Penile Torsion Research Articles

Is The Dorsal Dartos Flap Rotation Technique Successful in Children with Isolated Penile Torsion?

Penile torsion is a counterclockwise rotational anomaly of the penile shaft or glans. We aimed to evaluate the results of dorsal dartos flap rotation technique in children with isolated penile torsion. 5470 boys who applied to our clinic between 2012 and 2022 for circumcision were evaluated for congenital isolated penile torsion. They were classified according to the degree and direction of torsion and clinical findings were analyzed. According to the degree of torsion, penile degloving or dorsal dartos flap rotation technique with circumcision was performed. Patients whose torsion corrected after penile degloving were excluded from the study. The results of dorsal dartos flap rotation technique were evaluated. Results: Congenital isolated penile torsion ≥60° was identified in 1.04 % (n=57) of the children. Eight patients whose torsion corrected after penile degloving were excluded from the study. 49 patients who underwent dorsal dartos flap rotation had a mean age of 4.94 years (1-9) and a mean operation time of 29.9 min (20-40). The mean degree of torsion was 77.6° (60-110). The mean operation times in the < 90° and ≥ 90° dorsal dartos flap groups were statistically significant (p<0.05). Residual torsion was statistically significant in the < 90° and ≥ 90° dorsal dartos flap groups (p<0.05). At the postoperative 1st and 6th month follow-ups, torsion less than 10 degrees was observed in 3 patients who underwent dorsal dartos flap rotation technique. No residual torsion was observed in other patients. Isolated penile torsion cases should not be overlooked during circumcision. It seems possible to obtain successful results with dorsal dartos flap rotation in moderate and severe torsions.

Accessory Penile Frenulum: May Go Unnoticed throughout the Journey to Graveyard

AbstractAn accessory frenulum of the penis is so rare that only four cases have been documented so far. We came across a case of 45-year-old, sexually active man who sought medical attention for right foot injury caused by a road traffic accident. During a detailed clinical evaluation, he was discovered to have double frenulum in his penis. Along with the normal ventral frenulum he had an additional dorsal frenulum located at the 10 O'clock position. No history of penile torsion could be elicited from the patient. He had completed his family by the time of presentation, without any symptom of sexual dysfunction or dyspareunia. He was not offered any treatment for this congenital anomaly as it did not have any functional or aesthetic implication. A literature review was conducted to determine the incidence, spectrum of clinical presentation, and management of this pathology.

PRIMARY REPAIR OF PROXIMAL (GRADE IV) HYPOSPADIAS UTILIZING TUNICA VAGINALIS VASCULARISED FLAP

Background: Proximal (grade IV) hypospadias like scrotal and perineal are considered as severe challenging types for surgeons, problematic for the patients and their families, More than three hundreds surgical techniques were used to manage different type of hypospadias . Most of them associated with high incidence of complications. These complications are much more common in the proximal types as in our study. Post-operative fistula formation is expected complications. Utilising the tunica vaginalis as an additional layer during repair may prevent such complications. In this study we evaluated the benefits of using the tunica vaginalis flap as a supportive layer in the primary repair. Most related literatures about this subject used this technique after surgery to manage cases with post-operative fistulas. In the contrary we used this technique during the formal surgery to cover the new urethra to prevent fistula formation not after surgery. Aims of the study: A retrospective study, on fourteen patients with severe hypospadias (Proximal types), to evaluate the role of tunica vaginalis flap in the primary repair of the hypospadias. Patients and Methods: Between January 2016 and January 2024, fourteen children with Grade IV hypospadias were operated on. Only severe cases were treated with this method other simpler and more common cases were treated by different surgeries like Snodgrass technique. The age range was 2 to 16 years. All of them had 2 staged repair the first stage was correcting the chordae by incising the urethral plate excising the fibrous chordae tissues then covering the bare shaft with dorsal flaps. The tunica flap was used in the second stage which was done 6 to 12 months later. Folly's catheter was used for ten to fourteen days after surgery. And the patients were followed for a variable time 3months to 2 years period for the development of complications like fistula formation or stricture. Cosmetic considerations were also noted. Results: All the fourteen patients had proximal types (Grade IV) hypospadias. After surgery all patients had a good cosmetic outcome no fistula formation two had mild distal urethral stricture cured after few urethral dilatation. No post-operative penile torsion was noted. Two patients developed local infection treated conservatively. One patient had partial glanular dehiscence at the distal end which had no clinical significance. One patient complained from on and off penile cutaneous swelling lasted 3 weeks. Conclusions: Using tunica vaginalis vascularised flap to cover the new urethra in severe proximal hypospadias during the second stage seems to be a successful way in preventing fistula formation without increasing the patient's morbidity.

