Anterior Hypospadias Research Articles

Retrospective Comparative Study between Duplay and Koff Methods in Repair of Distal Hypospadias.

Hypospadias repair is a complicated surgery even in the best of hands. To date, there is a lack of consensus on which surgical technique offers more favourable post-operative outcomes. The present work was undertaken to evaluate and compare the outcomes and complications rates of two single-stage techniques widely used to repair primary anterior hypospadias, namely Thiersch-Duplay Tubularized Plate Urethroplasty and Koff Urethral Mobilisation and Advancement. Data from the medical records of 120 patients operated on for primary anterior hypospadias were retrospectively analysed and compared. The patients were divided into two groups: 60 patients underwent Thiersch-Duplay procedure (Group A) and 60 patients underwent Koff procedure (Group B). They were compared using the Chi-squared or Fisher's exact test to assess the relationship between the adopted surgical technique and the complications' development with a P < 0.05. Neither intraoperative complications nor acute post-operative complications occurred, whereas 28.3% ( n = 34/120) cases have exhibited at least one late post-operative surgical complication, including 38.3% ( n = 23/60) in Group A and 18.3% ( n = 11/60) in Group B, revealing a better outcome of the Koff procedure despite the statistical insignificance ( P = 0.102). We did not objectify any other complication besides meatal stenosis (MS), urethro-cutaneous fistula (UCF) and wound dehiscence. Overall, our study could not demonstrate the superiority of one technique above another. At the same time, it established the versatility, satisfactory cosmetic and functional results, low MS and UCF rates of Koff urethral mobilization and advancement technique in primary anterior hypospadias repair.

Outcome of Classical Tubularized Incised-Plate Urethroplasty (TIP) for Primary Anterior Hypospadias Repair: 5 Years’ Experience

Introduction: Classical Tubularized Incised-plate Urethroplasty (TIP) is a surgical procedure used to repair hypospadias, which is a birth defect in which the opening of the urethra located on the underside of the penis rather than at the tip. Aim of the Study: The aim of this study was to evaluate the surgical outcome of classical tubularized incised plate (TIP) urethroplasty. Methods: This retrospective study was conducted in the Department of Pediatric Surgery, Bangladesh Shishu Hospital &amp; Institute, Dhaka from July 2017 to June 2022. Total 53 patients were included in this study. Result: In the current study, the mean age of participants was 43.08±21.72 months where the minimum age was 12 months and maximum age was 103 months. The mean weight of participants was 19.25±7.78 kg. The mean penile length of participants was 35.9±8.05 mm. The mean operation time was 73.24±4.80 minutes. Mean operation cost was 277.50±40.46 US$. Mean hospital stay was 10.7±0.75 days. In our study, 15.09% had UC fistula, 5.66% had wound infection and 7.54% had meatal stenosis. Follow up period was 7.9±2.1 months. In this study, more than half (50.94%) had distal penile hypospadias, 28.30% had coronal hypospadias and 20.75% had sub-coronal hypospadias. Conclusion: According to the findings of our study, Tubularized Incised-plate (TIP) urethroplasty is found to be a safe and reliable technique for hypospadias repair. The rate of complications was found low in TIP urethroplasty.

Complications of Tubularized Incised-Plate (TIP) Urethroplasty in Anterior Hypospadias Repair: Interrupted VS Continuous Suture

Introduction: Hypospadias is a congenital defect that affects the development of the urethra in males, causing the urethral opening to be located on the underside of the penis rather than at the tip. Repair of hypospadias is a surgical procedure that aims to create a normal-appearing and functional penis that allows for normal urination. The tubularized incised-plate (TIP) technique is a widely used surgical approach for correcting distal hypospadias. TIP urethroplasty can be performed using either continuous or interrupted suture techniques. The present study aims to compare the complications of these two techniques in TIP urethroplasty for the repair of hypospadias. Aim of the Study: The aim of the study was to compare the complication rate among continuous and interrupted suture in TIP urethroplasty for anterior hypospadias repair. Methods: This Prospective Randomized comparative study was conducted at the Department of Pediatric Surgery, Bangladesh Shishu Hospital &amp; Institute, Dhaka, Bangladesh. The study duration was 5 years, from July 2017 to June 2022. After some drop-out patients, a total of 68 patients had been left, with Group-1 having 35 continuous suture TIP urethroplasty, and Group-2 having 33 interrupted sutures TIP urethroplasty. Result: The mean age of participants was 41.15±24.46 months in Group-1 and 38.05±25.14 months in Group-2. The mean weight of participants was 17.79±6.37 kg and 19.14±9.19 kg in Group-1 and Group-2 respectively. Operation time in group 1 and group 2 was 66.86±3.51 minutes and 79.38±5.04 minutes respectively, with statistically significant difference. But none of the post-operative complications had significant difference between the groups. Conclusion: The study showed that although operative time was significantly lower among patients undergoing continuous suture for TIP urethroplasty instead of interrupted suture TIP urethroplasty, the overall complications rate had no significant difference between the groups.

