Hypospadias Objective Penile Evaluation Research Articles

Reducing fistula rate in hypospadias repair: A comparative study between standard tubularized incised plate repair and incorporation of a layer of spongiosum tissue

The most prevalent complication in hypospadias repair is fistula formation. Adhering to the principle of providing urethroplasty coverage to mitigate fistula occurrence, we implemented a modification by integrating a spongiosum layer between the urethroplasty and the dartos flap. Our hypothesis posited that this approach would result in a reduced fistula formation rate. This study is a comparative analysis involving patients under 18 years of age who underwent primary hypospadias repair. The cases were allocated into two groups. In the study group, in addition to performing tubularized incised plate (TIP) repair, a spongiosum layer harvested from both sides of the urethra was used to cover the urethroplasty (modification of the Y-to-I urethroplasty). The control group underwent a standard TIP repair. The primary outcome was to assess urethrocutaneous fistula formation. Secondary outcomes included evaluating the development of meatal stenosis and glans dehiscence, along with assessing cosmetic results by the Hypospadias Objective Penile Evaluation (HOPE) score. Overall, 154 hypospadias cases were included in the study. Eighty-seven patients (56%) were allocated to the study group, and 67 (44%) were allocated to the control group. Urethrocutaneous fistula developed in 3 (3.4%) and 11 (16.4%) patients in the study and control group, respectively (p=0.006). Glans dehiscence occurred in 2 (2.3%) patients in the study group and 4 (6%) patients in the control group (p=0.198). Meatal stenosis was observed in 4 (4.6%) patients in the study group and 5 (7.5%) patients in the control (p=0.452). The mean HOPE score was 59 in both groups (p=0.36). This study details our encounters with the novel modification and compares the results with standard TIP. Our data suggest that adding a layer of spongiosum tissue over the urethroplasty reduces the complication of urethrocutaneous fistula without increasing the occurrence of dehiscence, significant meatal stenosis, or compromising cosmetic outcomes. We advocate for implementing the described surgical modification as a viable option for hypospadias repair.

Use of Validated Questionnaires to Predict Cosmetic Outcomes of Hypospadias Repair.

Hypospadias is a syndrome of penile maldevelopment. The primary goal of hypospadias surgery is to create a penis with normal appearance and function. Historically, the outcome of hypospadias repair has been assessed based on the need for reoperation due to urethroplasty complications (UC), including fistula formation, dehiscence, meatal stenosis, or development of a urethral stricture. The Glans-Urethral Meatus-Shaft (GMS) score is a standardized tool to predict UC. Analysis of the cosmetic outcomes of hypospadias repair based on the appearance of the reconstructed penis has been validated, and standardized scores have been published. The Hypospadias Objective Penile Evaluation (HOPE) score is a validated questionnaire used to assess postoperative cosmetic outcomes. Although predictors of surgical outcomes and UC have been well documented, predictors of optimal cosmetic outcomes are lacking in the literature. Furthermore, reoperation due to cosmetic considerations has been poorly reported. To identify predictors of cosmetic outcomes after hypospadias repair and to assess the reoperation rate according to cosmetic considerations. This prospective cohort study included 126 boys who underwent primary hypospadias repair. The severity of hypospadias, degree of penile curvature, glans width, preoperative HOPE, and GMS scores were documented. The standard technique for single-stage repairs, the tubularized incised plate urethroplasty, was performed. The primary endpoint was cosmetic outcomes evaluated by the HOPE score questionnaire six months postoperatively. Optimal cosmetic results were defined by HOPE scores ≥ 57. The study population consisted of the following cases: 87 (69%) subcoronal, 32 (25%) shaft, and 7 (6%) proximal hypospadias. Among the study participants, 102 boys (81%) had optimal cosmetic results (HOPE ≥ 57), and 24 boys (19%) had surgeries with suboptimal cosmetic outcomes (HOPE < 57). Ancillary procedures were performed in 21 boys (16%), of which 14 (11%) were solely for cosmetic considerations, and 7 were secondary to UC. Using the Receiver Operating Characteristic analysis of potential predictors of optimal cosmetic outcomes, the preoperative HOPE score had the highest area under the curve (AUC = 0.79; 95% CI 0.69-0.89, p < 0.001). After multivariable analysis, the degree of penile chordee (p = 0.013), glans width (p = 0.003), GMS score (p = 0.007), and preoperative HOPE score (p = 0.002) were significant predictors of cosmetic outcomes. Although meatal location predicted suboptimal cosmetic results in univariate analysis, it was not a factor in multivariable analysis. Over 80% of boys undergoing hypospadias repair achieved optimal cosmetic outcomes. More than 10% of cases underwent ancillary procedures, secondary solely to cosmetic considerations. Predictors of optimal cosmetic outcomes after hypospadias surgery included degree of chordee, glans width, and preoperative HOPE and GMS scores, which were the best predictors of satisfactory cosmetic results. Although meatal location is the main predictor of UC, it was not a predictor for cosmetic outcomes. Factors affecting cosmetic outcomes should be clearly explained to parents during the preoperative consultation.

