546 AN ALTERNATIVE FOR VENTRAL LENGTHENING IN CHILDREN WITH SEVERE PENILE CURVATURE THAT ALLOWS GRAFT COVERAGE DURING STAGED HYPOSPADIAS REPAIR

Abstract

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Lower Urinary Tract & Genitalia1 Apr 2011546 AN ALTERNATIVE FOR VENTRAL LENGTHENING IN CHILDREN WITH SEVERE PENILE CURVATURE THAT ALLOWS GRAFT COVERAGE DURING STAGED HYPOSPADIAS REPAIR Bruno Leslie, Bryce Weber, Rodrigo Romao, Walid Farhat, Darius Bagli, Armando Lorenzo, and Joao Pippi Salle Bruno LeslieBruno Leslie toronto, Canada More articles by this author , Bryce WeberBryce Weber toronto, Canada More articles by this author , Rodrigo RomaoRodrigo Romao toronto, Canada More articles by this author , Walid FarhatWalid Farhat toronto, Canada More articles by this author , Darius BagliDarius Bagli toronto, Canada More articles by this author , Armando LorenzoArmando Lorenzo toronto, Canada More articles by this author , and Joao Pippi SalleJoao Pippi Salle toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1271AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Staged repair using preputial grafts has become a popular option for proximal hypospadias with severe curvature. Corporal ventral lengthening (CVL) with autologous, xenogenic or synthetic grafts are often employed, however the initial lack of vascular supply precludes simultaneous superposition of free grafts during first stage urethroplasty. Herein we report preliminary results of a surgical strategy aiming to overcome this limitation, allowing concurrent CVL and preputial grafting for urethroplasty. METHODS The medical records of patients who underwent staged preputial graft urethroplasty (SPGU) for primary repair of perineal or penoscrotal hypospadias with severe curvature were retrospectively reviewed. All patients received pre operative testosterone. The decision to divide the urethral plate was made after complete degloving and urethral mobilization. Multiple deep ventral transverse incisions of the tunica albuginea from 3 to 9 o'clock position were performed in patients with persistent intrinsic curvature after plate transection. An inner preputial graft was then harvested and quilted directly over the incised albuginea, and a tie-over dressing applied. Second stage was done approximately 6 months later, when the graft was tubularized and covered with tunica vaginalis or dartos flap. Prior to tubularization an erection test was repeated and residual curvature addressed with dorsal plication (DP), if necessary. Age, outcomes, need for DP and complications were recorded. RESULTS 30 patients completed the two stages from 2006 to 2010. Mean age at first stage was 18 months (range 10m–11y) and mean interval between stages was 8 months (range 6–11). Mean follow up after the second stage was 16 months (range 6–36). All grafts took well and were suitable for tubularization. DP was required for minor residual ventral curvature in 14/30 (47%) patients. Relevant complications included a long urethral stricture secondary to balanitis xerotica obliterans (1), ventral skin contracture (1), small urethrocutaneous fistulas (2), glans dehiscence (2) and recurrence of mild curvature (2). The remaining 22 cases have no ventral curvature and early excellent cosmetic results, with a slitlike meatus placed in the glans. CONCLUSIONS Our results suggest that the use of deep ventral transverse corporeal incisions for correction of severe curvature allows SPGU and concurrent CVL. The early cosmetic and functional results with this approach are satisfactory with an acceptable complication rate. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e221-e222 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bruno Leslie toronto, Canada More articles by this author Bryce Weber toronto, Canada More articles by this author Rodrigo Romao toronto, Canada More articles by this author Walid Farhat toronto, Canada More articles by this author Darius Bagli toronto, Canada More articles by this author Armando Lorenzo toronto, Canada More articles by this author Joao Pippi Salle toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...