Isolated Severe Congenital Penile Torsion of 180 Degrees

Isolated Severe Congenital Penile Torsion of 180 Degrees

PENILE TORSION OF A TWO-YEAR-OLD BOY: A CASE REPORT

Objective: This case report presented Penile Torsion in pediatrics. Case(s) Presentation: A two-year-old boy with a chief complaint of rotated penile to the right side since birth. There were 45º in clockwise torsion, slight chordee, and uncircumcised. Patient underwent penile reconstruction surgery, including penile degloving, urethral mobilization, and plication. After seven days follow-up, parents were satisfied with straight penile erection and no torsion at all. After 3 months follow-up, parents reported satisfaction with the surgical outcome such as cosmetic appearance, straight erection, and normal stream urine. Discussion: Surgical techniques ranging from simple penile degloving with foreskin repositioning to more complex surgical procedure involving corporeal tissue. Surgery by using degloving of penile skin and realignment could be suitable for penile torsion &lt;90°. For the cases of &gt;90°, other techniques should be considered such as corporopexy procedure, rotation flap of dorsal dartos, or diagonal suturing of corporeal folds away from and parallel to the neurovascular bundle. Conclusion: Penile reconstruction surgery using penile degloving, urethral mobilization, and plication for penile torsion showed satisfaction result including cosmetic appearance, penile erection, and normal urine flow.&#x0D; Keywords: Chordee, penile reconstruction, penile torsion.

Supernumerary Frenulum on the Dorsum of the Penis: A Case Report

A supernumerary frenulum on the dorsal aspect of the penis, without penile torsion, is a rare condition. The present case report presents a 29-year-old male who experienced pain during sexual intercourse. He noticed a band of tissue on the underside of his foreskin that prevented the retraction of his prepuce during his first attempted sexual intercourse. The present case illustrates a supernumerary frenulum, which is an additional band of tissue on the dorsal side of the penis, alongside the normally positioned frenulum. It is a natural anatomical variation. The high prevalence of neonatal religious circumcision and general ignorance likely contribute to the under-reporting of this anomaly. This condition can significantly impact an individual’s sexual life and personal hygiene. The present case was aimed to enhance understanding of the embryology, prevalence, clinical implications and management of this anomaly.

Correction of Penile Torsion by Dissection and Resection of the Dysplastic Dartos Fascia

Correction of Penile Torsion by Dissection and Resection of the Dysplastic Dartos Fascia

To Compare the Outcomes of Dartos Flap and Tunica Vaginalis Flap as Secondary Cover after Second Stage Durham Smith Repair in Reducing Post-Operative Complications

