Distal Shaft Hypospadias Research Articles

STUDY OF SURGICAL OUTCOME OF HYPOSPADIUS CORRECTION BY MODIFIED SNODGRASS (TUBULARISED INCISED PLATE URETHROPLASTY) TECHNIQUE

Background:The incidence of hypospadias is around 1 in 300 male live births. It is the most common congenital abnormality of the urethra. Diagnosis is made on physical examination. There are three characteristic features, including an ectopic ventrally located urethral meatus usually a ventral penile curvature (chordee) and an incomplete dorsal hood prepuce Surgical repair of hypospadias deformity is a challenging and complex issue. However, the technique of Snodgrass and its modifications attend promising functional and cosmetic results. Aims & Objectives: The paper aims at finding the outcomes of correction of distal and mid-shaft hypospadias by modified snodgrass technique and to compare it with the data available for other techniques Patients And Methods: Source- All patients undergoing surgical correction of hypospadias within the study period of 6 months( 15th March 2023 to 15th September 2023) Type Of The Study: prospective observational study Sample size: 15 patients Inclusion criteria: 1) Patients with distal and mid shaft hypospadias 2) all patients giving consent for the surgery Exclusion criteria: 1) Patients with severe chordee 2) Patients with immunocompromised status 3) Patients not willing to stay in hospital for long as this procedure needs careful dressings and hospital care as we are dealing with children 4) Patients who already underwent modified snodgrass technique Result: This study includes 15 boys with hypospadias. On Presentaion Two Patient Had Mid Shaft Hypospadias With Severe Chordee Rest All Patients Had Distal Shaft Hypospadias With Minimal Chordee. Their ages ranged from 3 to 8 years average 5 years The mean follow up was 3 months and complications were observed in only FIVE (33%) patient. Conclusion: From 15th MARCH 2023 to 15th SEPTEMBER 2023 over 6 months this study has emphasized on the clinical outcomes including any urethrocutaneous fistula , hemorrhage,infection,recurrence of chordee or any stricture formation following modified snodgrass technique and only 20% cases developed urethrocutaneous fistula.

MP18-11 DOES LEVEL OF TRAINEE INVOLVEMENT HAVE AN IMPACT ON HYPOSPADIAS TIP REPAIR OUTCOME?

You have accessJournal of UrologyCME1 Apr 2023MP18-11 DOES LEVEL OF TRAINEE INVOLVEMENT HAVE AN IMPACT ON HYPOSPADIAS TIP REPAIR OUTCOME? Vinaya Bhatia, Rocio Goodman, Maria Jabbour, and Walid Farhat Vinaya BhatiaVinaya Bhatia More articles by this author , Rocio GoodmanRocio Goodman More articles by this author , Maria JabbourMaria Jabbour More articles by this author , and Walid FarhatWalid Farhat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003238.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Teaching hypospadias repair to trainees is a major component of pediatric urology fellowship training but is not a focus of training junior residents. Herein, we reviewed outcomes of distal hypospadias repairs performed by a single surgeon in the proficiency stage of practice in a residency program and compared these outcomes to those for the same surgeon in the same stage in a fellowship program. METHODS: We reviewed all distal tubularized incised plate repairs performed by a single surgeon from 2019-2021. Data included age, meatal location, presence of curvature, operative time, occurrence of complications, and follow-up duration. Of note, resident involvement comprised mainly assisting in penile degloving urethroplasty and included skin closure under direct supervision. Our outcomes were compared to previously published data using descriptive statistics and Fisher’s exact tests, in which a p<0.05 was designated as statistically significant. RESULTS: A total of 52 patients met our inclusion criteria. A total of 5 patients had a megameatus, 6 had a glanular hypospadias, and 34 had a distal shaft hypospadias. The median age at surgery was 0.72 months (IQR 0.75 months). All patients did have an indwelling stent post-operatively. One patient (3.3%) was found to have complications, which were fistulae and meatal stenosis (Table 1). The time to complication for this patient was 6 months. When comparing previous data to the current data, the overall complication rates were lower (p=0.03), with overall complication rates of 15% (29/187) versus 3% (1/52). CONCLUSIONS: This is the first study directly comparing hypospadias surgical outcomes for the same surgeon in a different practice setting, specifically fellowship and residency programs. Though the detailed role of fellows in hypospadias repair might not be well delineated, it did entail autonomy and delegation, while residents only assisted or performed skin closure under supervision. Our data suggest that fellowship training programs might need to determine key steps for hypospadias repair they teach or delegate. This process should be delivered in a gradual manner gauged to the level of trainees to ensure that outcomes are improved. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e227 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vinaya Bhatia More articles by this author Rocio Goodman More articles by this author Maria Jabbour More articles by this author Walid Farhat More articles by this author Expand All Advertisement PDF downloadLoading ...

