Presence Of Chordee Research Articles

Modified Hinderer's Technique for Serious Proximal Hypospadias with Ventral Curvature: Outcomes and Our Experience.

Hypospadias is a congenital anomaly that includes defi¬cient ventral structure of the penis. Proximal hypospadias cases make up 20% of all hypospadias cases. The choice of operative technique for hypospadias repair depends on the severity, and it is influenced by the surgeon's experience and perception of where priorities should lie. Several other factors interact to determine the type of repair, such as meatal site, presence of chordee, availabil-ity of the prepuce, and quality of the urethral plate and in addition surgeon's experience affects the type of repair. The treatment records of 42 penoscrotal and perineal hypospadias cases that were treated in our clinic from 1998 to 2017 were reviewed retrospectively. Cases with penoscrotal and perineal meatus were included in the study at the beginning of the urethroplasty. All cases had surgical intervention via Hinderer's tech-nique. Acceptable cosmetic results were obtained in 37 (85%) patients with an objective scoring system (HOSE) for evaluating the results of hypospadias surgery score. The mean score after surgery was 14.8. Fistula and wound breakdown occurred in 7 out of the 42 cases. In conclusion, the modified Hinderer's technique is a safe and reliable technique for both proximal and perineal hypospadias. Low complication rates and application in a single surgical session increase the comfort of both the patient and the surgeon.

Comparative study of two different procedures for primary hypospadias repair

Background: Different modalities of procedures for hypospadial repair have been described in the literature. Data about the outcome of two main different procedure of repair are scares from Iraq. The aim of this study is to compare the results of these two methods of hypospadias repairs. The present study compared two single stage hypospadias repairs, namely, tubularized incised plate (Snodgrass) repair and Mathieu’s repair.Methods: It involved 50 patients diagnosed with penile hypospadias, from March 2011 to April 2015 at the Department of Surgery, Al-Karama Teaching Hospital. After a detailed history, local examination was performed with reference to the site of meatus, shape of glans, and presence of chordee, patients were randomly assigned as Group A of 26 patients in whom Snodgrass repair was accomplished and Group B having 24 patients in whom Mathieu’s repair was performed. On follow-up, the patients were examined for the position of meatus, shape of meatus, urinary stream, urethra-cutaneous fistula, and stricture formation.Results: The results showed that the mean age of presentation was 7±6 years (range 1-13years). The mean operative time was 90±15 (75-105) minutes and 60±15 (45-75) minutes in Snodgrass and Mathieu’s repair respectively. Complications after surgery were urethero-cutaneous fistula in 2(7.69%) and 4 (16.67%), meatal stenosis in 1(3.84%) and 2(8.33%), wound infection in 4(15.38%) and 3(12.5%) cases in Snodgrass repair and Mathieu repair, respectively, wound dehiscence was equal in Snodgrass repair and Mathieu repair.Conclusions: It can be concluded that the cosmetic results were excellent with Snodgrass repair with a normal looking slit like meatus.

Hypospadias repair with onlay preputial graft: a 25-year experience with long-term follow-up.

To evaluate the long-term outcomes of hypospadias repair using an onlay preputial graft. Patient records from 1989 to 2013 were retrospectively reviewed. One surgeon performed all cases and surgical technique was the same for all patients. There were 62 patients in the cohort, with a mean (range) follow-up of 47.4 (1-185) months. The meatal location was separated into distal (one patient), midshaft (19) and proximal (42). In all, 22 (35.5%) patients had complications. There were three main types of complications, including meatal stenosis in three (4.8%), stricture in three (4.8%), and fistula in 21 (33.9%). The mean (range) timing of presentation with a complication after surgery was 24.9 (1-127) months. In all, 54.5% of the patients with complications presented at ≥1 year after the initial surgery and 31.8% presented at ≥3 years. On univariable analysis age at the time of surgery, length of the graft, presence of chordee or meatal location (proximal or midshaft) did not predict a complication. The width of the graft was associated with a complication, with each 1 mm increase in width decreasing the odds of a complication by 56%. On multivariable analysis width remained statistically significant (odds ratio 0.44, 95% confidence interval 0.230-0.840; P = 0.013) for predicting a complication. Hypospadias repair with onlay preputial graft is an option for single-stage repair, especially in cases of proximal hypospadias or where the urethral plate width and/or the glanular groove is insufficient for other types of repair. Compared with flaps, the use of grafts may decrease the risk of penile torsion and prevent less bulk around the urethra, improving skin and glans closure.