Hypospadias Repair: Outcome and Objective Evaluation with Hypospadias Objective Scoring Evaluation (HOSE), Hypospadias Objective Penile Evaluation (HOPE) and Pediatric Penile Perception Score (PPPS) from Parents Perspective and Preference in COVID-19 Era

Introduction. Hypospadias is a common congenital abnormality. It may also be associated with other urogenital tract abnormalities. Literature has described more than 300 techniques being used. An objective evaluation is useful for attending doctor and parents to ensure both understands detection of complication and to assess post operative satisfaction from both sides are similar. Thus study sought to assess the outcome of hypospadias repair with objective scoring evaluation from parents’ perspective during COVID-19 era. Methods. This was a retrospective study of all patient post-hypospadias repair in Urology Unit, Hospital Universiti Sains Malaysia from January 2020 to December 2022 during the Covid-19 period. All patient medical records were reviewed. Data analyzed for demographic, surgical treatment, complications, and objective evaluation with HOSE, HOPE and PPPS questionnaire and parents preferred questionnaire to be used using Microsoft Excel for Windows 2003 and qualitative variables were presented as frequencies and simple percentages. Result. Hypospadias A total of 21 pediatric patients operated. The mean age during surgery was 7.2 years old. Distribution of glanular 6 patients, distal 3 patients and majority are proximal hypospadias with 12 patients (57.2%). Proximal hypospadias, 6 proximal penile and 6 penoscrotal. Single stage repair 18 patients and 2 patients had scrotoplasty performed and 3 patients had two stage repairs. Majority of single stage surgery performed was TIP and two stage repairs done with Bracka’s technique. Overall mean follow-up time 16.78 month. Three patients had UCF with 14.3%. Questionnaire with HOSE showed mean score 14.38. The HOPE questionnaire showed mean score of 54.71 and PPPS mean score was 10.2. Majority of parents preferred to use HOPE with 66.7% as compared to HOSE 14.3% and PPPS 19%. Discussion. This study has a small sample size possible due to very low rate for hypospadias in Malaysia and Covid-19 pandemic. Due to the pandemic, European Association of Urology recommended for repair before 18 months. However, if done after 2 years old showed significant predictor for complications. Validated questionnaires are useful and comparable to assess objectively both functional and patient satisfaction. However, HOPE might overestimate quality of cosmetic outcome compared with PPPS. Despite many available evaluation scoring systems were compared, reports show similar conclusions with none being more superior. Conclusion. Hypospadias requires complex surgery and complications are expected but should be within acceptable standards. In COVID-19 era, hypospadias repair had to be delayed and causes negative impact to patients. Despite many various techniques available, surgeons experience and technique preference are very important. There is no evaluation score more superior than another. It has its advantages and disadvantages. Parents satisfaction and functional outcome after repair should be routinely done for objective assessment.

Long term follow-up on young adults that underwent hypospadias repair through urethral advancement in childhood.

Assess the long-term outcome on cosmetic appearance, voiding, sexual function, and psychological impact of young adults operated by urethral advance (UA) technique in childhood. Patients over 14 years old, who underwent UA hypospadias repair in our centre (2000-2010) were evaluated. All patients presented mid-distal hypospadias with subcoronal or penile meatus and curvature lower than 20°. The cosmetic appearance, urinary and sexual function, body perception and overall satisfaction were assessed through 5 questionnaires. From 2000 to 2010, 143 children underwent UA hypospadias repair. 36 patients between 14 and 27 years were evaluated. The Hypospadias Objective Penile Evaluation (HOPE) showed an average of 8.75 (+/- 0.97), which indicates a good aesthetic result. Voiding dysfunction symptoms were assessed through the American Urological Association Symptom Index (AUASI) where 80.6% had none or mild symptoms and 19.4% had moderate symptoms. Only 11/36 patients were sexually active, according to the International Index of Erectile Function (IIEF-15) scale, none had erectile dysfunction, and their relationships were satisfactory. Assessment of the body perception through the Genital Perception Scale (GPS) was positive or very positive in 88.9% of the patients. However, the perception of their genitals was positive or very positive in 77.8%, there is a negative correlation between the perception of their body and genitals in 13.9% of the patients. Our results indicate that UA technique for hypospadias repair might be a valid option for the correction of mid-distal hypospadias when indicated.

