represent the most challenging aspect of maintaining blood supply to the flap, which eventually leads to a high rate of complications. We modified a sealed Y-shaped penis foreskin vascular protection technique, which can repair the urethra in a single stage. The inner plate of the foreskin was cut along the coronal sulcus, and both sides of the urethral plate were cut as deep as Buck's fascia. The "Y"-shaped foreskin flaps on both sides of the mouth that are continuous with the urethral plate were sutured to form a new urethral skin tube. The urethral skin tube was turned to the ventral side, and the foreskin was reshaped and sutured. A total of 89 children had their urinary catheters removed 4 weeks after the operation. All children were evaluated at least once a year for 3 consecutive years. There were 11 patients with urine leakage that occurred after the operation. These children, diagnosed with urine leakage, underwent successful repair after the leakage occurred. There were no urethral strictures after the operation. The one-time success rate of this operation was 87.6% (78/89), and the incidence of urethral fistula was 12.6% (11/89). The results showed that sealed Y-shaped penis foreskin vascular protection surgery was safer and had a higher operation rate than the traditional hypospadias repair technique. Modifying Koyanagi repair by our improved Koyanagi hypospadias repair is an excellent technique with relatively low complication rates.
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Affiliation(s)
| | - Yifu Chen
- Hunan Children's Hospital Changsha City China
| | - Yu Liu
- Hunan Children's Hospital Changsha City China
| | - Tianqu He
- Hunan Children's Hospital Changsha City China
| | - Yanling Wang
- Changsha Hospital for Maternal and Child Health Care of Hunan Normal University Changsha City China
| | - Yuee Zu
- Changsha Hospital for Maternal and Child Health Care of Hunan Normal University Changsha City China
| | - Xiangwen Peng
- Changsha Hospital for Maternal and Child Health Care of Hunan Normal University Changsha City China
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Ben-David R, Kupershmidt A, Dekalo S, Herzberg H, Mano R, Dubi-Sobol A, Ben-Chaim J, Bar-Yosef Y. Dorsal penile curvature and megameatus intact prepuce hypospadias: A common association in a rare variant of hypospadias. J Pediatr Urol 2021; 17:517.e1-517.e4. [PMID: 33947636 DOI: 10.1016/j.jpurol.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Megameatus intact prepuce (MIP) is a rare variant of hypospadias. Unlike the hooded ventrally absent prepuce in non-MIP hypospadias, the prepuce in MIP hypospadias is fully circumferential and intact. The distal urethra remains wide with a deep glanular groove. While ventral curvature is a common finding in non-MIP hypospadias, neither ventral nor dorsal penile curvature has been reported in MIP hypospadias. OBJECTIVE To assess the association of the MIP hypospadias variant with penile curvature. STUDY DESIGN We retrospectively reviewed the medical records of all children who underwent hypospadias repair and identified those who were documented as having the MIP variant of hypospadias and operated in our center from January 1998 to June 2020. The patients were considered as having MIP hypospadias if no hypospadias had been evident before circumcision, if a circumferential circumcision scar was present (instead of the inverted V-shaped scar in the ventral aspect of the penis following circumcision of the hooded prepuce associated with non-MIP hypospadias), and if there was a wide meatus. Penile curvature was diagnosed intraoperatively by an artificial erection test that uses saline solution for injection. Patients were considered surgical candidates if the degree of curvature was equal to or greater than 30°. RESULTS The study cohort consisted of 118 male children who were identified as having the MIP hypospadias variant according to the inclusion criteria. The median age at repair was 1.1 years (interquartile range 8 months to 1.6 years). Penile curvature was found in 29 children (24%), of whom 23 had dorsal curvatures (19%) and 6 had ventral curvatures (5%). DISCUSSION MIP hypospadias is associated with penile curvature, and more frequently with dorsal than ventral curvature. This study is retrospective and does now identify specific features of MIP associated with penile curvature. We encourage pediatric urologists to perform an artificial erection test intraoperatively in children with the MIP variant and repair associated curvatures. CONCLUSIONS A dorsal curvature was found in 19% of patients with a MIP variant of hypospadias, and most of them (86%) required ventral plication due to the severity of the curvature.