Advantages and disadvantages urethral advancement with subglanular tunnel (UASGT) versus tabularized incised plate (TIP) for distal hypospadias repair: A prospective comparative study

Objectives: To assess the efficacy and safety of urethral advancement with sub glanular tunnel (UASGT) in comparison with tabularized incised plate (TIP). Methodology: This prospective comparative study included any child with distal hypospadias (sub-coronal and distal shaft). The exclusion criteria included previous failed correction surgery, sever chordee, parents' refusal, and micropenis. Sixty patients with sub-coronal and distal shaft hypospadias were enrolled from urosurgery clinic in Hilla Teaching and urosurgery private clinic from October 2020 to October 2022. Patients' ages were between 1 year to 7 years. The first group included 30 patients with sub-coronal and distal shaft hypospadias treated surgically by UASGT while the second group involved 30 patients also with sub-coronal and distal shaft treated by TIP. The choice of type of surgery depended on the parent's preference after explaining the two procedures. Results: In group 1 patients (UASGT), the mean surgical time was 40.3 minutes while in group 2 (TIP), it was 52.3 minutes. Regarding complications, in group 1, Only 1 (3.3%) patient developed wound dehiscence, and 5 (16.6%) developed meatal stenosis, which required frequent dilatation. Fistula never occurs in group 1. In group 2, 6 (20%) patients developed complete wound dehiscence. There was statistically significant less risk of wound dehiscence (p=0.05) and also less risk of fistula formation with (p&lt;0.001) in the group of patients who were treated with UASGT. Conclusion: UASGT was used for the treatment of distal types of hypospadias (subcoronal and distal shaft) with significantly less operative time than TIP and fewer post-operative complication like wound dehiscence and fistula formation.

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.

A comparative study between Snodgrass versus Mathieu with dartos flap urethroplasty for distal hypospadias repair

Objective The aim of this study was to compare between Snodgrass and modified Mathieu procedures regarding the complications rates and the operative time. Background Hypospadias is the presence of abnormal meatal opening along the ventral aspect of the penile shaft or into the perineum. Surgical management of hypospadias abnormality has challenged and perplexed surgeons. Patients and methods From April 2015 to December 2016, eligible boys were randomly assigned with equal probability to undergo one of the two techniques of hypospadias repair. The study included 40 children experiencing anterior distal shaft hypospadias. Surgeries were performed by a single surgeon. Patients were followed up after discharge. Results Mean age for the patients was 23 months, and the mean operative time varied from 70 min for Snodgrass to 100 min for Mathieu (P = 0.170). Success rate was 17 (85%) of 20 for the Snodgrass and 18 (90%) of 20 for modified Mathieu (P = 0.072). Complication rates in the form of urethrocutaneous fistula and meatal stenosis were the commonest, being 15% in Snodgrass and 10% in modified Mathieu repair. No statistically significant difference was found between tubularized incised plate and modified Mathieu procedure regarding complications (P = 0.721). Conclusion Snodgrass and modified Mathieu repair were safe, and the choice of one of the techniques will depend on the surgeon's decision.