Validity and Reliability of the Persian Version of Hypospadias Objective Penile Evaluation (HOPE) Questionnaire

Background and Objective: Surgical correction of hypospadias is one of the most common pediatric surgeries. Due to the several methods of hypospadias operations, the evaluation of results has always been challenging. Several questionnaires have been designed to reduce the discrepancy in the reports of hypospadias surgery, and the HOPE questionnaire is one of the most common. Based on our search, the reliability and validity of the Persian version of the HOPE (Hypospadias Objective Penile Evaluation) questionnaire have not been assessed yet. Materials and Methods: In this cross-sectional study, firstly, the questionnaire "Objective evaluation of penis in hypospadias" was translated by two urologists and an English language expert familiar with medical concepts according to the Backward-Forward translation method into Persian and then again into English, and finally, the questionnaire was sent to experts and compared with the original questionnaire. The quality of translation and content were finalized and corrected. Thereafter, in order to check the form and content validity, the questionnaire was sent to eight experts, and the content validity indices and its content validity ratio were calculated. In order to check the reliability-stability of the re-test, two questionnaires, including images after hypospadias surgery of 42 patients, were delivered to eight specialists in pediatrics, urology, and pediatric surgery to determine the score at a time interval of one week, and finally, the data were analyzed in SPSS software (version 23) using the test-retest method. The Intraclass Correlation Coefficient (ICC) index and its confidence interval were calculated by the scores obtained from twice answering the instrument for each factor and the entire questionnaire. In order to determine internal consistency and reliability, Cronbach's alpha coefficient was calculated for each factor and the entire questionnaire. Results: In our study, intraclass correlation coefficient values for inter-rater reliability in the HOPE score were calculated at 0.89, indicating the high reliability of this questionnaire in Persian. The internal consistency of the Persian version of the HOPE scale was confirmed, rendering a Cronbach's alpha coefficient of 0.98. Conclusion: The good validity and reliability of the HOPE scoring system in Persian support its use as a standard objective outcome measure of the cosmetic result after hypospadias surgery.

Post-Hypospadias Repair Penile Score in Follow-Up Patients of Urethroplasty

Background: Hypospadias is described as the abnormal location of the urethral meatus upon the ventral surface of the penis with variable association with the abnormal development of the urethral spongiosum, ventral prepuce, and penile chordee. Numerous studies have utilized techniques like "Penile Perception Score (PPPS)," "Hypospadias Objective Scoring System (HOSE)," and "Hypospadias Objective Penile Evaluation Score (HOPE)" to evaluate the outcome after hypospadias repair, but there is a lack of evidence analyzing the utility of "Post-Hypospadias Repair Penile Score (PHRPS)." This study was carried out to assess PHRPS in children undergoing hypospadias repair.Methodology: A prospective cohort study was conducted at the department of pediatric surgery, uni-II, The Children’s Hospital and University of Child Health Sciences, Lahore, Pakistan from November 2020 to December 2021. All male children aged up to 12 years and planning to undergo hypospadias repair during the study period were included. The PHRPS system was used to assess the outcomes of hypospadias repair. Qualitative data were represented as frequency and percentage, while mean and standard deviation (SD) were calculated for quantitative data.Results: During this period, a total of 37 children were treated for hypospadias. The mean age of the patients at the time of repair was 8.2±3.6 years, ranging between 1.5 years and 12 years. Out of 37 patients, 14 (37.8%) had penoscrotal hypospadias, while 12 (32.4%) had distal penile hypospadias. In terms of acute post-surgery complications, edema was reported in 9 (24.3%), bleeding 1 (2.7%), and surgical site infection 1 (2.7), while all of these were successfully managed conservatively. Seven patients were lost to follow-up, so they were excluded from the final analysis. On the basis of PHRPS scoring, 17 (56.7%) patients had excellent outcomes, 2 (6.7%) had good outcomes, 8 (26.7%) had acceptable outcomes, and 3 (10.0%) had poor outcomes.Conclusion: The PHRPS is a new but simple objective tool, facilitating surgical audit and balanced evaluation of the outcomes of traditional and innovative procedures. The outcome of hypospadias repair was generally found to be good.

The Effect of Pre-Incision Urethral Plate Width and Glanular Width on the Outcome of Tubularized Incised Urethral plate repair surgery in Distal Penile Hypospadias, A prospective study.