Comparative Study of Snodgrass and Mathieu’s Procedure for Primary Hypospadias Repair

Objective. Present study was undertaken to compare the results of two single stage hypospadias repairs, namely, Tubularized Incised Plate (TIP) repair and Mathieu's repair. Methods. The study included 100 patients of distal penile hypospadias, from January, 2008 to January, 2013. After a detailed history, local examination was performed with reference to the site of meatus, shape of glans, and presence of chordee. TIP repair was performed in 52 patients and Mathieu's repair in 48 patients. On follow-up, the patients were examined for the position of meatus, shape of meatus, urinary stream, urethrocutaneous fistula, and stricture formation. Results. The mean age of presentation was 6.2 ± 3.2 years (range 1.5–15years). The mean operative time was 63.7 ± 14.3 (45–90) minutes and 95.0 ± 19.1 (70–125) minutes in TIP and Mathieu's repair, respectively.Complications after surgery were urethero cutaneous fistula in 3(5.76%) and 7 (14.5%), meatal stenosis in 3(5.33%) and 4(8.33%), wound infection in 19.2% and 8.3% cases in TIP repair and Mathieu repair, respectively. The shape of meatus was slit-like and vertically oriented in 48(92.3%) patients who had undergone TIP repair. Conclusion. The Snodgrass repair is significantly faster, with more natural cosmetic appearance of the meatus than the Mathieu's repair.

The management of moderate and severe congenital penile torsion associated with hypospadias: Urethral mobilisation is not a panacea against torsion

ObjectivesTo evaluate the effectiveness of urethral mobilisation for correcting moderate and severe penile torsion associated with distal hypospadias. Patients and methodsNineteen patients with distal hypospadias and congenital moderate and severe penile torsion were treated surgically. The hypospadias was at the distal shaft, coronal and glanular in seven, eight and four patients, respectively, and six had mild chordee. The mean (SD, range) angle of torsion was 94.7 (19.9, 75–160)°. The urethra was mobilised down to the perineum. If the urethral mobilisation was insufficient the right border of the tunica albuginea was anchored to the pubic periosteum. The hypospadias was repaired using the urethral mobilisation and advancement technique, with a triangular plate flap for meatoplasty. The patients were followed up for 12–18months. ResultsAll patients had a successful functional and cosmetic outcome, with no residual torsion. Two patients had a small subcutaneous haematoma that resolved after conservative treatment. Massive oedema occurred in three patients and was treated conservatively. Urethral mobilisation did not correct the penile torsion completely. Although the mean (SD, range) angle of torsion was reduced to 86.1 (14.3, 65–130)°, statistically significantly different (P=0.001), it was not clinically important. The presence of chordee had no significant correlation with the reduction of penile torsion. ConclusionUrethral mobilisation cannot completely correct moderate and severe penile torsion but it might only partly decrease the angle of torsion. Periosteal anchoring of the tunica albuginea might be the most reliable manoeuvre for the complete correction of penile torsion.

Foreskin Reconstruction Reduces the Complication Rate of Distal Hypospadias Repair

Purpose In our centre during distal Hypospadias repair the preference is to reconstruct the foreskin, unless parents request circumcision (e.g. for religious reasons). Our hypothesis is that foreskin reconstruction in distal Hypospadias reduces the long-term risk of complications. This study aims to test this hypothesis by retrospectively comparing the complication rates of distal Hypospadias repairs with and without foreskin reconstruction. Material and Methods A retrospective case note review was performed of distal Hypospadias repairs between September 2003 and December 2006. Information about type of Hypospadias, presence of chordee, surgical procedure, surgeon, post-operative complications including readmission, urethral fistulae, wound infection and dehiscence, meatal stenosis, foreskin complications, and details of any further surgery were recorded. Comparisons were made using Fisher exact test, p Results 146 cases were identified (Matthieu 130, Snodgrass 8, MAGPI/meatoplasty 8). 117 (80%) had foreskin reconstruction and 29 (20%) were circumcised. 12 were lost to follow-up. Follow-up averaged 3.3 years (range 2.3 to 5.7). Long-term complications (3 fistulae, 7 foreskin complications) occurred in 10 of 110 (9%) of foreskin reconstructions, and 6 of 24 (25%) in the circumcised group (2 fistulae, 2 meatal stenoses, 2 dehiscences). Foreskin reconstruction significantly reduced long-term complications, p Conclusions Foreskin repair significantly reduces complications in distal Hypospadias repair, and is a reliable technique for both specialists and trainees.