Background: Interposition flaps are mainstay in the success of hypospadias surgery because they lead to decrease in complications of hypospadias repair significantly especially urethrocutaneous fistula by buttressing the neo urethral suture line. Many interposition flaps have been tried with varying outcome results. Most commonly used interposition flaps are Tunica vaginalis flap and dorsal dartos flap however, recently interest have also researched in Durham smith de-epithelialized dartos based overlay flap. Though there are many publications comparing outcome of dorsal dartos and tunica vaginalis flap but hardly any study that has compared all three interposition flaps. So, we aimed to compare the outcomes of dorsal dartos flap (DF), tunica vaginalis flap (TVF) and Durham smith de-epithelialized dartos based overlay flap as interposition layer in TIP urethroplasty. Aim: To compare the outcomes of dorsal dartos flap (DF), tunica vaginalis flap (TVF) and Durham smith de-epithelialized dartos based flap as secondary interposition cover after Tubularized incised plate urethroplastyin reducing post-operative complication. Materials and Methods: A retrospective study was conducted in which case records of 78 patients who had undergone repair for distal and midpenile hypospadias with minimal chordee and favorable anatomy by the Tubularized incised plate urethroplasty with interposition flap over 2 years (2017-2019) were reviewed. Patients were divided in three groups with 26 subjects in each group. Group A consisted of patients with dorsal dartos interposition flap, Group B comprised of patients with Tunica vaginalis interposition flap and Group C consisted of patients with Durham smith deepithelialized dartos based overlay cover. Outcome variables noted were the complications including wound dehiscence, Urethrocutaneous fistula, Meatal stenosis, Penile torsion, skin necrosis and preputial edema. Statistical methods were applied to compare these complications in all three groups. Results: Total number of complications in group A were 11(42.3%) and most common complications were skin necrosis (n=7, 26.9%) and urethrocutaneous fistula (n=6, 23.1%). Total number of complications in group B were 7(26.9%) while Chordee and preputial edema (n=6, 23.1% each) were among the most common complications. 9(34.6%) patients developed complications in group C and most common complications were penile torsion (n=6, 23.1%) and urethrocutaneous fistula (n=4, 15.4%). Conclusion: We have seen in our study that TV flap is a good option as second cover with lesser complications especially in terms of fistula related complications while Durham smith onlay cover found to be equally better option as it showed no skin complications and other complications were almost comparable to TV flap cover.

To Compare the Outcomes of Dorsal Dartos Flap, Tunica Vaginalis Flap and Durham Smith De-Epithelialized Dartos Based Flap as Secondary Interposition Cover after Tubularized Incised Plate Urethroplasty in Reducing Post-Operative Complications

Interposition flaps are mainstay in the success of hypospadias surgery because they lead to decrease in complications of hypospadias repair significantly especially urethrocutaneous fistula by buttressing the neo urethral suture line. Many interposition flaps have been tried with varying outcome results. Most commonly used interposition flaps are Tunica vaginalis flap and dorsal dartos flap however, recently interest have also researched in Durham smith de-epithelialized dartos based overlay flap. Though there are many publications comparing outcome of dorsal dartos and tunica vaginalis flap but hardly any study that has compared all three interposition flaps. So, we aimed to compare the outcomes of dorsal dartos flap (DF), tunica vaginalis flap (TVF) and Durham smith de-epithelialized dartos based overlay flap as interposition layer in TIP urethroplasty. Aim: To compare the outcomes of dorsal dartos flap (DF), tunica vaginalis flap (TVF) and Durham smith de-epithelialized dartos based flap as secondary interposition cover after Tubularized incised plate urethroplastyin reducing post-operative complication. Materials and Methods: A retrospective study was conducted in which case records of 78 patients who had undergone repair for distal and midpenile hypospadias with minimal chordee and favorable anatomy by the Tubularized incised plate urethroplasty with interposition flap over 2 years (2017-2019) were reviewed. Patients were divided in three groups with 26 subjects in each group. Group A consisted of patients with dorsal dartos interposition flap, Group B comprised of patients with Tunica vaginalis interposition flap and Group C consisted of patients with Durham smith deepithelialized dartos based overlay cover. Outcome variables noted were the complications including wound dehiscence, Urethrocutaneous fistula, Meatal stenosis, Penile torsion, skin necrosis and preputial edema. Statistical methods were applied to compare these complications in all three groups.