To determine hypospadias repair's cosmetic and functional outcome concerning the urethral plate width and glanular width. A prospective study including 38 patients. The urethral plate width (UPW) was measured preoperatively. The cosmetic outcome was evaluated by hypospadias objective penile evaluation [HOPE] score, and the urinary stream evaluated functional outcome. We included boys with distal penile hypospadias and excluded recurrent cases with severe chordee. All patients were operated on by Snodgrass tubularized incised plate repair (TIP); they were followed up for one year. Success was defined as slit-shaped meatus at the tip of the glans without fistula. The mean age of surgery was 4.5 ± 2.1 years. UPW was < 8 mm in 24 patients (63.2 %) (Group A), while 14 patients (36.8 % ) (Group B) had a UPW ≥ 8 mm. Overall, the mean ± SD of UPW was 4.84 ± 1.29 mm. The mean ± SD of GW was 9.52 ± 1.56 mm. Overall success was documented in 35/38 patients (92.1 %). No significant relation was founded between the complications and UPW of the patients (p-value = 0.7). Overall, the mean ± SD HOPE score was 39.1 ± 8.83. A significant relation was found between the cosmetic outcome of the two groups and the HOPE score (p-value = 0.02). The pre-incision urethral plate width and glanular width were not correlated with the TIP outcome. A better HOPE score is associated with a wide urethral plate.

Application of the Mathieu combined tunnel technique for repairing glans dehiscence after failed hypospadias repair.

Repairing glans dehiscence after failed hypospadias repair is challenging for pediatric surgeons. Here, we introduced and evaluated a newly modified Mathieu technique, Mathieu combined tunnel (MCT), which involves multiple custom-designed flaps for the shortage of flap source material after repeated operations; we also constructed a tunnel to avoid the glans incision that may carry new risks of dehiscence. This retrospective study included 26 patients who were consecutively admitted to the First Affiliated Hospital of Sun Yat-Sen University (Guangzhou, China) for glans dehiscence repair after failed hypospadias repair from October 2014 to October 2020; sixteen patients underwent surgery using the MCT (MCT group) and ten patients underwent surgery using the tubularized incised plate (TIP) technique (TIP group). The operative time, blood loss, postoperative complications, normal urethral meatus rate, success rate, and Hypospadias Objective Penile Evaluation (HOPE) score were compared between the two groups. The MCT group achieved an overall satisfactory penile appearance and voiding function, with a higher rate of normal urethral meatus (15/16, 93.8%) and a lower rate of glans dehiscence (1/16, 6.2%), compared with the TIP group (70.0% and 30.0%, respectively). However, these differences were not statistically significant, possibly because of the limited number of patients (all P > 0.05). Mean postoperative HOPE scores were similar in the MCT group (mean ± standard deviation: 8.83 ± 0. 89) and TIP group (8.94 ± 0.57) (P > 0.05). No significant differences were found between the two groups in terms of blood loss and success rate, nor in the rates of various complications (e.g., fistula, urethral stricture, and glans dehiscence). In conclusion, the MCT technique appears to be feasible and reliable for repairing glans dehiscence after failed hypospadias repair.

Extended TIP vs. Standard TIP for primary distal hypospadias repair: randomized study for comparing functional and cosmetic outcomes

Objectives The aim of this study was to critically evaluate distal extension of the midline urethral plate incision, extended tubularized incised plate (e-TIP) technique, with the standard TIP and investigating predictors of functional and cosmetic success. Methods In a prospective study, consecutive patients with primary distal hypospadias presented for repair were randomized to undergo either extended TIP (e-TIP) or standard TIP (s-TIP) technique. Cosmetic outcome was evaluated postoperatively using Hypospadias-Objective-Penile-Evaluation (HOPE) score and measurement of ventral-glans-closure-length (VGCL) and meatal length (ML). Functional outcome was evaluated by maximal flow rate (Qmax), average flow rate (Qave), and postvoid residual urine (PVR). The effect of preoperative parameters on the outcome was assessed with regression analysis. Results In all 94 cases, out of 110 randomized, were available for analysis. Forty-six in e-TIP group and 48 cases in s-TIP group with comparable preoperative demographics. Median (inter-quartile range) of postoperative total HOPE-score was 57(45–60) vs. 55(44–60) for e-TIP and s-TIP (p < 0.001), respectively. The mean (SD) ratio of VGCL/ML was 87% (26) versus 46% (12) for e-TIP vs. s-TIP, respectively (p < 0.001). Both complications and functional outcomes were comparable. Urethral plate (UP) width and the use of e-TIP technique were significant predictors of successful cosmetic outcome in regression analysis (p = 0.019 and p = 0.001), respectively. Conclusion Extension of midline urethral plate can potentially create a vertical slit-like meatus located at the glans tip without compromising the functional outcome, thus providing better cosmetic outcome compared with the standard technique. The UP width was a significant predictor of superior cosmetic outcome.

