Abstract
Objectives: The objective of the study is to investigate the feasibility and efficacy of urethroplasty with a Buck's fascia integral-covering technique (BFIC) to wrap and restore the normal anatomical structure of the penis in one-stage hypospadias surgery.Methods: One-stage surgeries for hypospadias management were performed using BFIC from January 2016 to September 2020 at four high-volume medical centers in China. The technique integrates Buck's fascia with glans wings to mobilize and wrap the urethra and restore penile anatomical relationships. The clinical data, postoperative follow-up data, and complications were recorded, and the results were analyzed.Results: A total of 1,386 patients were included in the study: 1,260 cases of primary hypospadias and 126 cases of re-operations; distal in 382 cases (27.6%), mid-shaft in 639 (46.1%), proximal in 365 (26.3%); tubularized incised plate (TIP) in 748 cases, inlay-graft in 124, onlay-graft in 49, Mathieu in 28, free-tube graft urethroplasty in 406, and 31 of hybrid procedures. One thousand one hundred forty-two patients (82.4%) were found to have penile curvature (>10°) after artificial erection and all corrected by dorsal plication/s or transection of the urethra plate (UP) simultaneously. The median followed-up time was 27 months (6–62). A total of 143 (10.3%) complications were recorded: 114 (9.0%) in the primary operations and 29 (23%) in the re-operations, 15 (3.9%) in distal hypospadias, 61 (9.5%) in mid-shaft, and 67 (18.4%) in proximal. The complication rate in UP preservation and transection was 10.1 and 10.8%, respectively. Of all case complications, there were 73 (5.2%) of fistula, 10 (0.6%) of dehiscence, 22 (1.6%) of meatal stenosis, 21 (1.5%) of stricture, 6 (0.7%) of diverticulum, and resident curvature in 11 cases (1.2%). The overall complication rate in TIP and free-tube procedure was 9.8 and 9.9%, respectively, and fistula occurred in primary TIP of 33 cases (4.9%).Conclusions: Buck's fascia with the glans can be used as an integral covering technique in one-stage distal to proximal hypospadias and primary or re-operative hypospadias repair. It is safe, feasible, and effective for the repair of hypospadias.
Highlights
A survey of 27 European countries showed that the prevalence of hypospadias was 20.9 per 10,000 births and that the trend was increasing [1]
This was a retrospective analysis of clinical data from patients who underwent hypospadias repair with a Buck’s fascia integralcovering (BFIC) technique from January 2016 to September 2020 at four high-volume medical centers in China—including the Anhui Provincial Children’s Hospital (AHCH), the Beijing Children’s Hospital (BJCH), the Sichuan Provincial People’s Hospital (SCPH), and the Xiamen Maternal and Children’s Health Hospital (XMCH)
In the primary/re-operative operations, 675/73 were done by Tubularized incised plate (TIP), 109/15 by inlay-graft, 39/10 by onlay-graft, 23/5 by Mathieu, 384/22 by free-tube graft, and 30/1 by other hybrid procedures
Summary
A survey of 27 European countries showed that the prevalence of hypospadias was 20.9 per 10,000 births and that the trend was increasing [1]. Some studies have indicated a complication rate of ∼10% for distal and over 50% for proximal hypospadias repairs [2]. Many techniques have been described, and no single, best method of urethroplasty has been clearly identified [3], investigators recently reported that beneficial modifications to hypospadias surgery could improve operative results [4, 5]. Since 2016, there have been attempts to apply Buck’s fascia (BF) and the glans as integral covering tissues, providing an intermediate layer to cover the neo-urethra in TIP and similar procedures in China. Differing results have been obtained in some centers, and the overall results showed that the effect was better than that of simple pedicled dartos fascia (DF). We report the preliminary results from four large hypospadias treatment centers in China
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