Urinary flow rates in anterior hypospadias: Before and after repair and its clinical implication.

Hypospadias is a common urological anomaly which could be surgically corrected with good cosmetic results. We aimed to detect changes in urinary flow parameters both before and after tubularised incised plate urethroplasty (TIPU) using uroflowmetry. Data collected were clinically implemented hypothesising the probability of urethrocutaneous fistula following stricture with Qmax variation. This study is a prospective analysis done from December 2017 to October 2019. A total of 104 cases of anterior hypospadias were included in the study. A single surgical unit did TIPU. Pre-operative and post-operative uroflowmetry was done, and Qmax was recorded at 3 months, 6 months and 1 year after surgery. Mean Qmax was calculated for all intervals. A significant decrease in Qmax of a child (<2 standard deviation) was ascertained. Urethral calibration was done in those cases with a significant decrease of Qmax and analysed statistically. The mean age was 6.97 ± 2.41 years. Out of 104 children, 73 (70.2%) and 31 (29.8%) had distal and mid-shaft hypospadias, respectively. The pre-operative mean Qmax of the population was 6.20 ± 0.42 ml/s. Arithmetic mean Qmax at 3 months, 6 months and 1 year was 8.53 ± 0.42, 11.18 ± 0.47 and 13.71 ± 0.44 ml/s, respectively. On comparing the pre-operative with post-operative mean Qmax, a significant increase was found postoperatively (P < 0.0001). Twenty-four patients had significantly decreased Qmax value after 6 months. In these patients, follow-up urethral dilation was done with significant improvement. The changes in maximum flow rate (Qmax) are suitable for use in routine follow-up. A significant decrease in Qmax over time indicates the onset of urethral stricture. These cases are to be intervened before venturing to redo urethroplasty.

Evaluation of double faced transverse preputial (onlay) island flap for hypospadias repair in pediatrics: a randomized controlled study

BackgroundThe preputial onlay island flap technique has been popularized for hypospadias repair as a result of offering a consistent combination of acceptable functional and cosmetic results. Like other techniques, urethrocutaneous fistulae and stricture continues to be the most common complications, in addition to other complications, which could be attributed to the compromise in flaps vascularity. Some authors describe a technique that resolves some of these problems by combining the unique benefits of the double faced preputial flaps. The aim of this study:- to evaluate double faced preputial onlay island flap technique for complications rate, outcomes of surgical procedure, and cosmetic results in comparison to transverse inner preputial flap technique.Patients and methodsThis was a prospective randomized controlled study that included 68 patients with anterior, mid-penile, and posterior penile hypospadias, with shallow and narrow urethral plate of size less than 6 mm, who underwent single-stage repair using preputial flaps, conducted at the department of pediatric surgery (Al-Azhar University, Cairo, Egypt), between May 2019 and October 2021, to evaluate double faced transverse preputial onlay island flap technique. Thirty-four patients underwent double faced transverse preputial onlay island flap (group A) and another 34 patients underwent inner transverse preputial onlay island flap (control group) (group B). The follow-up period ranged from 12 to 26 months.ResultsThe overall complication rate was 20.5% (14 of 68 children). Complications developed in 5 cases (14.7%) in group A who underwent double face onlay island flap (2 glannular dehiscence, 1 penile rotation, 1 fistula, and 1 diverticulum), as opposed to 9 patients in group B (26.4%) who underwent transverse inner preputial flap (3 developed glannular dehiscence, 2 skin flap necrosis, 3 fistulae, and 1 diverticulum). After management of the complications, all patients had good surgical outcomes with satisfactory cosmetic results.ConclusionDouble faced transverse preputial onlay island flap is an alternative option to reconstruct narrow urethral plate hypospadias. So that double faced transverse preputial onlay island flap technique appears to achieve satisfactory surgical outcomes with lower complication rate.