Postoperative complications and outcomes of Mathieu and Snodgrass techniques in a sample of Iraq patients with anterior distal shaft hypospadias

Background: Hypospadias is a common congenital anomaly of the penis in which the urethra opens proximal to its normal position at the tip of the glans. The purpose of this study was to compare the outcomes of Mathieu and Snodgrass techniques in the repair of anterior distal shaft hypospadias.Methods: From October 2009 to November 2010, forty five patients with the ages ranged 1 to 12 years suffering from anterior distal shaft hypospadias, were assessed. Inclusion criteria were anterior distal shaft hypospadias, and exclusion criteria were association with chordee, circumcision, and surgical repair history. Twenty-five patients underwent surgical repair using Snodgrass technique and 20 patients using Mathieu technique. Surgery was performed by one single surgeon, acquainted with both techniques. Patients were examined 1 week, and 1 month after discharge. Data including duration of the surgery, stenting time and any kind of complications such as break down, meatal stenosis, and fistula formation were collected. Also, success rate was calculated for every single patient and accordingly, the two groups were compared.Results: Mean operative time were 74±26minutes for Mathieu group and106.11±23 for minutes in Snodgrass group (P&lt;0.05). Stenting mean duration was 6.8±1.1 days, in Mathieu group and, 6.3±0.8 days in Snodgrass group (P&gt;0.05). The rate of break down, meatal stenosis, and fistula formation were 10%, 0%, and 5% in Mathieu group and 4%, 8%, and 8% in Snodgrass group respectively (P&gt;0.05). Success rate was 88% in Snodgrass group and 85% in Mathieu group (P&gt;0.05).Conclusions: In spite of some reports about preference for Snodgrass technique, we concluded that both techniques are as acceptable and as effective as each other for hypospodias repairing, regardless of cosmetic outcomes; however, we need further studies and larger sample sizes to determine which is the superior technique.

Comparative study between the usage of transurethral diversion and suprapubic cystostomy after distal hypospadias repair by tubulerized incised urethroplasty

Objective:-to compare the usage of transurethral urinary diversion and that of suprapubic cystostomy after distal shaft hypospadias repair by tubulerized incised urethroplasty.Method: - between December 2008 to October 2010 a 48 boys who had primary hypospaidais under went surgical repair by tubulerised incised urethroplasty, they divided into two groups according to the type of urinary diversion that used post operatively; group A with suprapubic diversion and group B with transurethral nasogasteric tube diversion.Result: - 48 boys aged between 3-21years with hypospadais had divided in to two equal groups according to type of post operative urinary diversion (suprapubic and transurethral), the distribution of hypospadais type similar in both groups. Urinary diversion was more effective , post operative complication were rare ,no trigon irritation and excellent cosmetic result (100%) were recorded following transurethral diversion with nasogasteric feeding tube ,conversely the creation of suprapubic cystostomy increased incidence of trigon irritation (12.5%) and fistula formation( 4.17 %).Conclusion: - transurethral urinary diversion was very effective and gave better result than suprapubic cystostomy in distal type hypospadias repair.

Experience with tubularized incised plate urethroplasty in distal and mid penile hypospadias

Background: Whilst hypospadias is a common congenital defect in boys its aetiology largely remains unknown. The objective of this study was to evaluate the results of tubularized incised plate (TIP) urethroplasty in distal and mid-penile hypospadias repair. Patients and Methods: This was a prospective clinical study conducted in the Department of Pediatric Surgery over a period of 42 months (January 2012 to June 2015). All patients with distal and mid shaft hypospadias who underwent TIP urethroplasty in our department were studied. The patients were followed up for a period of 1 year after surgery. Results: Fifty eight patients (N = 58) with hypospadias (29 distal and 29 mid penile) were included in the study. The mean age at presentation was 4.5 years (range 3–7 years). The mean operative time was 70 min (range 55–90 min). The mean duration of postoperative stay was 11 days (range: 10–14 days). Overall 15 patients (25.86%) developed complications. Urethrocutaneous fistula (UCF) developed in 10 (17.24%) patients. Meatal stenosis occurred in six (10.34%) patients. Five patients (8.62%) developed flap necrosis and dehiscence of glans occurred in two patients (3.44%). The difference in complication rate between different types of hypospadias was not statistically significant (P > 0.05). There was no statistically significant difference in cosmetic and functional outcome between two groups operated by TIP urethroplasty. Conclusion: TIP urethroplasty is a simple and effective technique of repair for distal and mid-penile hypospadias in properly selected patients. It offers good functional and cosmetic results.