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Affiliation(s)
- Reuben Ben-David
- Pediatric Urology, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Aviv Kupershmidt
- Pediatric Urology, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Snir Dekalo
- Pediatric Urology, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Haim Herzberg
- Pediatric Urology, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Roy Mano
- Pediatric Urology, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Adit Dubi-Sobol
- Pediatric Urology, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Jacob Ben-Chaim
- Pediatric Urology, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Yuval Bar-Yosef
- Pediatric Urology, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel.
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Ekberli G, Ateş U, Sözduyar S, Gurbanov A, Göllü G, Koloğlu M, Yağmurlu A, Dindar H, Çakmak A. Megameatus intact prepuce and associated anomalies. Journal of Contemporary Medicine 2020; 10:1-5. [DOI: 10.16899/jcm.705034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Duan SX, Li J, Jiang X, Zhang X, Ou W, Fu M, Chen K, Zheng L, Ma SH. Diagnosis and Treatment of Hypospadias With Megameatus Intact Prepuce. Front Pediatr 2020; 8:128. [PMID: 32296666 PMCID: PMC7136419 DOI: 10.3389/fped.2020.00128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/09/2020] [Indexed: 02/05/2023] Open
Abstract
Purpose: To evaluate the diagnosis and treatment methods of hypospadias with megameatus intact prepuce (MIP). Materials and Methods: A retrospective analysis was performed in 27 MIP children, 13 of whom underwent tubularized incised plate urethroplasty (TIP procedure), 7 underwent the Duplay procedure, 5 underwent the Mathieu procedure, 1 underwent meatal advancement and glanuloplasty (MAGPI procedure), and 1 underwent the glans approximation procedure (GAP). The patients were followed for 6-36 months to evaluate the surgical outcomes by the Pediatric Penile Perception Score (PPPS). Results: A total of 27 patients with a mean age of 8.12 ± 3.0 years were enrolled in this study, and 25 cases (25/27, 92.6%) were accidentally discovered during the first visit for phimosis. The patients had a formed urethra of 0.5 to 1.5 cm. Complications occurred in 4 of the 27 patients (14.81%): 2 patients with urethral fistula and 2 patients with meatal stenosis. One patient had a case of self-healed urethral fistula, and the remaining 3 patients underwent reoperation. The post-operative effect was satisfactory in all patients, and the urinary flow and stream during urination were normal. The overall average PPPS score of non-operative surgeons and parents was satisfactory. There were no significant differences in meatus appearance, glans appearance, skin appearance, and general appearance PPPS score among the Mathieu, TIP, and Duplay surgical procedures. Conclusions: MIP clinical manifestations are concealed and usually noted when circumcision is attempted. The suitable procedure for each patient should be tailored according to the anatomic features, and several techniques can be used with good functional and cosmetic results.