Is the Snodgrass technique suitable for different types of hypospadias? Single-center experience

Background: Hypospadias is a congenital penile defect and Tubularized Incised Plate (TIP) urethroplasty is a widely accepted option to repair this defect. Our experience about the outcome of hypospadias repair by this technique is discussed. Methods: This is a retrospective analytical study consisting of 80 cases, conducted between May 2017 to December 2019 at the Department of Pediatric Surgery, Maternity, and Children’s Hospital Dammam. All the cases with anterior, middle, and posterior hypospadias, who underwent Snodgrass TIP urethroplasty, were included in the study. The same surgeon performed all the operations. The follow-up period lasted for 2 years, after surgery and the final outcome of the procedure was recorded, based on the observations. Results: The age range of the patients varied between 1 to 9 years. Anterior hypospadias constituted 64 (80%) cases followed by middle hypospadias 13 (16.25%), and posterior hypospadias 3 (3.75%). By type, glanular hypospadias was the most common 30 (37.5%), followed by sub-coronal 19 (23.75%), coronal 15 (18.75%), mid-penile 11 (13.75%), proximal penile 2 (2.5%) and penoscrotal hypospadias 2(2.5%). Scrotal hypospadias was the least common type, 1 (1.25%). Overall complications that required re-intervention occurred in 16 (20%) cases. Urethrocutaneous fistula (UCF) which occurred in 7 (8.75) cases was the most common complication, followed by meatal stenosis in 4 (5%) and glans dehiscence and urethral stricture 2 in each (2.5% each). Total repair disruption was the least common complication that was noticed in 1 (1.25%) case. Functional and cosmetic results were judged as satisfactory. Conclusion: For hypospadias repair, TIP urethroplasty is the procedure of choice for anterior hypospadias with excellent results. It is also quite suitable with middle hypospadias and acceptable for posterior hypospadias for selected cases. The overall complication rate is low and also offers very good functional and cosmetic results.

Outcome of Repair of Anterior Penile Hypospadias by Snodgrass Technique- A Study of 50 Cases

Introduction: Hypospadias is a developmental anomaly characterized by a urethral meatus that opens onto the ventral surface of the penis proximal to the end of the glans. Hypospadias occurs in 1 in 125 live male births. Classically three abnormalities are found in the hypospadias penis: 1) an ectopic opening of the urethral meatus at the ventral surface. 2) A ventral curvature of the penis (Chordee), and 3). A hooded foreskin on the dorsum of the penis with a lack of skin on the ventral due to a V-shaped defect referred to as urethral delta. There are anterior (65%), middle (15%, and posterior penile hypospadias (20%). Objective: The objective of surgical repair of hypospadias is to provide complete straightening of the penis, placing the meatus at the tip of the glans, forming a symmetrical conical-shaped glans, and constructing a urethra uniform in caliver and acceptable skin coverage. Materials and Methods: This is a Cross-sectional variety of descriptive type of observational study conducted in the department of pediatric surgery, Dhaka Medical College &amp; Hospital, Dhaka, Bangladesh, from 1st January 2009 to 30th June 2010. The total number of cases is 50. Patients having anterior penile hypospadias were selected by simple random sampling. The mean age of the patients was 5.22 years (2 to 10 years). Surgical correction was done with the Snodgrass technique. The mean operative time was 90 minutes. Post-operative hospital stay was10 days. Results: Satisfactory results were obtained in 35 (70%) patients, and only 14 (28%) had urethrocutaneous fistula, wound infection 5(10%), and meatal stenosis 2 (4%). The final outcome was evaluated based on urethrocutaneous fistula, meatal stenosis, and cosmesis. Out of 50 patients, 35 (70%) did not have a urethrucutaneous fistula and were cosmetically acceptable. Conclusion: Early detection and correction are essential to minimize the complications and also to lessen the psychological trauma of the patient. For this, a thorough examination of the neonates following delivery in different maternal and child care clinics is mandatory. Early and timely measures also give the best cosmetic and functional results. So we should put all our efforts into achieving this goal.