SINGLE STAGE HYPOSPADIAS REPAIR IN PRIMARY CASES AND THEIR PATIENT RELATED OUTCOMES – TERTIARY CARE CENTER EXPERIENCE

Objective: This study aims to study whether hypospadias repair in primary cases can be done in a single stage. We present patients’ perspective and their outcomes in 268 primary hypospadias cases among which around 90% of patients (n=240) had their hypospadias surgery after recommended age of repair (18 months). All primary cases were managed in a single stage. Material &amp; Methods: From January 2010 – December 2019, 377 patients were included and outcomes were documented. Patients with prior hypospadias with complications (n=48), chordee without hypospadias (n=16), isolated penile torsion (n=12), and 33 patients who were lost to follow-up were excluded. The age at surgery, location of the meatus, chordee, associated anomalies, techniques used for correction, postoperative complications with overall success rate and patient related outcomes were evaluated. Results: After orthoplasty, distal hypospadias was seen in 59% (n=158), middle in 22.8 % (n=61) &amp; proximal in 13.1% (n=35) patients. Fourteen patients (5.2%) had penoscrotal transposition. Chordee was present in 71.2% (n=192) cases. Urethral closure was done using TIP alone in 18 cases, TIP, and spongioplasty (n=233). The success rate of one-stage surgery was 73.5% in our series which correlated with PRO with high significance. Conclusion: The rate of complications increased with the length of urethral tube reconstruction. Hypospadias fistula was the most common, followed by glanular dehiscence. The use of the TIP in primary repairs, spongioplasty &amp; additional buffering layers reduced the complication rates. Patients can have acceptable residual chordee and torsion and their surgical results correlated well with patient related outcomes(PRO).

Congenital Isolated Penile Torsion and Simple Surgical Repair in Children

Amaç: Amacımız konjenital izole penil torsiyon prevalansını saptamak ve basit bir teknik ile onarım sonuçlarını sunmaktır.Materyal ve Metot: Kliniğimize sünnet istemiyle 2016 ile 2019 yılları arasında başvuran 2650 erkek çocuk konjenital izole penil torsiyon açısından değerlendirildi.Torsiyon derecesi ve yönüne göre sınıflandırıldı ve klinik bulguları incelendi. Torsiyon derecesi &amp;gt;45 derece olan hastalara sünnet ve degloving uygulandı. Raphe mevcut konumunda bırakılarak frenilum-cilt yeniden hizalama ile torsiyon düzeltildi. Sonuçlar değerlendirildi.Bulgular: Çocukların %1,2 (n=32)’sinde &amp;gt;45° konjenital izole penil torsiyon tespit edildi. Torsiyon yönü %93,8 (n=30) hastada sola, %6,2 (n=2) hastada sağa idi. Hastaların %37,5 (n=12)’inde peniste eğrilik, okul çağındaki üç hastada peniste eğrilik ve yana işeme şikayeti vardı. Ameliyat sonrası hastaların %9,3 (n=3)’ünda kendiliğindendüzelen ekimoz görüldü. Hiçbir hastada rezidü torsiyon görülmedi.Sonuç: Çocuklarda &amp;gt;45° izole penil torsiyon oranı %1,2 idi. Raphe mevcut konumunda bırakıldığında basit ve güvenli bir yöntem olan degloving-cilt yeniden hizalama ile tüm torsiyonlar düzeltilebilir.

Factors Associated with Short Term Outcomes of Hypospadias Repair at the University Teaching Hospitals-Lusaka, Zambia

The study aimed to establish whether age at the time of surgery, glans size, urethral plate width, suture material, urethral catheter blockage/dislodgement and haemoglobin level influence short term outcomes of hypospadias surgery at the University Teaching Hospitals (UTH), Lusaka Zambia. This was a consecutive (total enumerative) observational cohort study done at D-block and Clinic 7 at UTH Lusaka over nine months. A total of 41 patients were enrolled, and their demographic data, haemoglobin, maximum glans width size and urethral plate size before creating glans wing or midline plate incision were noted and measured. Logistic regression assessed urethroplasty complications on urethral plate size, glans size, haemoglobin, suture material and catheter problems. The average age of participants was 34 months. Distal hypospadias was the most common type at 61%, while middle hypospadias was 27% and proximal hypospadias 12%. The complication rate was 34%. The most common complication seen was urethrocutaneous fistula at 53%. The other complications seen included 11.8% glanular dehiscence, 11.8% infections, 6% persistent chordee and 6% penile torsion. The risk factors for postoperative complications included the location of the urethral opening. The more proximal the site of the hypospadias, the higher the complication rate. Complications were strongly associated with haemoglobin levels of less than 11.5g/dl (p=0.001) and catheter blockage or dislodgment (p=0.008). There was no association of complications with Socioeconomic status, age at the time of repair, glans width size or suture material. Contrary to the finding of many authors, a wider urethral plate in this study was associated with a higher complication rate.