Long-term outcome of non-stented tubularized incised plate urethroplasty for distal hypospadias repair: a complication analysis.

IntroductionAlthough it is apparently simpler to perform unstented tubularized incised plate (TIP) repair for distal hypospadias repair, consensus on feasibility of the use of unstented repair is still a matter of debate. Evidence reporting that unstented repair outcome is comparable to stented repair, especially in the long-term, is still weak due to reporting outcome inconsistencies, different study designs, inclusion of more than one technique, and inherent variability in meatal locations. Thus, we need a continuous and evolving assessment of the outcome of unstented repair to compile adequate evidence on the advantage of unstented TIP repair in distal hypospadias entity. The aim of this article was to review our long-term results with tubularized incised plate urethroplasty for distal hypospadias repair without a postoperative stent to determine its outcome which might justify its use.Material and methodsAfter a review of 154 patients with distal penile hypospadias, who underwent repair in Minia Urology & Nephrology University Hospital in the period between June 2015 and February 2018, we excluded cases who underwent MAGPI repair, redo cases and patients who failed to complete follow-up. We chose 72 patients who had only 1st time TIP repair and whom we could contact. A total of 44 out of 72 cases with stented repair were assigned to Group A, while 28 cases with unstented repair were assigned to Group B. Success was assessed based on Hypospadias Objective Penile Evaluation (HOPE) score by three separate senior pediatric urology consultants, independent of the surgeon and in the absence of high post-void residual urine (PVR). Average rate was calculated to be compared between both study groups.ResultsThere was no statistically significant difference regarding preoperative meatal location and age at repair and short-term complications. In the long-term; there was no statistically significant difference between the occurrence of urethrocutanous fistula (UCF, 4 vs 2 cases in Group A & B, respectively) and complete disruption (2 cases in each group) with need for redo repair. Results of total mean of HOPE score calculated showed no statistically significant differences between study groups and also failed to showed statistical significance on individual domains of HOPE score.ConclusionsUnstented TIP repair showed a similar outcome to stented TIP repair of distal hypospadias especially in the long-term despite a more troublesome early postoperative period.

Flap Method is Better Than the Tubularized Incised Plate Method for the Surgical Treatment of Distal Hypospadias

BACKGROUND: Urethroplasty techniques generally can be divided into two methods, the flap method (Mathieu and Onlay Flap) and no flap with tubularized incised plate (TIP) urethroplasty method. Complications are common after urethral reconstructioninclude urethrocutaneous fistulae and cosmetic appearance, which is usually measured by Hypospadias Objective Penile Evaluation (HOPE) scoring system.&#x0D; AIM: The aim of this study was to determine whether there are differences in the outcome of flap method compare to TIP method in distal hypospadias patients who underwent urethroplasty.&#x0D; PATIENTS AND METHOD: The subjects of this study were patients with distal hypospadias who underwent urethroplasty in Sanglah General Hospital from September 2017 to December 2017. Thirty-six samples were selected by consecutive sampling.&#x0D; RESULTS: The results showed a significant difference in the incidence of meatal stenosis (p = 0.05) and urinary stream disturbances(p = 0.05) between two methods. No significant differences were found in the incidence of urethrocutaneous fistulae (p = 0.500) and the unsatisfactory HOPE score (p = 0.169).&#x0D; CONCLUSION: This research showed that meatal stenosis andthe maximum urinary stream were better in flap method compared to TIP method in distal hypospadias patients underwent urethroplasty.

Psychosexual Outcome, Sexual Function, and Long-Term Satisfaction of Adolescent and Young Adult Men After Childhood Hypospadias Repair