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Affiliation(s)
- Shou Xing Duan
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jianhong Li
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xuewu Jiang
- Department of Pediatric Surgery, Shenzhen Pingshan District Woman's and Children's Hospital, Southern Medical University, Shenzhen, China
| | - Xuan Zhang
- Department of Pediatric Surgery, Shenzhen Pingshan District Woman's and Children's Hospital, Southern Medical University, Shenzhen, China
| | - Wenhui Ou
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Maxian Fu
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Kaihong Chen
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Lian Zheng
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- *Correspondence: Lian Zheng
| | - Shu Hua Ma
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Shu Hua Ma
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Cortellazzo Wiel L, Pederiva F, Castagnetti M, Barbi E, Pennesi M. Boy with fish-mouth meatus. Arch Dis Child 2019; 104:940. [PMID: 29903890 DOI: 10.1136/archdischild-2018-315360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2018] [Indexed: 11/04/2022]
Affiliation(s)
| | - Federica Pederiva
- Department of Pediatric Surgery, Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Marco Castagnetti
- Section for Pediatric Urology, University Hospital of Padua, Padua, Italy
| | - Egidio Barbi
- University of Trieste, Trieste, Italy.,Department of Pediatrics, Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Marco Pennesi
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
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Abstract
OBJECTIVE The megameatus variant of anterior hypospadias with an intact complete foreskin occurs in approximately 1%-3% of hypospadias. Hence, the objective of the study was to evaluate the results of tubularized urethral plate urethroplasty (TUPU) in megameatus intact prepuce (MIP). MATERIALS AND METHODS A retrospective study (June 1996-June 2015) of MIP from our hypospadias registry was conducted. All patients with megameatus, either with an intact prepuce or with one previously removed, were included in the study. Case sheets of clinical records, investigations, clinical photographs, and videos were reviewed. Patients were classified into, glanular, coronal, subcoronal, and distal penile. TUPU were done. Patients were called for follow-up at 1, 3, 6, and 12 months postoperatively, and then yearly for the assessment of the cosmetic appearance and fistula, meatal stenosis, or other complications. RESULTS Of 1026 patients with hypospadias, we identified 13 cases of megameatus variant of hypospadias; three of the 13 had been circumcized previously. Glanular approximation was done for the one patients of the glanular variant, and another had frenuloplasty. These two patients were excluded from the study. Incision in the inner preputial skin was closed in 10 patients to have an intact prepuce. Follow-up period varied from 6 months to 4 years (median follow-up 2½ years). None of the patients developed complications such as fistula, meatal stenosis, and/or wound dehiscence. CONCLUSIONS Surgical correction of MIP in the era of increased cosmetic awareness is justified. Excellent results are obtained with TUPU and along with spongioplasty and frenuloplasty because of availability of wide urethral plate and well-developed spongiosum in these patients. TUPU should be the preferred procedure in cases of MIP.
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Affiliation(s)
- Amilal Bhat
- Department of Urology, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
| | - Mahakshit Bhat
- Department of Surgery, M.G. Medical College, Jaipur, Rajasthan, India
| | - Akshita Bhat
- Department of Surgery, S.P. Medical College, Bikaner, Rajasthan, India
| | - Vikash Singh
- Department of Urology, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
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Abstract
AIM AND OBJECTIVE To evaluate the effect of penile block vs caudal epidural on the quality of analgesia and surgical outcome following hypospadias repair. BACKGROUND Intraoperative penile engorgement because of caudal epidural may result in tension on surgical sutures and alter surgical outcome. METHODS Fifty-four ASA I and II children were randomly allocated to group P (penile block, 0.25% bupivacaine, 0.5 mg·kg(-1) ; n = 27) and group C (caudal epidural, 0.25% bupivacaine, 0.5 ml·kg(-1) ; n = 27), respectively. Quality of analgesia was assessed by visual analog scale (VAS) score recorded at 0, 0.5, 3, 6, 12, 24 h, and once a day for the next 4 days. Duration of analgesia was calculated from the institution of block to the first analgesic demand by child or VAS > 5. Total morphine consumption in the first 48 h and oral paracetamol consumption till 5th day were recorded. Children were regularly followed up in their respective outpatient clinic for early or late complications. RESULTS In group P, lower mean VAS scores were seen from 0.5 h after surgery till day 3 and analgesia lasted for significantly longer duration (82 min) when compared with caudal epidural, P < 0.001. Incidence of urethral fistula formation after primary hypospadias repair was 19.2%, and all had received caudal epidural. An increase of 27% in penile volume from baseline value was observed 10 min after caudal epidural placement, P < 0.05. CONCLUSION Penile block provided better analgesia when compared with caudal epidural in children undergoing primary hypospadias repair. Postoperative urethral fistula formation was more likely in children who received caudal epidural.