A comparative study of two operative procedures in anterior hypospadias repair: limited urethral mobilization and tubularized incised plate urethroplasty.

Objectives: This study is aimed to compare the results of limited urethral mobilization and tubularized incised plate urethroplasty in the management of anterior hypospadias, in terms of cosmetic and functional outcomes, complication rate, operative time, and hospital stay. Study Design: Prospective Randomized Controlled study. Settings: Department of Pediatric Surgery, DHQ Teaching Hospital Sahiwal. Period: January 2019 to December 2020. Material and Methods: A total of 89 patients with anterior hypospadias were included. Patients were divided randomly into two groups. In group A, limited urethral mobilization was performed and in group B, tubularized incised plate urethroplasty was carried out. A self-structured performa was used to collect the data of all patients. Both groups were compared in terms of the operation time, hospital stay, postoperative complications, cosmetic appearance, and functional outcomes. Results: Forty-five patients were included in group A, age ranged from 2.5 to 12 years (mean 4.83years). Forty-four patients were included in group B and their ages ranged from 3.5 to 11years (mean 4.76 years). The operation time was significantly less for group A than for group B. In group A, it ranged from 54 to 69 min with an average time of 60.51 min and in group B from 70 to 88 min, with an average of 79.34 min. The mean hospital stay period in group A was 7.37 days, ranged from 7 to 9 days, and in group B was 11.04 days, ranging from 10 to 13 days. The mean follow-up period in both groups was 7.45 months, ranging from 3 months to 12 months. Meatal stenosis was the most common complication in group A, which developed in 6.66% (n=3) patients. Urethrocutaneous fistula was the most common complication in group B, which developed in 6.81% (n=3) patients. Cosmetic appearance and functional outcome were good and comparable in both groups. Conclusion: Although both techniques, tubularized incised plate and limited urethral mobilization urethroplasty are acceptable modalities for the management of anterior hypospadias. But limited urethral mobilization urethroplasty seems to be a good option due to its simplicity, short hospital stay, significant shorter operative time, low fistula formation rate, and good cosmetic and functional outcomes.

De-epithelized preputial skin flap with &amp; without fibrin glue as a covering layers in repair of anterior hypospadias by snodgrass technique : a randomized controlled study

De-epithelized preputial skin flap with &amp; without fibrin glue as a covering layers in repair of anterior hypospadias by snodgrass technique : a randomized controlled study

MANAGEMENT OF ANTERIOR HYPOSPADIAS, OUR EXPERIENCE WITH SNODGRASS REPAIR TECHNIQUE MARDAN MEDICAL COMPLEX MARDAN TEACHING HOSPITAL

OBJECTIVE: To report on the short-term outcomes of anterior hypospadias tabularized incised plate urethroplasty,as reported by Snodgrass.MATERIAL AND METHODS: From January 2014 to December 2016, patients with anterior hypopadiaswithout chordae were the subjects of this research, which took place at the Mardan Medical Complex surgical department in Mardan. The research had 56 patients ages 3 to 13 years, with a mean age of 5.1. Anterior distal shafthypospadias with a healthy urethral plate was an inclusion criterion, while chordae and a history of prior surgery wereexclusion criteria. A new urethra was created around a size 6 to 8 Fr stent after the full length of the urethral platewas cut along the midline. Subdartos fascia covered the newly formed urethra. In every instance, sufratullae were usedfor pressure dressing.RESULTS: During the investigation, there were three complications: six cases (10.7%) of urethrocutaneous fistuladevelopment, four cases (7.1%) of meatal stenosis, and two cases (3.5%) of glandular dehiscence. In our research, theoverall rate of problems was 21.42%.CONCLUSIONS: For anterior hypospadias, the Snodgrass treatment has outstanding functional and estheticoutcomes. Comparing this operation to others, the incidence of complications is modest.KEYWORDS: Distal Hypospadias, Snodgrass repair.