Comparison of Urethrocutaneous Fistula Rate After Single Dartos and Double Dartos Tubularized Incised Plate Urethroplasty in Pediatric Hypospadias.

Background and objectiveTubularized incised plate (TIP) urethroplasty is an easy and popular technique for repairing hypospadias, however urethrocutaneous fistula (UCF) is a frequently reported complication. Different techniques are used to reduce this complication. We aimed to compare the rate of UCF after single dartos and double dartos TIP urethroplasty in children with distal and mid penile hypospadias.MethodsA randomized controlled trial (NCT 04699318) was conducted in the Department of Pediatric Surgery, Mayo Hospital, Pakistan from August 2017 to February 2018, after ethical approval. After informed consent, a total of 60 patients with distal and mid penile hypospadias who were uncircumcised, had no chordee, and/or previous surgery, were randomly allocated in two groups using computer generated table numbers. Group A underwent single dartos TIP urethroplasty and Group B underwent double dartos TIP urethroplasty. Catheter was removed on day 10 post-operatively in both groups and primary outcome (UCF) was noted after a week of catheter removal. Rate of UCF was compared using chi square and p-value of <0.05 was taken as significant. Data was stratified to check for effect modifiers.ResultsOut of 60 children, eight (13.3%) developed UCF. In Group A, seven (23.3%) developed UCF and in Group B, one (3.3%) developed UCF (p-value 0.02). In both groups, no patient (0%) had urethral disruption, penile torsion, skin necrosis or meatal stenosis.ConclusionAdditional covering of neo-urethra by a double dartos layer significantly reduces fistula rate after tubularized incised plate urethroplasty in both primary distal and mid penile hypospadias.

Efficacy of fibrin sealant as waterproof cover in improving outcome in hypospadias surgery.

Background:This prospective comparative study aims to assess the efficacy of fibrin sealant to improve outcomes in paediatric patients operated for hypospadias.Materials and Methods:Forty consecutive patients with hypospadias were randomised into two groups of twenty patients each. The first group underwent hypospadias repair, technique depending on the type of hypospadias, whereas in the second group, fibrin sealant was used to reinforce the urethroplasty. Assessment was done with respect to the type of hypospadias, type of repair done, operative time, immediate post-operative complications (early ooze and skin flap-related complications), intermediate complications (urethra-cutaneous fistula) and delayed post-operative complications (penile torsion and poor cosmetic outcome) at follow-up. We also compared the overall improvement in outcome among the two groups.Results:First Group: The mean operative time was 1 h and 45 min. Complications were seen in nine patients: Early ooze (n = 2); skin flap-related complications (n = 3); fistula (n = 7); poor cosmetic outcome (n = 7) and penile torsion (n = 4). Second Group (Fibrin Sealant): The mean operative time was 1 h and 30 min. Post-operative complications were observed in five patients: Coronal fistula (n = 3) and poor cosmetic outcome (n = 3). On comparing, the differences in outcomes of ooze, skin flap-related complications and torsion were found to be statistically significant with P < 0.05. The differences in the urethra-cutaneous fistula and cosmetic appearance were not found to be statistically significant. The difference in overall improvement in complications was found to be statistically significant.Conclusion:Fibrin sealant, when applied over the urethroplasty suture line as a waterproof cover, may help to improve the outcome in patients with hypospadias.