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Affiliation(s)
- Pankaj Kundra
- Department of Anaesthesiology & Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
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Abstract
Purpose Complications in hypospadias surgery are higher than other reconstructive procedures. The incidence of complications can be reduced if proper preventive measures are taken. The review aims to highlight incidences, causes, and preventive measures of acute complications of hypospadias repair. Materials and Methods Literature reports were reviewed in Pubmed by giving the key word acute complications of hypospadias repair, wound infection, wound dehiscence, flap necrosis, edema, penile torsion, urethral fistula, bleeding and hematoma and urethral stents problems. Summaries of all articles were reviewed with full text of relevant article and results were analyzed. Results Besides mentioning the complications of hypospadias repair in individual articles on the subject, we did not come across any separate article on this subject in the published English literature. Fistula is the commonest complication followed by edema and penile torsion. Conclusions Most acute complications can be prevented with adherence to principles of plastic and microsurgery, meticulous preoperative planning, and judicious postoperative care. Deviation from these principles may lead to disaster and even failure of the repair. The aim in hypospadias surgery should be following these principles and bring down the complication rates < 5% in distal hypospadias and < 10% in proximal hypospadias.
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Elbatarny AM, Shehata SM, Ismail KA. Megameatus intact prepuce variety of hypospadias: tips for repair using the modified glanular approximation procedure. Annals of Pediatric Surgery 2011; 7:82-7. [DOI: 10.1097/01.xps.0000398026.62997.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Bar-Yosef Y, Binyamini J, Mullerad M, Matzkin H, Ben-Chaim J. Megameatus intact prepuce hypospadias variant: application of tubularized incised plate urethroplasty. Urology 2005; 66:861-4; discussion 864. [PMID: 16230154 DOI: 10.1016/j.urology.2005.04.070] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Revised: 03/14/2005] [Accepted: 04/14/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The characteristics of the megameatus intact prepuce (MIP) hypospadias variant present a unique challenge to surgeons. Dissatisfaction with the results of conventional repair methods led to the emergence of several alternative surgical approaches, including the glanular approximation (GAP) and pyramid procedures. The application of tubularized, incised plate (TIP) urethroplasty has not been documented in this setting. METHODS Twenty-four patients (mean age 18.5 months, range 6 to 60) presented with MIP. They had all been circumcised. The meatus was glanular in 6, coronal in 15, and distal shaft in 3 patients. Glanular MIP was repaired by meatal advancement and glanuloplasty (n = 2) or the GAP technique (n = 4). Coronal MIP was repaired by the GAP (n = 7) or TIP urethroplasty (n = 8), and distal shaft MIP was repaired by TIP urethroplasty (n = 3). Stents or catheters were used only with TIP urethroplasty. The mean follow-up period was 40 months (range 8 to 80). RESULTS Satisfactory cosmetic and functional results were achieved in 20 patients (83%). The other 4 patients included 1 patient who underwent GAP and meatoplasty and 3 of the 11 patients who underwent TIP urethroplasty, of whom 2 underwent meatoplasty and 1 simple local repair of a urethrocutaneous fistula without the need for urethral reconstruction. CONCLUSIONS The success rates for all selected techniques were satisfactory. TIP urethroplasty can be successfully used in the more severe, proximal forms of MIP.
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Affiliation(s)
- Yuval Bar-Yosef
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Abstract
After more than 100 years of innovation in hypospadias repair, new concepts regarding penile curvature, the urethral plate, and the means for urethroplasty are changing surgical practices. With the introduction of the tubularized incised plate technique it is possible to simplify decision-making algorithms in hypospadias surgery, while achieving good functional and cosmetic results.
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Affiliation(s)
- W Snodgrass
- Pediatric Urology Section, Children's Medical Center, Dallas, TX 75235, USA.
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