Primary Hypospadias Repair Research Articles

Comparative Study Between Tubularized Incised Urethral Plate and Tubularized Incised Plate with Preputial Graft in Hypospadias Repair

Background: Hypospadias is a common congenital anomaly, affecting approximately 1 of 300 live male births making hypospadias the second most common birth defect in boys after cryptorchidism. there are more than 100 techniques for urethral reconstruction among these techniques the tubularized incised urethral plate (TIP) which was proposed by Snodgrass in 1994 has been the most popular technique for the repair of primary hypospadias. Objective: To study the difference between tubularized incised urethral plate and tubularized incised plate with preputial graft in hypospadias repair. Patient and methods: This prospective randomized study included sixty patients suffering from hypospadias who was admitted to the urology department of Menoufia and Kafr El-Sheikh University Hospitals from December 2018 to June 2020 which were randomized into two groups; group I underwent the classic TIP repair and group II underwent TIP repair with inlay preputial graft. Operative details, postoperative complications were reported also uroflowmetry was done for all cases at the 3rd and 6th months postoperatively. Results: There was no significant difference between both techniques regarding the postoperative complications and overall success rate (P 0.718) which were 83.3% and 86.7% in A and B respectively. The uroflowmetry at 3rd month postoperatively showed no significant groups difference in Q max between both groups (p >0.05) while there was a significant improvement in Q max in the 6th month in the grafted group (p. 0.001) Conclusion: despite both the classic TIP repair and TIP with preputial graft were comparable according to the overall success rate and postoperative complications the grafted TIP was more superior to classic TIP in the functional outcomes which were assessed by the uroflowmetry (Q max).

Plate Objective Scoring Tool (POST); An objective methodology for the assessment of urethral plate in distal hypospadias

Estimation of the quality of the urethral plate (UP) seems to be important when assessing postoperative outcomes of hypospadias repair, but its evaluation remains subjective. We developed an objective model aiming to standardize this assessment, proposing a methodology that could be adopted in future studies designed to evaluate outcomes in the treatment of hypospadias. To evaluate the inter and intra observer reliability of a method to assess the quality of the urethral plate (UP) in hypospadias (POST - Plate Objective Scoring Tool) based on elements of glans characteristics. The reliability of such scoring methodology was compared to an analog accepted tool: the Glans-Urethral Meatus-Shaft (GMS) score. A secondary goal was to compare some characteristics of the UP in GMS score to POST values; aiming to find the threshold between favorable and unfavorable plates. Data were prospectively obtained from prepubertal boys who underwent primary hypospadias repair between January 2018 and November 2019. Intrinsic elements of the glanular UP (A: distal midline mucocutaneous junction; B: Glanular knob where the mucosal edges of the UP's edge change direction; C: Glanular/coronal junction) were marked and the AB/BC ratio calculated. The "G" and "M" components of the GMS score were measured electronically three times by four different reviewers with variable pediatric urology experience and blinded to each other values. Favorable UP, according to the GMS score was compared to measurements obtained by POST (AB/BC ratio). 84 subjects were enrolled. The POST score had an excellent inter-observer agreement for the evaluation of the UP in distal hypospadias (Kappa=0.832) while the "G" parameter of the GMS correlated poorly among the observers. The Inter-Class Correlation (ICC) analysis to examine the intra-rater agreement value was 0.914 (95% CI 0.87, 0.95.). AB/BC ratio values ranged from 0.6 to 1.6, with a mean of 1.12. The POST cut-off value for "favorable" UP was 1.2 (AUC=0.62) 95% CI (0.52-0.84) (sensitivity 80% and specificity 60%). The POST score has higher inter-observer reliability and functions favorably when compared to the GMS. In addition, it demonstrated a high intra-observer reliability among observers of variable experience. Our findings suggest that the POST score adds to evaluation of the UP and could be incorporated as an additional criterion to assess outcomes in distal hypospadias repairs.

The Success Level of Hypospadias Repair in Adults.