Vascularized dorsal dartos flap to prevent fistula in tubularized incised plate urethroplasty for primary distal and mid shaft hypospadias

The aim of the present study was to evaluate the importance of neourethral covering using vascularized dorsal flap for preventing fistula in Tabularized incised plate (TIP) urethroplasty. The study included 52 children (aged 2-10 years) who had hypospadias repaired including 44 with distal and 8 with mid shaft hypospadias. In all children, a standard tabularized incised plate urethroplasty was followed by reconstruction of new surrounding urethral tissue. A longitudinal dartos flap was harvested from excessive dorsal preputial and penile hypospadiac skin and transposed to ventral side by a buttonhole maneuver. It was sutured to the glans wings and the neomeatus and to the corpora covernosa over the neo-urethra. Thus the new urethra was completely covered with well-vascularzed subcutaneous tissue. At a mean follow-up of 18 months, the result was successful with no fistula or urethral stenosis, except 2 of the mid penile hypospadias. All patients had good functional and cosmetic results with straight penis and vertical slit shaped meatus at the tip of the penis. The 2 patients developed tiny fistula, which were closed spontaneously after meatal dilatation. In conclusion, urethral covering should be part of TIP urethroplasty. A dorsal well-vascularized dartos flap, button holed ventrally is a good choice for preventing fistula for distal and mid shaft hypospadias.

Adult hypospadias: urethral and penile reconstruction.

This article provides a subjective, concise review of contemporary advances in reconstructive urology as it pertains to adult hypospadias repair. Herein, we highlight the most important and interesting articles among the many published within the past 12 months. The main themes in the recent literature covered herein, include management of postoperative complications, long-term follow-up, and penile cosmesis. Recent literature would suggest beauty is in the eye of the beholder when it comes to cosmesis after hypospadias repair. Long-term data are reassuring regarding uroflow improvement through puberty and into adulthood for common distal shaft hypospadias repairs.

Safety of Tioguanine During Pregnancy in Inflammatory Bowel Disease.

Conventional thiopurine [azathioprine and mercaptopurine] treatment during pregnancy in patients with inflammatory bowel disease [IBD] is considered to be safe; however data on the safety and teratogenicity of the non-conventional thiopurine tioguanine [TG] in pregnant IBD patients are lacking. We aim to describe the safety and teratogenicity of TG treatment during pregnancy in IBD patients. This was a retrospective, multicentre descriptive case series of female IBD patients using TG during pregnancy. Data on disease and medication history, pregnancy complications, pregnancy outcome, mode of delivery, preterm birth, birthweight, congenital abnormalities, laboratory signs of myelosuppression or hepatotoxicity, and 6-thioguaninenucleotide [6-TGN] concentrations in mother and neonate were collected. In all, 13 patients [77% Crohn's disease, 23% ulcerative colitis] used TG [median dose 18 g/day] during pregnancy; 19 pregnancies, including 1 twin pregnancy, were included. Spontaneous abortion occurred in three pregnancies. In 7 of the 16 ongoing pregnancies a caesarean section was performed. One neonate had a mild congenital abnormality [distal shaft hypospadias]. In the singleton pregnancies, the median birthweight was 3410 g at a median of gestational age of 39 weeks. No preterm birth [< 37 weeks] or low birthweight [< 2500 g] was observed in the singleton newborns. In the twin pregnancy an induction of labour was performed at 35 + 1 weeks of gestation because of pre-eclampsia. Both neonates had a low birthweight. This relatively small case series supports safe use of TG in pregnant IBD patients. Still, consideration should be given to the indication and continuation of TG during pregnancy.