Primary anterior hypospadias repair: a review of clinical outcomes

Hypospadias is a common congenital urogenital deformation. Its most frequent form is anterior hypospadias, where the urethral meatus was located at the glans (glandular), just below the glans (sub-coronal), or on the distal shaft. Various surgical procedures can be performed to correct anterior hypospadias. The most common used procedures are meatal advancement and glanduloplasty incorporated (MAGPI), tubularized incised plate (TIP), and Mathieu repair procedures. Choosing which procedure to date there are no guidelines on determining which procedure to perform or which will produce the best results. We conducted a review to compare the outcomes of each procedure, considering cosmetic and functional aspects, as well as risks of complications. The results showed lack of evidences that perform direct comparison among the different outcomes; therefore, we have to rely on observational and descriptive sources. However, available evidence painted a picture of somewhat comparable outcomes on all aspects between the three procedures for anterior hypospadias. The underlying theme was the importance of selecting the appropriate procedure for each patient, considering each patient’s unique anatomical presentation for the best cosmetic outcome, as well as the skill and confidence of each surgeon.

A cover flap reduces the rate of fistula after urethroplasty whatever the severity of hypospadias.

To determine which patients should benefit from the interposition of a well-vascularized flap between the neourethra and the penile skin and if it should be performed even in mild hypospadias. A retrospective study on patients with a primary hypospadias repair was performed (2003-2017). Only patients undergoing urethroplasty based on the principle of a tubularization were selected to ensure comparable groups. Patients were assigned in two groups according to the use or not of a cover flap. Univariate analysis and adjusted logistic regression were used to evaluate the relation between postoperative complications, the severity of hypospadias, the use of flap and patients' characteristics. Three-hundred and seventy-six patients were included with anterior (59.3%), midshaft (27.4%) and posterior hypospadias (13.3%). The median follow-up was 54months (24months-17years). The overall rate of fistula was 11.7% (n = 44). Comparing the outcome in children with flap (n = 217) to controls (n = 159) showed that the use of a flap reduces the rate of fistula (6.5 vs 18.9%, p < 0.001). Stratification of the study according to the phenotype reveals that the more severe the hypospadias, the more protective was the flap (OR = 2.6 for anterior, 5.5 for midpenile, 7.1 for posterior hypospadias). The flap remains nevertheless significantly effective whatever the phenotype (p < 0.05 for anterior, p = 0.01 for midpenile, p = 0.02 for posterior hypospadias). The more severe the hypospadias, the more effective is the cover flap to avoid fistula. It remains nevertheless suitable even in anterior hypospadias and the use of a cover flap should not be limited to the surgery of severe phenotypes.

Single-stage urethroplasty: An eight-year single-centre experience and its associated factors for urethrocutaneous fistula

Introduction: This study aimed to describe single-stage urethroplasty and to determine factors associated with urethrocutaneous fistula after the procedure at our institution. Methods: All hypospadias patients without any prior surgery who underwent single-stage urethroplasty from July 2010 to January 2018 were included. In total, 179 patients were followed for at least one year postoperatively. Information on types of hypospadias, operation techniques, chordee degree, preoperative pyuria (urine white blood cell count &gt;5/HPF), urethral defect length and urethrocutaneous fistula formation was collected. Results: We obtained 103 cases of posterior (57.5%), middle (57 cases) and anterior (19 cases) hypospadias on whom onlay preputial island flap (71 cases), tubularized incised plate (46 cases) and Duckett’s transverse preputial island flap (35 cases) were conducted. After 47.1±25.8 months of follow-up, urethrocutaneous fistula were found in 23 (12.8%) patients associated with posterior hypospadias occurrence ( p=0.025), longer urethral defect ( p=0.007) and preoperative pyuria ( p&lt;0.001). Chordee degree ( p=0.886) and age ( p=0.187) were not significant factors associated with urethrocutaneous fistula formation. Conclusion: Single-stage urethroplasty is a versatile procedure for various hypospadias cases, with a urethrocutaneous fistula rate of 12.8%. Posterior hypospadias, preoperative pyuria and longer urethral defect were associated with urethrocutaneous fistula formation. Level of evidence Level 2B.