IntroductionHypospadias is the abnormal opening of the urethra at the undersurface of the penis. Hypospadias repair is performed in such patients to treat the condition. The success level of hypospadias repair in adults still needs to be established on a larger scale. Therefore, we conducted this study to document the success level of hypospadias repair in adults in our setting to add to the literature.Materials and methodsThis prospective study was conducted at a major metropolitan hospital in Karachi over a period of six months. A total of 75 male patients aged between 20-50 years and diagnosed with hypospadias of any level with or without mild to moderate chordee were included. Demographic features such as age and the duration of hypospadias were noted. Hypospadias repair using a tubularized incised plate (TIP) urethroplasty technique was performed, and the patients were observed for three days in the ward and for three months in the outpatient department for any complications. The procedure was considered a success if there were no complications and no need for a second surgery; we also took into account patient satisfaction with the procedure to determine the success level. The mean and standard deviation were calculated for patient age and the duration of hypospadias. Frequency and percentages were calculated for distribution of patient age, distribution of the duration of hypospadias, and the success of hypospadias repair. The correlation of patient age and the duration of hypospadias with the success of hypospadias repair was also determined by applying the Chi-square test, and a p-value of ≤0.05 was considered to be statistically significant.ResultsThe mean age and the duration of hypospadias for the study population were the same at 31.43 ± 8.47 years. Distribution of patient age and the duration of hypospadias was also the same with 51 (68%) patients of ≤35 years of age and 24 (32%) patients of >35 years of age. Hypospadias repair was successful in 52 (69.33%) patients but unsuccessful in 23 (30.66%). The stratification of patient age and the duration of hypospadias with the success of hypospadias repair showed a significant inverse relationship (p = 0.017). The data relating to patient age and the duration of hypospadias showed the same values as hypospadias is a birth defect.ConclusionAdult patients undergoing primary hypospadias repair generally show good outcomes. However, the chances of favorable outcomes gradually decrease with age. Hence, patients should be encouraged to undergo the procedure as early in their lives as possible. Patients who are middle-to-old aged should especially be counseled about the relatively higher risk of unsuccessful procedures. Further analysis is needed to confirm the validity of these findings.

191 - The role of one-stage buccal mucosal graft urethroplasty for secondary anterior urethral strictures following failed primary hypospadias repair: Long-term outcomes from a high volume referral center

191 - The role of one-stage buccal mucosal graft urethroplasty for secondary anterior urethral strictures following failed primary hypospadias repair: Long-term outcomes from a high volume referral center

MP35-15 ONE-STAGE BUCCAL MUCOSAL GRAFT URETHROPLASTY FOR SECONDARY ANTERIOR URETHRAL STRICTURES FOLLOWING FAILED PRIMARY HYPOSPADIAS REPAIR: 10-YEAR EXPERIENCE FROM A REFERRAL CENTER

