Abstract
Aims and Objective: To develop a better operation for hypospadias patients with poor and bad quality urethral plate and damaged urethral plate as in hypospadias cripples. Materials and Methods: I operated 21 cases of hypospadias with Appendicular mucosal tube implant with Dartos wrap operation from 17/04/2017 to 03/03/2019, in Jawale Institute of pediatric Surgery, and that group was labeled as group A. 27 cases of hypospadias were operated in same time span with conventional techniques such as extended Snodgrass operation and Byar’s two-stage operation (group B), kept as control. 7 patients (33.33%) were cases of hypospadias cripples with multiple surgeries done in the past. 4 patients (9.52%) patients had congenital short urethra. Remaining 10 patients (50%) were fresh cases with no operation done in past but with bad and fibrotic urethral plate. The longest follow up was 3 years and the shortest of 1 year. Technique of Operation: Appendicectomy performed by open technique and the serosa of Appendix cut longitudinally and stripped off the mucosal tube. The proximal hypospadias opening sutured with the appendicular mucosal tube with 6 sutures of 5-0 Vicryl. Dartos fascia is raised from the scrotum wrapped over the tube and 8 - 10 interrupted stitches taken with 5-0 Vicryl. Glanuloplasty performed over it. Suprapubic diversion did and kept for 3 weeks postoperatively. Results: In group A, 3 patients developed fistula and only 1 (4.76%) required repair at the end of 6 weeks. 2 (9.52%) patients developed grade 3 infection and settled with conservative treatment. UFR was normal at the end of 12 weeks (12.85 Ml/sec. In group B, 11 patients developed fistula and 9 (33.33%) required repaired. 9 (33.33%) patients developed strictures and all of them required multiple urethral dilatation under GA. 7 (25.92%) patients developed meatal stenosis.UFR was badly reduced with average of 5.78 ML/Sec. Conclusion: The operation proves to be a much better option compared to the conventional for group A patients. We need a series with longer follow up and larger number of patients.
Highlights
The incidence of hypospadias [1] is generally 1 in 200 live births
Materials and Methods: I operated 21 cases of hypospadias with Appendicular mucosal tube implant with Dartos wrap operation from 17/04/2017 to 03/03/2019, in Jawale Institute of pediatric Surgery, and that group was labeled as group A. 27 cases of hypospadias were operated in same time span with conventional techniques such as extended Snodgrass operation and Byar’s two-stage operation, kept as control. 7 patients (33.33%) were cases of hypospadias cripples with multiple surgeries done in the past. 4 patients (9.52%) patients had congenital short urethra
The proximal hypospadias opening sutured with the appendicular mucosal tube with 6 sutures of 5-0 Vicryl
Summary
The incidence of hypospadias [1] is generally 1 in 200 live births. There are a variety of operations described for hypospadias. There are a good number of cases done by less qualified doctors with multiples surgeries done which destroy the urethral plate, known as hypospadias cripples. Such patients have poor results with the conventional operations. The conventional operations described in medical literature for above type of patients are Byar’s two staged urethroplasty, extended Snodgrass operation, Buccal mucosa urethroplasty, bladder mucosa urethroplasty and Duckett’s transverse island operation. All these operations are technically demanding and have a very high complication rate. I am describing an operation here which is technically less demanding and has much lower complication rates than the above options
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