Urethral duplication with chordee – surgical management

Background Urethral duplication may be evident at birth or may present later in childhood with a double urinary stream, or infection. Methods In a retrospective review at 3 institutions, 13 cases of urethral duplication were identified between 1987-2004, ranging in age from 1 day to 14 years. Evaluation consisted of radiographic imaging, intraoperative urethroscopy and artificial erections. The urethral configuration, meatal position, presence of chordee and any associated anomalies were assessed. Results All boys were identified with a double meatus of which 54% had epispadias and 15% had hypospadias with a relatively normal position of the anomalous meatus. Voiding cystography or a retrograde urethrogram was beneficial to classify these lesions. Vesicoureteral reflux or ureteral ectopia was present in 15 of boys. According to the classification proposed by Effman – 15% of boys were Type II A1 and the balance were Type II A2. Operative management consisted of dorsal urethrectomy, often with release of suspensory ligament, in order to fully resect the extra urethra, as well as chordeelysis or ventral penile plication in 69% of patients. Surgical techniques will be reviewed. Surgery was uniformally successful with follow –up of 10 months-16 years. Conclusions Dorsal urethrectomy is curative for urethral duplication with concomitant chordeelysis or plication. Surgery should ideally be accomplished during infancy, as genital resconstructive surgery is best tolerated in this age group.

Investigation of factors affecting result of distal hypospadias repair: Comparison of two techniques

Objectives To evaluate the factors affecting the results, as well as the success of two techniques, by retrospectively investigating cases of distal hypospadias in which the patients had undergone Mathieu urethroplasty or tubularized incised plate urethroplasty. Methods We retrospectively evaluated 117 patients who underwent distal hypospadias repair. A percutaneous suprapubic catheter (Cistofix) and urethral split catheter were placed as a diversion in the 41 patients undergoing Mathieu urethroplasty. The Cistofix and urethral catheter were placed in 35 patients and a urethral catheter was placed in 41 of the patients who underwent tubularized incised plate urethroplasty. The success rates were compared according to the surgical technique, age, hypospadias status (primary or secondary), type of urinary diversion, and presence of chordee. Results No statistically significant difference in the success rate was found between the two techniques. Furthermore, the different types of diversion used in tubularized incised plate urethroplasty did not affect the success rate. When the success of primary hypospadias repair (n = 84) was compared with secondary hypospadias repair (n = 33), success in patients with secondary hypospadias was low. No difference was observed when operational success was compared in terms of patient age (older versus younger than 5 years of age) or the presence or absence of chordee. Conclusions Our results have shown that tubularized incised plate urethroplasty should be preferred for distal hypospadias because of the better cosmetic results, invasive urinary diversions should be avoided, and the most importance should be given to the initial surgical intervention.

A Prospective Audit of Hypospadias Correction in a Regional Paediatric Surgery Centre

To prospectively review the management and treatment of hypospadias in a single regional centre, and in particular, to assess the spectrum of cases treated, techniques used and to determine the nature of the complications. One hundred and fifty-three consecutive boys undergoing hypospadias repair during a 36-month period were included in the study. Information was collected prospectively and included the site of the urethral meatus, presence of chordee, surgical technique employed, use of urinary diversion, and the prescription of postoperative antibiotics and analgesics. Patients were assessed in the clinic following surgery at which time information on outcome and complications was obtained. One hundred and fifty-seven procedures for hypospadias were performed. Single-stage reconstruction was performed in 145 boys. GRAP (glanular reconstruction and preputioplasty) repair was the most common operation employed (n=112). The overall fistula rate was 11.7 % with the majority of patients having a satisfactory functional and cosmetic outcome following surgery. A variety of techniques can be employed to provide satisfactory correction of hypospadias with an increasing emphasis on single-stage day case procedures. GRAP repair is the favoured option for distal hypospadias and incorporates preservation of the prepuce.

Modified Mathieu’s surgical procedure for distal penile hypospadias—our institutional experience

Aims and Objective: This study was carried out to show modified Mathieu’s procedure to reduce the rate of complications of Mathieu’s procedure for the repair of primary distal hypospadias. Settings and Design: Prospective study. Materials and Methods: This study was carried out in the Department of Paediatric Surgery from March 2012 to March 2016. Children between 3 and 12 years were included in the study. We managed 40 patients with primary distal hypospadias. Those who had previous repair, chordee were excluded from the study. After a detailed history, local examination was performed with reference to the site and shape of meatus, glandular groove, penile size, and presence of chordee. Modified Mathieu’s was performed in 40 patients. On follow-up, the patients were examined for the position and the shape of the meatus, urinary stream, urethrocutaneous fistula, and stricture formation. Statistical Analysis Used: Done. Results: The mean age of the presentation was 7.5 ± 2.68 years (range 3–12 years). The mean operative time was 52.37 ± 5.42 min in modified Mathieu’s repair. Complications after surgery were urethrocutaneous fistula in one (2.5%), glandular disruption in 2 (5%), meatal stenosis in zero, wound infection in zero cases in modified Mathieu’s repair. The shape of meatus was near to rounded in all patients who had undergone modified Mathieu’s repair, which was accepted by parents cosmetically and with urinary stream in our study. Conclusion: The modified Mathieu’s repair is significantly faster with less complication in spite of having round-shaped meatus, which was cosmetically and with good urinary stream accepted by parents in our study.