377 MANAGEMENT OF HYPOSPADIAS CRIPPLES WITH TWO-STAGED BRACKA TECHNIQUE: FUNCTIONAL RESULTS IN THE LONG-TERM FOLLOW-UP

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery (III)1 Apr 2013377 MANAGEMENT OF HYPOSPADIAS CRIPPLES WITH TWO-STAGED BRACKA TECHNIQUE: FUNCTIONAL RESULTS IN THE LONG-TERM FOLLOW-UP Silke Riechardt, Roland Dahlem, and Margit Fisch Silke RiechardtSilke Riechardt Hamburg, Germany More articles by this author , Roland DahlemRoland Dahlem Hamburg, Germany More articles by this author , and Margit FischMargit Fisch Hamburg, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1765AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In patients called ‘hypospadias cripples' because of recurrent urethral strictures, deviation or fistulas after several interventions the functional outcome of reconstructions is seldom reported. The two-staged buccal mucosa urethroplasty remains an option for these patients. We present a large series with long-term functional follow-up. METHODS Between 2002 and 2011 a two-staged buccal mucosa urethroplasty was performd in 49 patients (age 5-69 years, mean 36, median 27). Most of the patients had initially penile (47%) or penoscrotal (26.5%) hypospadias, two had perineal hypospadias and 6 had additional BXO. They had 1 to 30 previous surgeries (mean 4.6). Most of the patients came for reconstruction because of strictures (89.8%). Additionally we found serious deviation (46.9%), fistulas (14.3%), recurrent urinary tract infections (26%), hair in the urethra (16%) and one urethral stone. For long-term follow-up patients were contacted by questionnaire. 38 (77.5%) answered, mean follow-up is 36 months (4-100 months), median is 46 months. RESULTS After the first 6 months postoperatively recurrent stenosis was observed in 5 patients (10 %), from whom 3 were treated conservatively, 2 patients got a meatotomy. In the long term follow-up no further complications occurred. According to the questionnaire 63% of the patients void with a good or excellent urinary stream, 95% without any residual urine. 18 (47%) patients suffer of postvoiding dribbling. 11 patients (28.9%) reported problems with the donor side, mainly numbness, only 3 (8%) patients needed reconstruction because of scars. 33 (87%) patients reported no or only slight change of the erectile function. Slight or no deviation postoperatively is seen in 36 (95%) patients, slight or no shortening of the penis in 35 (92%) patients. 26 (68%) patients had no change of ejaculation, the changes which are reported had been mainly less volume or less pressure. Only two patients (5%) had a serious change of their erectile function. 30 (79%) patients were satisfied or very satisfied with the outcome. CONCLUSIONS The two-staged buccal mucosa urethroplasty is a good option in hypospadias cripples. A good functional outcome can be achieved with no further complications in the long-term follow-up and satisfaction rates of nearly 80%. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e153 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Silke Riechardt Hamburg, Germany More articles by this author Roland Dahlem Hamburg, Germany More articles by this author Margit Fisch Hamburg, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...