MP52-15 SURGICAL TREATMENT OF HYPOSPADIAS AFTER PUBERTY: CHALLENGES AND STRATEGIES

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II1 Apr 2016MP52-15 SURGICAL TREATMENT OF HYPOSPADIAS AFTER PUBERTY: CHALLENGES AND STRATEGIES Mujun Lu, Dachao Zheng, Haijun Yao, Dongdong Xiao, and Zhong Wang Mujun LuMujun Lu More articles by this author , Dachao ZhengDachao Zheng More articles by this author , Haijun YaoHaijun Yao More articles by this author , Dongdong XiaoDongdong Xiao More articles by this author , and Zhong WangZhong Wang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.491AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Primary hypospadias is recommended to receive surgery before two years old. But in China, a lot of patients had missed the best age at surgery due to economic condition. Compared to infants with hypospadias, the hypospadias after puberty have rarely been reported internationally, and have not yet unified diagnostic and treatment practices. This article summarizes the surgical treatment result of the hypospadias after puberty in our clinic and proposes the surgical algorithm and strategy for the hypospadias after puberty. METHODS The clinic profiles of 601 hypospadias patents from January 2000 to December 2012 were summarized, including 384 cases under 10 years old (before puberty, 63.9%) and 217 cases after puberty (36.1%). The age of patients after puberty ranged from 10 to 38 years old (mean: 22.39 ± 7.0). After penile curvature extension, the severity of hypospadias was determined by the site of meatus. Patients received penile curvature extension step by step until ventral curvature was corrected. The process of penile curvature extension includes degloving of penile skin, mobilizing and releasing the urethral plate, excision of the ventral urethral plate adjacent fiber, duplication of dorsal penile tunica albuginea and transection of urethral plate. There were 36 cases with distal hypospadias (16.44%), 56 with middle hypospadias (25.57%) and 127 with proximal hypospadias (57.99%), among which 68 were primary and 151 were redo cases. The surgical treatments consisted of tubularized incised urethral plate (TIP), various flaps and two-stage methods. The follow up duration ranged from 6 to 34 months. Post-operative complications included fistula, meatal stenosis, diverticulum, infection, dehiscence, necrosis et al. RESULTS In after puberty hypospadias cases, there were 16 cases receiving TIP and 20 cases receiving flaps for distal ones, with a total complication rate of 16.67% (6/36). As for middle hypospadias, 19 cases received TIP, 29 cases received flaps and 8 cases received two-stage method, with a total complication rate of 21.43% (12/56). In cases of proximal hypospadias, there were 19 TIP cases, 71 flaps cases and 37 twos-stage cases, with a total complication rate of 33.07% (42/127). CONCLUSIONS The step-wise ventral curvature extension can correct ventral curvature, which is the foundation of urethral reconstruction. Compared to hypospadias before puberty, the total post-operative complication rate of hypospadias after puberty is higher. For hypospadias after puberty, TIP and flaps are recommended for distal and middle types, while two-stage methods for proximal one. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e694 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Mujun Lu More articles by this author Dachao Zheng More articles by this author Haijun Yao More articles by this author Dongdong Xiao More articles by this author Zhong Wang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...