Modified Snodgrass Repair for Hypospadias: Outcome at a General Surgical Unit

Background: Hypospadias occurs in around one in 200-300 male live births and is the most common congenital abnormality of the urethra. There are three characteristic features; Firstly the external meatus opens on the underside of the penis or the perineum, secondly the ventral aspect of the prepuce is poorly developed ('hooded prepuce') and thirdly there is usually a ventral deformity of the erect penis (chordee). Many methods have been used to repair hypospadias. We worked on Modified Snodgrass repair for mid-shaft and distal hypospadias in a General Surgical Unit. Objective: To study the outcome of Modified Snodgrass Repair with respect to outcome and post operative complications like fistulas, disruption, meatal stenosis, residual chordae ,penile torsion and infections.Material and Methods: All patients with hypospadias according to exclusion and inclusion criteria admitted to Surgical B unit of Saidu Teaching Hospital from 1st January 2015 to 21st December, 2019 were entered in the study. U shape incision was made around the urethral plate. Urethral incisions were extended to the mid-glans. Urethral plate was incised in center upto midglans. After tubularization of urethral plate and circumferential incision proximal to coronal sulcus from each edge of urethral plate, the penile skin was degloved upto or near to penoscrotal junction depending upon extent of chordee. Neourethra was formed and covered by Dorsal Dartos facial flap which was slit in the centre and brought out to ventral surface by passing the glans through the slit. The child was followed after a week to change dressing and after 10 days to remove catheter and then after one month and three months for checking complications and outcome.Results: Total of 100 subjects were included in study,(67%) having anterior and (43%) having middle hypospadias. Mean age was 3.7 years. Complications were recorded in 21% of patients. Urethro cutaneous fistula in 9%, Total disruption in 1%, Infections in 5%, Meatal stenosis in 2% ,Catheter blockage in 2% and penile torsion occurred in 2% of patients. 97% cases had good cosmetic shape. The fistulas were repaired after 6 months in two layers and had satisfactory results.Conclusion: A properly performed Modified Snodgross repair can be performed in General Surgical Unit with reasonable efficacy if expertise is available

&lt;p&gt;Congenital Isolated Penile Torsion: A Case Report in 2 Brothers&lt;/p&gt;

&lt;p&gt;Congenital Isolated Penile Torsion: A Case Report in 2 Brothers&lt;/p&gt;

Using two “V” shaped flaps in penile torsion treatment

Introduction: Penile torsion is a congenital malformation that causes a rotational deformity of the penile shaft. Several techniques have been considered for penile torsion repair. In this study, we described our experience using two separate “V” dartos flaps, which leads to a more satisfying result. Patient and methods: Two young men with severe penile torsion aged 24 and 28 years old were candidates for surgery. During our novel method for penile torsion repair, we degloved the penis and dissected the dartos fascia from the penis shaft, then cut it distally from the sub-coronal region with a longitudinal cut to make two dartos flaps in a “V” shape. With these two flaps, we corrected penile torsion in a more satisfying way without crossing the urethra. Results: Penile torsion and concurrent chordee were completely corrected after surgery. Urine culture was sterile and uroflowmetry indicated a maximal urinary flow of 12 ml/s 3 months after the operation. Both patients were satisfied with ejaculation and their follow-up indicated complete resolution of penile torsion. Conclusions: Penile torsion is a challenging congenital anomaly. We used a two “V” shaped flap passage method to complete penile rotation and chordee correction without performing any plication techniques. Our penile torsion correction procedure resulted in the successful repair of torsion and excellent outcomes. Level of evidence: Not applicable for this multicenter audit.

Update in management of Congenital Penile Curvature complex .