Urethral Mobilization for Distal and Mid Shaft Hypospadias with Chordee

Urethral Mobilization for Distal and Mid Shaft Hypospadias with Chordee

Urethral Mobilization for Distal and Mid Shaft Hypospadias with Chordee

Many options are available for repairing mid shaft to distal hypospadias. Reported complications include poor cosmesis, persistent chordee, meatal stenosis and fistula. We hypothesized that advancing the intact native urethra would facilitate chordee correction and minimize complications. We retrospectively reviewed our records of all 248 hypospadias repairs done from July 2003 to May 2009 and identified patients younger than 18 years with distal or mid shaft hypospadias who underwent repair by urethral mobilization. The outcomes recorded were patient satisfaction, bladder scan volume, and the rate of fistula, meatal stenosis or other complications. Of the patients 83 met study inclusion criteria, including 5 (6%) treated with previous failed hypospadias operations. The hypospadias site was the distal, mid shaft and megameatal intact prepuce variant in 69 (83.1%), 11 (13.3%) and 3 patients (3.6%), respectively. Chordee was present in 80 patients (96.4%). The mean degree of chordee was 61.5 degrees, mean age at operation was 35.7 months and mean followup was 18 months (range 0.25 to 79). Of parental responses 94% were pleased or very pleased. Mean bladder volume on bladder scan was 9.7 ml (range 0 to 81). Fistula developed in 1 patient (1.2%). There were no meatal stenosis cases. Urethral mobilization results in excellent cosmesis and a low complication rate. This technique is especially well suited to patients with prior operations or deficient preputial skin. Using the native urethra with its blood supply is our preferred method of repairing distal and mid shaft hypospadias with chordee.

Comparative Study in Anterior Distal Hypospadias Reconstruction Utilizing Different Techniques (Mathieu and Snodgrass): Outcome, Complications and Failure Rate

Purpose: To compare the outcomes of Mathieu and Snodgrass techniques in the repair of anterior distal shaft hypospadias Materials And Methods: From march 2012 to march 2013 .45 patients with the age(range1 to 12) years suffering from anterior distal shaft hypospadias, were assessed. Inclusion criteria were anterior distal shaft hypospadias, and exclusion criteria were association with chordee, circumcision, and surgical repair history.25 patients underwent surgical repair using Snodgrass technique and 20 patients, using Mathieu technique. Surgeries were performed by one single surgeon, acquainted with both techniques. Patients were examined 1 week, and 1 month after discharge. Data including duration of the surgery, stenting time and any kind of complications such as break down, meatal stenosis,and fistula formation were collected. Also, success Rate was calculated for every single patient and accordingly, the two groups were compared. Results: Mean operative time, were 74 ± 26.minutesin Mathieu group and106.11 ± 23.Minutesin Snodgrass group (P 0.05). The rate of break down, meatal stenosis, and fistula formation were 10%, 0%,and 5% in Mathieu group and 4%, 8%, and 8% in Snodgrass group, respectively (P >0.05). Success rate was 88% in Snodgrass group and 85% in Mathieu group (P >0.05) Conclusion: In spite of some reports about preference for Snodgrass technique, we concluded that these techniques are as acceptable and as effective as each other for hypospodias repairing, regardless of cosmetic outcomes; however, we need further studies and larger sample sizes to determine which is the superior technique. Aim of Study:To compare the outcomes of Mathieu and Snodgrass techniques in the repair of anterior distal hypospadiasConclusion: In spite of some reports about preference for Snodgrass technique, we concluded that apart from the cosmetic outcome which is in favor of Snodgrass repair, both techniques are as acceptable and as effective as each other for hypospadias repair and the essence of success depends on surgeons experience, fine suture materials and the use of well vascularized intermediate (covering) layer.

Editorial Comment

Hypospadias repair, along with the management of vesicoureteral reflux, are arguably the 2 leading problems that helped to define modern pediatric urology. John Duckett coined the term “hypospadiology” to encourage those who performed hypospadias repair to view the complex topic as one deserving of serious dedicated study. 1 Duckett J.W. Hypospadias. in: Walsh P.C. Retik A.B. Vaughan E.D. Campbell's Urology. 7th ed. WB Saunders, Philadelphia1998 Google Scholar For many urologists, it meant the development of new procedures such as the meatal advancement and glanduloplasty, transverse island flap, or tubularized incised plate (TIP or Snodgrass). However, it should also encompass an understanding of how these methods have been adapted and their limitations. Surgical solutions are not fixed but reflect the level of medical knowledge of their era. Improvements in the understanding of the underlying problem, anatomy, technique, and materials have led to advances in nearly all types of operations. Fashion also is a factor; some operations become quite in vogue for a number of years and then fade away as a new style emerges or if a major advancement in knowledge makes them obsolete. Surgical Outcome of Different Types of Primary Hypospadias Repair During Three Decades in a Single CenterUrologyVol. 79Issue 6PreviewTo evaluate the surgical outcome of different techniques of primary hypospadias repair in a single department. Full-Text PDF ReplyUrologyVol. 79Issue 6PreviewWe would like to thank the reviewer for the valuable comments. We do agree that the surgical techniques in the “hypospadiology” field have undergone a major evolution. Our report reflects this evolution. During the past 3 decades, many techniques were applied in our patients, along with the changes in the hypospadias surgery around the world. However, the surgical outcome is still not optimal. Even in the distal shaft hypospadias repair, the complications ratio can reach 30% and can be greater in the proximal localization of the hypospadias meatus. Full-Text PDF