BackgroundThe psychosexual outcome in adolescents and young adults (AYA) men born with hypospadias is precarious. However, the factors responsible for impaired outcome in some AYA men have been understudied. AimTo explore the outcome after hypospadias repair in childhood of AYA men aged 16–21 years and examine their opinion and their parents’ opinion about this type of surgery. MethodsCross-sectional assessment of 193 AYA men born with hypospadias and 50 male controls was performed. Questionnaires such as the Decision Regret Scale, Pediatric Penile Perception Score, Sexual Quality of Life–Male, International Index of Erectile Function, and a custom-made questionnaire were used. The Decision Regret Scale and a custom-made questionnaire were also completed by the participants' parents. Physical examination including Hypospadias Objective Penile Evaluation and measuring stretched penile length was performed. OutcomesThis study reports the psychosexual functioning (ie, social, relational, and sexual), erectile and sexual function after childhood hypospadias repair, using ad hoc measures. In addition, the opinion about hypospadias repair of patients and their parents is represented. ResultsThe number of surgeries and satisfaction regarding penile appearance were the most important factors associated with the opinion on hypospadias repair and the psychosexual outcome. Most AYA men were more satisfied with their penile appearance than the physician. 80% of men were satisfied with having had a childhood hypospadias repair, even though they had not been able to consent to surgery themselves. Erectile and ejaculation problems were mild and seen in approximately 10% of the population. Clinical ImplicationsBased on our data, deferring hypospadias repair until the patient can decide himself is not warranted. However, physicians who accept a suboptimal esthetic outcome and withdraw from repeated surgery may contribute importantly to the patient's well-being, especially in proximal forms of hypospadias. Strengths & LimitationsThis is one of the rare studies addressing the AYA's psychosexual outcome after childhood hypospadias repair. Strengths include the combination of clinical and psychosexual data from a very large cohort of men and their parents to provide a more holistic view. By entering this study, participants might have a different comfort level regarding their sexuality or have a different body image than the overall population of young men. ConclusionUncomplicated hypospadias surgery results in equal psychosexual outcome as controls and in high satisfaction rates; multiple surgeries are a risk factor for poorer outcomes. 80% of men are satisfied with childhood hypospadias repair.Tack LJW, Springer A, Riedl S, et al. Psychosexual Outcome, Sexual Function, and Long-Term Satisfaction of Adolescent and Young Adult Men After Childhood Hypospadias Repair. J Sex Med 2020;17:1665–1675.

PROKSİMAL HİPOSPADİASLI VE CİDDİ KORDİLİ ÇOCUKLARIN İKİ AŞAMALI AMELİYAT SONUÇLARININ HİPOSPADİAS OBJEKTİVE PENİL SKORLAMA (HOPS) İLE DEĞERLENDİRİLMESİ

AbstractPurposeSurgical management for the severe proximal hypospadias remains controversial and it might be challenging. In this study,we evaluated the surgical outcome of patients with proximal hypospadias managed by two staged repair with dorsal prepucial flaps.Patients and MethodsForty one boys with proximal hypospadias are enrolled between January 2006 and September 2016. The location of the urethral meatus was at the penoscrotal junction (PSH), at the scrotum (SH) or at the perineum (PRH). First stage; chordee was released and the prepucial flaps were constructed. Second stage; urethroplasty was performed according to Thiersch-Duplay principle. We assessed postoperative complication rates and utilized Hypospadias Objective Penile Evaluation (HOPE) scoring to evaluate the cosmetic outcome.ResultsThere are a total of 41 boys (31 PSH(%76), 3 SH(%7) and 7 PRH(%17). The mean age at first operation was 15±5,3 months. The mean interval between the stages of the surgical procedures was 10.1±4.,9months.Sixteen patients had various enzyme deficiency or dysgenesis. In two patients, diverticulum is developed after the repair. stenosis has encountered in 10 patients and fistula in 5. Two patients had dehiscence at glanular level. Relation did not demonstrated between the severity of hypospadias and development of fistula, stricture and diverticulum (p&amp;gt;0,05). HOPE scores; 9,4 for the position of the meatus, 5,8 for shape of the meatus, 7,2 for shape of the glans penis, 9,3 for penile torsion and 9,8 penile curvature. Conclusion Incorporating the dorsal prepucial skin flaps in staged procedures has both satisfactory cosmetic and functional success rates.

Bracka's Method of Proximal Hypospadias Repair: Preputial Skin or Buccal Mucosa?

To analyze treatment results of staged surgical repair of proximal forms of hypospadias according to Bracka's technique using preputial vs buccal grafts. We retrospectively reviewed 220 patients with proximal forms of hypospadias treated with Bracka's urethroplasty technique. They were divided into 2 groups: Group I-108 patients treated with preputial skin grafts in 2001-2013; Group II-112 patients who underwent urethroplasty with buccal mucosa grafts in 2013-2016. Of the Group I patients with preputial skin grafts, complications were obtained in 33 (31%) cases; in Group II-23 (20%) cases. Complications include fistulas, defects of urethra, and scar contraction of grafts. The cosmetic results according to Hypospadias Objective Penile Evaluation scale were more satisfactory when buccal mucosa grafts were used. Further studies are needed to analyze the long-term changes posturethroplasty with both preputial skin and buccal mucosa grafts. This is one of the only studies to compare complications and histology of the 2 free grafts: preputial skin and buccal mucosa. This study affirms that a staged surgical method with the use of free grafts according to Bracka's technique is a successful method of treatment of proximal forms of hypospadias in children achieving good functional and cosmetic results with a relatively low rate of complications.