Background:Congenital curvature of the penis results from abnormal efflorescence of the tunica albuginea of the corpora cavernosa and not accompanied with urethral anomaly. Complex Congenital curvature of the penis has two abnormal elements : mal-rotation either clockwise or anti clockwise and curvature of the penis either dorsal or ventral. Aim of the work: To present update in management of congenital curvature complex of the penis. Background: Congenital curvature of the penis results from abnormal efflorescence of the tunica albuginea of the corpora cavernosa and not accompanied with urethral anomaly. Complex Congenital curvature of the penis has two abnormal elements: mal-rotation either clockwise or anti clockwise and curvature of the penis either dorsal or ventral. Aim of the work: To present update in management of congenital curvature complex of the penis. Patients and Methods:This prospective study done at Al-Azhar University Hospital in Damietta. Fifteen patients [15] with congenital curvature complex of the penis were evaluated and corrected from June. 2019 to January 2020, their mean age was 5.1 ± 2.34 years [range 2–10 year]. The direction of torsion was anticlockwise in 12 patients and in 3 patients was clockwise. Four patients had dorsal curvature and Eight patients had ventral curvature, while three patients had lateral curvature. All patients treated at first by modified Nesbit's procedure for correction of curvature, then dorsal flap of dartos layer for correction of penile torsion in one stage. Results: All cases with congenital curvature complex of the penis corrected in one-set surgery, which is simple, familiar and safe procedure with high successful rate. There were only a few transient complications, such as edema, mild bleeding, and penile hematoma resolved spontaneously. No recurrence of mal-rotation or curvature reported. Conclusion: Congenital Penile Curvature Complex can be treated in single-stage surgery with excellent functional and cosmetic outcomes by combination of modified Nesbit's procedure with dorsal flap of dartos layer. Patients and Methods:This prospective study done at Al-Azhar University Hospital in Damietta. Fifteen patients (15) with congenital curvature complex of the penis were evaluated and corrected from June. 2019 to January 2020 ,their mean age was 5.1 ± 2.34 years (range 2–10 y). The direction of torsion was anticlockwise in 12 patients and in 3 patients was clockwise. Four patients had dorsal curvature and Eight patients had ventral curvature, while three patients had lateral curvature. All patients treated at first by modified Nesbit's procedure for correction of curvature, then dorsal flap of dartos layer for correction of penile torsion in one stage.Results:All cases with congenital curvature complex of the penis corrected in one-set surgery, which is simple, familiar and safe procedure with high successful rate.There were only a few transient complications, such as oedema, mild bleeding, and penile hematoma resolved spontaneously. No recurrence of mal-rotation or curvature reported.Conclusion: Congenital Penile Curvature Complex can be treated in single-stage surgery with excellent functional and cosmetic outcomes by combination of modified Nesbit's procedure with dorsal flap of dartos layer.

Use of human amniotic membrane repair of anterior urethral defect: First clinical report.

To evaluate the use of human amniotic membrane allograft to prevent urethrocutaneous fistula after tubularized incised plate repair for redo-hypospadias and anterior urethral defects. This pilot study included 28 patients (mean age 25.3±11years) with a history of previous failed hypospadia repair, who underwent tubularized incised plate urethroplasty in one session by the same surgical team from April 2016 to April 2019. After the reconstruction of a neourethra and proper hemostasis, a human amniotic membrane allograft - Grafting Scaffold - was used to cover the suture lines. The mean follow-up time was 13.3±4.5months. Two urethrocutaneous fistulas occurred within the first 2weeks after the surgery, one of which was caused by the infection of the surgical site. No penile torsion, urethral diverticula, meatal stenosis or glans dehiscence was reported. Amniotic membrane graft provides an applicable, low-cost, feasible, biodegradable and safe second cover in redo-hypospadias repairs by tubularized incised plate technique. Its use is technically easy; it has satisfactory cosmetic outcomes and might decrease urethrocutaneous fistula formation.

MP65-08 DIFFICULTIES IN LONG-TERM FOLLOW-UP AFTER SURGERY FOR DISTAL HYPOSPADIAS: A REALITY THAT EXCEEDS OUR EXPECTATIONS!