545 USE OF FIBRIN GLUE AS AN ADJUNCT IN HYPOSPADIAS REPAIR

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Lower Urinary Tract & Genitalia1 Apr 2011545 USE OF FIBRIN GLUE AS AN ADJUNCT IN HYPOSPADIAS REPAIR Ayme Schmeeckle, Dennis Venable, and John Mata Ayme SchmeeckleAyme Schmeeckle Shreveport, LA More articles by this author , Dennis VenableDennis Venable Shreveport, LA More articles by this author , and John MataJohn Mata Shreveport, LA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1270AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previously, we reported a positive experience with fibrin glue (Tisseel TM) in securing skin grafts during genital reconstruction. It has been suggested that fibrin glue may decrease incidence of urethrocutaneous fistulae and postoperative bleeding when used during hypospadias surgery. Herein, we report our results of a retrospective review comparing a cohort of patients with mid to distal shaft hypospadias undergoing primary tubularized incised plate (TIP)reconstruction with and without fibrin glue. METHODS We reviewed a group of 39 patients, ages 7 months to 14 years, who underwent a TIP hypospadias repair from 2008 to 2010. 13 patients had a thin layer of fibrin glue applied over the neourethra and 26 patients did not. Averages ages were 27 months in the fibrin group and 10 months in the non-fibrin group. Two patients in the fibrin group had midshaft hypospadias compared to seven in the non-fibrin group. All patients had urethral catheters for 5 to 7 days postoperatively and Tegaderm dressings. We compared the complication rates of the two groups at a mean follow-up of 15 months. RESULTS Although there was a subjective assessment that minor bleeding stopped more readily in the fibrin group intraoperatively, estimated blood loss in all patients was negligible since all repairs were done with tourniquet control. No patient in either group developed significant hematoma or required return to the operating room for postoperative bleeding. In the fibrin group, 6 of the 13 (46.15%) patients developed a urethrocutaneous fistula compared to 2 of 26 (7.69%) in the non-fibrin group. One patient in each group had a partial glans dehiscence associated with the fistula. All patients who elected for fistula repair received successful surgical correction in the standard fashion without fibrin glue at 6 months postoperatively. CONCLUSIONS Patients receiving fibrin glue had a greater than six fold increased incidence of fistula formation. These findings suggest that fibrin glue may disrupt normal tissue incorporation in the postoperative healing phase. Although fibrin glue helped stop bleeding from glansplasty, it made no difference in the overall estimated blood loss. Further basic science studies on wound healing with fibrin glue as well as larger clinical prospective, randomized trials are needed to help define the role of fibrin glue in hypospadias surgery. Until the results of such trials are known, fibrin glue should be used with caution in patients undergoing hypospadias repair. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e221 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ayme Schmeeckle Shreveport, LA More articles by this author Dennis Venable Shreveport, LA More articles by this author John Mata Shreveport, LA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Dartos flap coverage of the neourethra following repair for primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas: it is a safe approach