Assessment of the effect of urethral plate width on outcome of hypospadias repair

The paradigm for hypospadias repair is a straight penis with a vertical meatus at the tip of the glans that provides satisfactory urination and is cosmetically acceptable to the parents of the patient. To determine the cosmetic and functional outcomes of hypospadias repair in relation to the width of the urethral plate. This study was a prospective evaluation of patients operated for hypospadias. The urethral plate width (UPW) of the patients were measured preoperatively using vernier calipers. The patients were categorized into groups A and B. Group A patients have a UPW <8mm, whereas group B patients have a UPW ≥8mm. The width of the urethral plate was correlated to the cosmetic outcome (using hypospadias objective penile evaluation [HOPE]) and functional outcome (using the urinary stream) of hypospadias repair. Overall, 47 patients had their hypospadias repaired during the study period. But, only 42 patients who had their distal hypospadias repaired using tubularized incised plateurethroplasty were evaluated. There were 20 patients (47.6%) in group A and 22 patients (52.4%) in group B, with a mean urethral plate of 7.3mm±0.50 SD. The mean UPW in group A was 5.6mm±1.22 SD and the mean UPW in group B was 8.8mm±0.88 SD. Overall, mean HOPEscore was 40.0±6.83 SD. Group A patients had a mean HOPE score of 38.7±7.49 SD, whereas Group B patients had a mean HOPE score of 41.2±6.08 SD. P-value was 0.725, which is not statistically significant. Relating good urinary stream (15 in group A and 20 in group B) with the width of the urethral plate statistically (using Spearman correlation technique) gave a P-value of 0.03 (P<0.05), which is statistically significant. Our findings indicate that the cosmetic outcome of hypospadias repair may not be determined by UPW, but the functional outcome may be predicted by the width of the urethral plate.

Outcome after Hypospadias Repair: Evaluation Using the Hypospadias Objective Penile Evaluation Score.

The Hypospadias Objective Penile Evaluation Score (HOPE-Score) is a concise and reproducible way to describe hypospadias severity. We classified boys undergoing primary hypospadias repair to determine the correlation between the HOPE-Score and the severity of hypospadias first and the outcome after surgery second. Patients who underwent primary hypospadias repair from 2005 to 2014 were identified. An independent physician assessed retrospectively the HOPE-Score, using photographies of the patients before, after primary surgery, and after all necessary surgeries. The correlation between the HOPE-Score and the severity of hypospadias, on the one hand, and the outcome after surgery, on the other hand, were analyzed. The HOPE-Score was assessed preoperatively for 79 boys, postoperatively for 66, and after all necessary surgeries for 21 patients. Mean HOPE-Score reached 30.2 ± 5.9 before surgery, 42.2 ± 6.1 after primary surgery, and 43.7 ± 3.4 after all necessary surgeries. A significant correlation between the HOPE-Score and the severity of hypospadias before surgery was observed. The boys with glanular hypospadias scored significantly higher (36.3 ± 5.4) than those with distal (29.6 ± 4.4) and proximal hypospadias (21.1 ± 3.5). Furthermore, a significant correlation between the HOPE-Score and the outcome after hypospadias repair was observed. Patients who needed no reintervention after primary hypospadias repair scored significantly higher postoperatively (45.1 ± 5.4) than those who needed a second (40.8 ± 4.2) or more than two surgeries (36.9 ± 7.4). The HOPE-Score is a good system to assess the severity of hypospadias and the cosmetic outcome after hypospadias repair.

The Correlation between Types of Hipospadia and Hypospadias Objective Penile Evaluation Score in Padang

The Correlation between Types of Hipospadia and Hypospadias Objective Penile Evaluation Score in Padang

Cosmetic Outcome of Tubularized Incised Plate Depends on The Type of Hypospadias: A Case Control Study