You have accessJournal of UrologyPediatrics: Hypospadias and Penile Surgery (MP65)1 Apr 2020MP65-08 DIFFICULTIES IN LONG-TERM FOLLOW-UP AFTER SURGERY FOR DISTAL HYPOSPADIAS: A REALITY THAT EXCEEDS OUR EXPECTATIONS! Leopold A. Azakpa, Liza Ali, Matthieu Peycelon*, Anthony Kallas-Chemaly, Goharig Enezian, Yves Aigrain, Christine Grapin-Dagorno, Pascale Philippe-Chomette, Annabel Paye-Jaouen, and Alaa El Ghoneimi Leopold A. AzakpaLeopold A. Azakpa More articles by this author , Liza AliLiza Ali More articles by this author , Matthieu Peycelon*Matthieu Peycelon* More articles by this author , Anthony Kallas-ChemalyAnthony Kallas-Chemaly More articles by this author , Goharig EnezianGoharig Enezian More articles by this author , Yves AigrainYves Aigrain More articles by this author , Christine Grapin-DagornoChristine Grapin-Dagorno More articles by this author , Pascale Philippe-ChomettePascale Philippe-Chomette More articles by this author , Annabel Paye-JaouenAnnabel Paye-Jaouen More articles by this author , and Alaa El GhoneimiAlaa El Ghoneimi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000940.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Evaluating the outcomes of distal hypospadias surgery for a better standard of care requires long-term follow-up (FU). The aim of this study was to report adherence to a FU protocol and to analyze underlying challenges of long-term FU by evaluating long-term complications. METHODS: A retrospective study identified all patients operated upon for a distal hypospadias by 5 surgeons (2002-2010). The standard protocol for follow-up protocol was a clinical examination at 1 month after surgery, at 1 year, after being toilet-trained, and every 5 years until puberty. Uroflowmetry was performed at every visit after being toilet trained. All children who missed at least one visit were contacted by phone or mail for a new visit. The primary outcome was adherence to the FU protocol. Non-parametric tests were used for statistical analysis. RESULTS: A total of 345 children were included in the study. The median age at surgery was 14 months (5 months–13 years). Ventral couverture and penile torsion were identified in 36.3% and 11.4% respectively. 149 (43.2%) patients had a FU of less than 1 year. 40 (11.6%) patients never returned to clinic after surgery. 196 (56.8%) and 87 (25.2%) patients had a FU at 1 and 5 years without requiring to reschedule an appointment. A total of 226 children were contacted and 58 (25.7%) of these subsequently returned for a clinical exam. When accounting for all FUs, 239 (69.3%) and 123 (35.7%) patients had a check-up at 1 and 5 years. Surgical procedures included tubularized incised plate urethroplasty (TIPU) in 142 (59.4%) children and Thiersch-Duplay urethroplasty in 84 (35.1%). Median FU was 5.5 years (1-14). At puberty, 6 (1.7%) came spontaneously at the clinic and 51 (14.8%) after being called and mailed. We did not identify risk factors to stop being followed-up. The urethral complication rate was 15.9% (38/239) (10.0% fistula, 4.6% stenosis) at 5 years with 54% identified after 1 year of FU. Initial perioperative evaluation (type penile curvature and torsion), surgical procedure, and experience of the pediatric urologist were not identified as a risk factor for urethral complications (overall, fistula and stenosis respectively). CONCLUSIONS: Postoperative FU after distal hypospadias surgery is a challenge. The difficulties of following children who undergo a surgery for distal hypospadias are real. Standardizing postoperative FU is necessary. Expressing the risk of complications to families is critical. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e976-e976 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leopold A. Azakpa More articles by this author Liza Ali More articles by this author Matthieu Peycelon* More articles by this author Anthony Kallas-Chemaly More articles by this author Goharig Enezian More articles by this author Yves Aigrain More articles by this author Christine Grapin-Dagorno More articles by this author Pascale Philippe-Chomette More articles by this author Annabel Paye-Jaouen More articles by this author Alaa El Ghoneimi More articles by this author Expand All Advertisement PDF downloadLoading ...