Urethrocutaneous fistula and neourethral dehiscence are frequently seen complications of hypospadias surgery requiring reoperation. In this study we report the experience of one surgeon with dartos flap coverage in primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas repair. A total of 23 patients underwent hypospadias and urethrocutaneous fistulas repair from January 2006 to May 2009. Fourteen patients were operated on for primary hypospadias repair at our institution and 9 patients were admitted for hypospadias complications such as failed hypospadias repair and urethrocutaneous fistula. In all the patients, the dartos flap was dissected and transposed to cover the neourethra. Operative results were recorded. The primary surgical procedure was a one-stage repair in 61% (n = 14); tubularised incised plate (TIP) urethroplasty in 43% (n = 6) and a Mathieu procedure in 57% (n = 8). Urethrocutaneous fistulas complicating the previous initial hypospadias repair were anterior in 33% (n = 2), middle in 33% (n = 2) and proximal in 33% (n = 2). Repair of the fistula was successful on the first attempt in all patients. The reason for redo surgery in 3 patients was complete dehiscence and the patients had distal shaft hypospadias. Dartos flap coverage of the neourethra seems to be an effective method of reducing the fistulous complication rate following primary and secondary hypospadias repair.

Double-Cross Flap Protection: New Technique for Coverage of Neourethra in Hypospadias Repair

We analyzed a new urethra preserving approach, double-cross flap protection, during tubularized incised plate urethroplasty. We compared the results of 57 patients treated with this new procedure and 80 patients treated with 2 different techniques. We studied 137 patients with hypospadias between October 2002 and March 2008. Patients were divided into 3 groups. Group 1 consisted of 40 patients (mean age 50 months) undergoing tubularized incised plate urethroplasty. Group 2 included 40 patients (mean age 48 months) undergoing tubularized incised plate urethroplasty with dorsal subcutaneous flap. Group 3 consisted of 57 patients (mean age 39 months) undergoing tubularized incised plate urethroplasty with 2 de-epithelialized preputial flaps twisted ventrally and sutured individually over the neourethra. All patients were operated on by the same surgeons. Statistical analysis of postoperative complications was performed by ANOVA and chi-square test. In Group 1 fistula developed in 6 patients (15%) and was associated with stenosis of the neourethra in 4 (10%). In Group 2 fistula developed in 4 patients (10%). In Group 3 no fistula was observed, but mild stenosis of the neomeatus developed in 3 patients (5.3%), which was treated with dilation. Thus, the incidence of fistula in group 3 was significantly less (p = 0.015). Double-cross flap protection is safe and significantly reduces the incidence of postoperative fistula.

Editorial Comment

Although no one has the data, I believe that the tubularized incised plate repair is now the most commonly used hypospadias procedure worldwide for children with middle to distal shaft hypospadias. This report comes from a large clinic with considerable experience in the care of boys with hypospadias. The authors are well qualified to assess their experience and to report on the modifications they have found helpful in refining their technique.

Split Prepuce In Situ Onlay Hypospadias Repair: 17 Years of Experience

We report our 17-year experience using split prepuce in situ onlay hypospadias repair, including long-term followup of the first 100 patients initially reported on in 1998. We identified 421 patients who underwent in situ onlay repair. Charts were retrospectively reviewed to determine preoperative management, intraoperative details and complications. In situ onlay repair was used to repair glanular hypospadias in 22 cases (5.2%), coronal hypospadias in 184 (43.7%), distal shaft hypospadias in 152 (36.1%), mid shaft hypospadias in 51 (12.1%), proximal shaft hypospadias in 7 (1.6%) and hypospadias in the penoscrotal region in 5 (1.2%). Repair was successful with 1 procedure in 376 patients (89.4%), which increased to 99.8% after a second procedure. Complications were defined as any problem that gave the surgeon or family reason for concern. Functional complications requiring reoperation occurred in 45 patients (10.6%). Minor complications requiring simple procedures or early postoperative evaluation occurred in 17 patients (4%). Concerns not requiring intervention occurred in 27 patients (6.4%). There were no urethral strictures. Three patients (0.7%) were lost to followup. Repair is pending in 1 patient. In situ onlay repair preserves the urethral plate and allows the formation of a well vascularized flap with adequate tissue to completely cover the neourethra, resulting in a low rate of major complications. With longer followup, inclusion of more mid shaft repairs and expansion to more proximal degrees of hypospadias our complication rates are higher than previously reported but there have been no urethral strictures in 17 years of experience. Since complications present at a median of 158 days (mean 570) after the procedure, long-term followup is indicated.