New Technique for the Treatment of Anterior Hypospadias Doubles-Y Glanuloplasty prospective Evaluation and A Systematic Review

Introduction: Hypospadias is the ectopic closure of the urethral meatus at the ventral surface of the penis. The diversity of techniques proposed to treat hypospadias has caused a great debate among urologists about the effectiveness of these techniques. The objective of our study is to develop the double Y glanduloplasty technique, expose and compare the results of this technique to improve the management of anterior hypospadias.

A case of distal hypospadias masquerading as Megameatus intact prepuce

Hypospadias is an common abnormality in males which the urethral opening is ectopically located on the ventrum of the penis as far down as in the scrotum or perineum. Classic hypospadias is characterized by the triad of ventral urethra defect, absence of dorsal prepuce and chordee. A megameatus with intact prepuce (MIP) is an unusual variant of an anterior hypospadias. It is characterized by a widely splayed coronal or subcoronal meatus, a deep glanular groove, a normally conformed prepuce, and no chordee. Here, we report a case of a 23-year-old male who was diagnosed as MIP clinically but found to be a hypospadias intraoperatively.

The outcome of limited urethral mobilization urethroplasty for anterior hypospadias.

Objectives: Hypospadias, one of the most common genital anomalies, is characterized by an abnormal meatal opening on the ventral aspect of penis. Anterior hypospadias are the most common. Most of the surgical techniques involves the construction of neourethra with significant risk of urethrocutaneous fistula. Limited urethral mobilization technique involves the advancement of native urethra. Study Design: The objective of this study was to evaluate the outcome of Limited Urethral Mobilization Urethroplasty for Anterior Hypospadias. Setting: The study was conducted in the Department of Paediatric Surgery, DHQ teaching Hospital Sahiwal. Period: From January 2016 to December 2018. Material &amp; Methods: A total number of 187 patients were included in this study. Limited urethral mobilization technique was used in all patients. Minimum age was 2.5 Years and maximum age was 12 years. Cosmetic appearance, functional outcome and complication rate were assessed. Results: Wound infection developed in 3.20 %( n=6) patients. Complete glanular disruption was seen in 2.13 %( n=4) patients. Partial disruption of glans with meatal retraction was observed in 1.60 %( n=3) patients. Post-operative haematoma was seen in 1.60 %( n=3) patients. Meatal stenosis in 1.06 %( n=2) patients. Post-operative bleeding and diverticula was observed in 0.5 %( n=1) patients each. Vertical oriented, slit like meatus at the tip of glans was achieved in 95.72 %( n=179) patients. Conclusion: Limited urethral mobilization urethroplasty is a technique with proven benefits and effectiveness in the terms of cosmesis and functional outcome with a minimal number of complications because of the usage of native elastic urethra.

Outcome of urethral mobilization and advancement after anterior hypospadias surgery

BackgroundIn hypospadias surgery, despite continued refinement of various surgical procedures, there is no completely satisfactory technique in terms of complications and cosmesis. In recent literature, urethral mobilization and advancement (UMA) is gaining popularity in the management of distal penile hypospadias with no or very low complication rate as compared to all other techniques. The aim of this study is to share our results by using UMA in the management of anterior hypospadias with or without chordae.ResultsA total of 60 patients of anterior hypospadias having the mean age 57.15 ± 38.73 months were included. The mean length of hospital stay was 2.83 ± 1.33 days. The only peroperative complication was urethral injury during urethral mobilization seen in one patient. The most common postoperative complication was hematoma seen in five (8.3%) cases. Two patients (3.3%) had retraction of urethra. One patient had wound infection. Stenosis was labeled in four (6.6%). At 3 months follow-up, 93.3% patients had slit-like meatus and good urinary stream.ConclusionWe found that UMA technique had good functional as well as excellent cosmetic outcome, so the technique can be adopted for anterior hypospadias correction.

