Abstract
ABSTRACTIntroduction To assess the feasibility of vacuum physiotherapy meant to decrease graft contraction and recurrent penile curvature (PC), hence successful tubularization and a straight penis in patients underwent two-stage buccal mucosa graft (BMG) urethroplasty, in proximal hypospadias repair.Material and methods Between January 2014 and July 2018, 59 two-stage BMG urethroplasties performed at our referral center, were included in the study. The parents were counseled to use the vacuum device between the two stages. An internal, self-administered, semiquantitative, non-validated questionnaire was designed to record parent and patient adherence to the vacuum physiotherapy and parent satisfaction. Success rate of graft tubularization, curvature correction rates, and status of early (4 months) postoperative urinary stream were evaluated.Results Of 45/59 (76.3%) who returned the questionnaire, 77.8% followed the recommended physiotherapy protocol using the vacuum device. 93.3% of parents replied that the use of the vacuum was easy or moderately easy. None of the parents interrupted the physiotherapy because of perceived difficulty or intolerability. 100% of parents would have repeated the physiotherapy, if they had to. Overall, success rate of tubularization was 98.3% (58/59), complete curvature correction was achieved in 88.2% (52/59) of patients, and 79.7% (47/59) of patients showed a straight and powerful early post-operative urinary stream.Conclusions Physiotherapy with the vacuum device is safe, easy and practically feasible. Our vacuum physiotherapy protocol had high compliance rate. Vacuum physiotherapy should be considered for further assessment in patients undergoing two stage hypospadias repair using buccal mucosa.
Highlights
To assess the feasibility of vacuum physiotherapy meant to decrease graft contraction and recurrent penile curvature (PC), successful tubularization and a straight penis in patients underwent two-stage buccal mucosa graft (BMG) urethroplasty, in proximal hypospadias repair
Two stage buccal mucosa graft (BMG) urethroplasty becomes a good viable option in such patients, where the single stage procedure is likely to result in suboptimal outcomes [3]
Approximately 8-10% of BMGs develop fibrosis or contracture after the first stage requiring re-grafting and one third of the graft have some degree of fibrosis/induration, which results in suboptimal outcomes after second stage urethroplasty [4]
Summary
To assess the feasibility of vacuum physiotherapy meant to decrease graft contraction and recurrent penile curvature (PC), successful tubularization and a straight penis in patients underwent two-stage buccal mucosa graft (BMG) urethroplasty, in proximal hypospadias repair. Vacuum physiotherapy should be considered for further assessment in patients undergoing two stage hypospadias repair using buccal mucosa. Proximal hypospadias repair represents a challenging endeavor for pediatric urologists and plastic surgeons worldwide [1] In these complex patients, single stage urethral closure is hampered by severe penile curvature (PC), scarred urethral plate and deficiency of genital tissue [2]. Two stage buccal mucosa graft (BMG) urethroplasty becomes a good viable option in such patients, where the single stage procedure is likely to result in suboptimal outcomes [3]. In spite of these possible complications, no special precautions are usually taken after the first stage of surgery to increase the success rate of tubularization [6] and decrease the rate of recurrent PC at second stage
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