Background: Recent studies show Tubularized Incised Plate (TIP) urethroplasty, commonly used for distal hypospadias repair, can be used in proximal hypospadias with a decent success rate. It was contented that the age of the patient when undertook the surgery influences the outcome, with young age gaining more favourable outcome than the older. One the objectives of hypospadias repair is the cosmetic outcome, which can be evaluated using Hypospadias Objective Penile Evaluation (HOPE) questionnaires. Our objective is to compare the proportion of the young and the older patients based on the cosmetic surgical outcome. Methods: In Sanglah General Hospital, Denpasar, 38 patients who had undergone a TIP urethroplasty from January 2012 until December 2015 were evaluated using HOPE questionnaires. Results: The sample are divided into two equally-numbered groups based on the HOPE total score. The median of the age of the subjects when they undergone the surgery is 4.8 years (1.89-18.10). The proportion of the over 5 year old in the cosmetically unsatisfying group (case) is the same as the proportion in the cosmetically satisfying group (control), 52.63%, EOR=1 (p&gt;0.05). The proportion based on the year of surgery are different, but not statistically significant (p&gt;0.05). Based on the type of hypospadias, the proportion of subjects with proximal hypospadias in the case group is more than in the control group, EOR=14.95 (p&lt;0.05). It shows proximal hypospadias is a risk factor for cosmetically unsatisfying result post TIP urethroplasty. Conclusions: It should be taken into account that TIP in proximal hypospadias has a greater risk to produce an unsatisfying cosmetical result.

Penile appearance after hypospadias correction from a parent's point of view: Comparison of the hypospadias objective penile evaluation score and parents penile perception score

As there is only scarce information on the parents' view of the cosmetic outcome after hypospadias surgery we aimed to evaluate whether the results of the hypospadias objective penile evaluation (HOPE) score are transferable to parents satisfaction as measured by the pediatric penile perception score (PPPS). 42 patients after hypospadias correction were included (2 (6.9%) glandular, 20 (68.9%) coronal, 6 (20.6%) penile and 1 (3.4%) scrotal hypospadias, median age 15.0 months). Two surgeons independently assessed HOPE score; the PPPS score as well as 4 questions specifically designed by a psychologist were completed by fathers and mothers. 29 (69.9%) full datasets were available for evaluation. Parents' assessment of the cosmetic results was worse than surgeons' assessment (81.13% [PPPS] vs. 92.81% [HOPE] of the respectively possible highest score, P < 0.0001). All 58 parents (100%) were convinced that surgery led to a better cosmetic aspect of their sons' genitalia although both, mothers and fathers, perceived the operation as a major encumbrance (fathers 3.62 vs. mothers 3.97 on a scale from 0-6, P = 0.22). Parents can be encouraged preoperatively that a hypospadias operation, seen from their point of view will be a major amendment to the cosmetic appearance of their sons' genitalia even if the operation itself is perceived as a major psychological burden. In direct comparison of the highest possible score of either tool (HOPE or PPPS), the cosmetic results were judged significantly more optimistic by surgeons as compared to parents using validated tools. HOPE score results therefore may not be transferred uncritically to the parents view on the cosmetic results.

Preputioplasty associated with urethroplasty for correction of distal hypospadias: A prospective study and proposition of a new objective scoring system for evaluation of esthetic and functional outcome

ObjectiveMost surgical procedures for correction of hypospadias involve the removal of foreskin resulting in a circumcised penis. We report our experience and the medium-term results in the reconstruction of the foreskin during the correction of distal hypospadias. Materials and methodsBetween January 2007 and December 2011, 445 patients aged between 8 and 120 months underwent surgical correction of hypospadias. In 354 out of 445 patients, we performed the reconstruction of the foreskin. Urethroplasty was performed according to either the TIPU (tubularized incised urethral plate urethroplasty; Snodgrass) technique (233/354, 66%) or MAGPI (meatal advancement glanduloplasty incorporated) procedure (121/354, 34%). In 91 out of 445 patients urethroplasty was performed using classic TIPU technique and they were circumcised. The cosmetic and functional results were evaluated using the Hypospadias Objective Penile Evaluation (HOPE) scoring system. ResultsAt a 12 months follow-up, 300 patients (84.7%) had retractable foreskin while 54 patients (15.3%) required postoperative steroid application. We had a total complication rate of 8.7%. As for preputioplasty, 16 patients (4.5%) had partial or total dehiscence of the reconstructed foreskin, one patient was circumcised for persistent phimosis (0.2%). As for urethroplasty complications, we recorded 11 fistulas (3.1%) and three stenosis (0.9%). The complication rate of the control group of circumcised patients was of 3.3% (2 fistulas [2.1%] and 1 stenosis [1.2%]). ConclusionsOur experience shows that foreskin reconstruction can be performed successfully in selected patients with distal hypospadias. However, preputioplasty add an additional 4.7% complication rate. As for the complications of urethroplasty, it seems that preputioplasty does not increase the incidence of complications on the urethra reconstruction. We propose a new objective scoring system (modified HOPE score) for evaluation of esthetic and functional outcome.