EVALUATION OF ONE STAGE MODIFIED MATHIEU’S URETHROPLASTY FOR DISTAL PENILE HYPOSPADIAS IN BIHAR POPULATION

With an incidence of 1:300, hypospadias is one of the most common genital anomalies in male newborns. Hence the present study was planned to evaluate the one stage Flip- flap procedure to repair Distal Penile Hypospadias. Mathieu’s technique (peri-meatal based flap) makes use of the urethral plate in the repair of anterior hypospadias, thereby creating an almost natural neo-urethra. In a circumcised baby or after previous unsuccessful repair, Mathieu’s flap may be one of the few options left to repair anterior hypospadias.&#x0D; A total of fourteen patients were included in this study. Their age ranged from 1-13 years, mean age was 4.9 years. Construction of neourethra is generally recommended to be completed before the school going age. The 14 cases of hypospadias are primary repaired by modified Mathieu’s Flap technique to achieve both cosmetic and functional normality. An overall success rate of 87.5% was achieved and In the remaining 14% of the cases, success was achieved with only one additional procedure.&#x0D; The protocol followed the recommended guidelines of surgery. The present study was planned in the Department of Plastic Surgery, Pulse Emergency Hospital, Patna, Bihar. Total surgeries done from Oct 2016 to Nov 2017 were included in the present study.&#x0D; The present study concludes that in a developing country like India with rural patients having poor access to good healthcare facilities. One stage Repair is beneficial in many ways. The follow-up compliance of poor rural patients is extremely poor because they need to come to the urban cities for treatment. The authors have seen multiple cases where the patients have gone for the Chordee Correction (first stage of a two-stage repair) in childhood and then reported after a decade.&#x0D; Keywords: Hypospadias, MAGPI, Mathieu flap, Single-stage repair, etc.

Prenatal imaging of genital defects: clinical spectrum and predictive factors for severe forms.

To report the clinical spectrum of genital defects diagnosed before birth, identify predictive factors for severe phenotypes at birth, and determine the rate of associated malformations. A retrospective study (2008-2017) of 4580 fetuses, identified prenatally with abnormalities evaluated by our Reference Center for Fetal Medicine, included cases with fetal sonographic findings of abnormal genitalia or uncertainty of fetal sex determination. Familial, prenatal and postnatal data were collected via a standardised questionnaire. In all, 61 fetuses were included. The positive predictive value (PPV) of the prenatal diagnosis of genital defects was 90.1%. Most cases were 46,XY-undervirilized boys, 42 cases (68.8%), which included 29 with mid-penile or posterior hypospadias, nine with anterior hypospadias, and epispadias, micropenis, scrotal transposition, and buried penis (one each). In all, 46,XX-virilized girls were identified in seven cases (11.5%), which included four with congenital adrenal hyperplasia, two with isolated clitoromegaly, and one with ovotestis. Other defects included prune belly syndrome and persistent cloaca (six cases). Early detection during the second trimester (58.1% vs 18.8%, P=0.03), intra-uterine growth restriction (IUGR) (45.2% vs 9.1%, P=0.06), and curvature of the penis (38.7% vs 0%, P=0.02), were more frequently related to severe defects in male newborns. Associated malformations (14 cases, 22.9%) and genetic defects (six) were frequent in undervirilized boys. Prenatal imaging of genital defects leads to a wide range of phenotypes at birth. Its PPV is high and extra-urinary malformations are frequent. Early diagnosis during the second trimester, associated IUGR, and curvature of the genital tubercle, should raise suspicion of a severe phenotype and may justify delivery near a multidisciplinary disorders/differences of sex development team.

Results of Surgery Performed on 151 Patients of Hypospadias: Single Center Experience

Background: Hypospadias is defined as the hypoplasia of the ventral side of the penis such as the abnormal ventral opening of urethral meatus, chordee, and abnormal distribution of circumcision skin. The purpose of this study is to share our experiences with patients who underwent hypospadias repair surgery in a university hospital. Materials and Methods: After obtaining approval from the hospital’s ethical review board, the files of 151 patients with hypospadias who underwent surgery between March 2013 and October 2018, were examined retrospectively. One hundred thirty-five patients (89%) had anterior, and 16 patients (10.6%) had posterior hypospadias. Results: The average age of patients was 4,2 years (1-14). While 30% of the patients with anterior hypospadias had cordee below 30 degrees, 100% of patients with posterior hypospadias had chordee. In terms of complications, 15(9,9%) patients had urethro-cutaneous fistula, 20 (13,2%) patients had meatal stenosis, 3 patients (1.9%) glans dehiscence, and 1 patient (0.6%) had ventral skin necrosis. Conclusion: Hypospadias surgery is still challenging due to being associated with certain complications. As one single surgery does not yield good results for any hypospadias, these patients should be managed with specific operations selected according to the patient.