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I (MP35)1 Apr 2020MP35-15 ONE-STAGE BUCCAL MUCOSAL GRAFT URETHROPLASTY FOR SECONDARY ANTERIOR URETHRAL STRICTURES FOLLOWING FAILED PRIMARY HYPOSPADIAS REPAIR: 10-YEAR EXPERIENCE FROM A REFERRAL CENTER Malte W. Vetterlein*, Justus Stahlberg, Omar Bahassan, Oliver Engel, Roland Dahlem, Margit Fisch, and Silke Riechardt Malte W. Vetterlein*Malte W. Vetterlein* More articles by this author , Justus StahlbergJustus Stahlberg More articles by this author , Omar BahassanOmar Bahassan More articles by this author , Oliver EngelOliver Engel More articles by this author , Roland DahlemRoland Dahlem More articles by this author , Margit FischMargit Fisch More articles by this author , and Silke RiechardtSilke Riechardt More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000879.015AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical reconstruction of secondary urethral strictures following failed primary hypospadias repair is challenging due to impaired vascularization of the ventral shaft skin. Evidence is sparse regarding the role of one-stage procedures in this setting. We here provide long-term outcomes of a large series of patients undergoing one-stage buccal mucosal graft urethroplasty (BMGU) for hypospadias-associated urethral strictures. METHODS: Overall, data on 81 patients with a failed hypospadias repair undergoing one-stage BMGU between 2009 and 2018 at our institution were extracted. First, baseline and initial hypospadias characteristics were stratified by stricture location (meatus vs. penile vs. bulbar) and were compared by descriptive analyses. Second, surgical characteristics of the current one-stage BMGU were evaluated similarly. Third, Kaplan-Meier estimates were calculated for recurrence-free survival. Recurrence was defined as any further instrumentation. Fourth, we evaluated the subsequent recurrence management. RESULTS: Overall, 25 (31%), 47 (58%), and 9 (11%) presented with meatal, penile, and bulbar stricture, respectively. Primary hypospadias location was distal, penile, and proximal in 46 (57%), 14 (17%), and 7 (8.6%) patients, respectively. In 28 patients (35%), primary hypospadias repair had been a staged procedure. At presentation, the meatus was involved in 54 (67%) patients and we found concomitant urethrocutaneous fistula in 9 (11%) patients. Median graft length was 4.0 cm (IQR 2.5-5.0) and grafts were longer, the more proximally the stricture was located (p<0.001). We performed an inlay, onlay, or a combined technique in 57 (70%), 17 (21%), and 7 (8.6%) patients, respectively. In 62 patients (77%) with available follow-up (median 70 months), surgery was successful in 37 patients (60%), translating into 2-yr and 5-yr recurrence-free survival estimates of 70% and 56%, respectively. Of 25 patients with recurrence, 5 (20%) refused from further surgery, whereas 6 (24%), 1 (4.0%), 8 (32%), and 5 (20%) men underwent urethrotomy, meatoplasty, one-stage, and staged urethroplasty, respectively. CONCLUSIONS: One-stage BMGU for anterior hypospadias-associated urethral stricture is associated with reasonable long-term success of roughly 60% when performed at a high volume referral center. The estimates derived from this study may guide in preoperative counseling to harmonize patients’ expectations with a realistic prognosis of treatment success. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e518-e518 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Malte W. Vetterlein* More articles by this author Justus Stahlberg More articles by this author Omar Bahassan More articles by this author Oliver Engel More articles by this author Roland Dahlem More articles by this author Margit Fisch More articles by this author Silke Riechardt More articles by this author Expand All Advertisement PDF downloadLoading ...

A comparative study between Snodgrass and urethral advancement methods in the repair of distal penile Hypospadias

Background: Numerous original methods have been introduced to repair hypospadias with variable results. Aim of The Work: The aim of this work is to evaluate the two techniques, Snodgrass and anterior urethral advancement for the repair of distal hypospadias. Materials and Methods: A total of, 16 patients with distal hypospadias underwent primary repair in a prospective controlled randomized trial. Eight patients were allocated for a Snodgrass procedure and another 8 patients were allocated for a urethral advancement procedure. A comparative study was conducted, and the outcome was evaluated in terms of satisfactory functional and cosmetic outcomes. The study was done between January 2019 and December 2019. Results: The mean duration of surgery was significantly shorter for the Urethral advancement than for the Snodgrass procedure 56 minutes versus 76 minutes respectively. The cosmetic and functional results were better in the urethral advancement than Snodgrass. All patients healed uneventfully but one of the patients who underwent urethral advancement repair had chordee. One patient had a urethrocutaneous fistula and two patients had a failure of repair that occurred in the Snodgrass group. Conclusion: Urethral advancement is a safer and more reliable modality for the primary repair of distal penile hypospadias. It has many advantages, shorter operative time and better functional and cosmetic results.

Time to Complication Detection after Primary Pediatric Hypospadias Repair: A Large, Single Center, Retrospective Cohort Analysis.

Controversy remains within the pediatric urology community regarding adequate duration of followup after hypospadias repair. Some have suggested that minimal long-term followup is necessary due to a low incidence of late complications. The objective of this study was to delineate time to complication detection for primary hypospadias repairs. We queried our prospectively maintained hypospadias database and identified all patients undergoing primary hypospadias repair from June 2007 to June 2018. Patients were excluded if they had undergone primary repair elsewhere or did not have a followup visit. Complications were defined by the need for an additional unplanned surgical procedure. Kaplan-Meier analysis was performed to assess time to complication by degree of hypospadias. A total of 1,280 patients met inclusion criteria, of whom 976 (68.9%) underwent distal, 64 (4.9%) mid shaft and 240 (18.8%) proximal hypospadias repair. Complication rates were 10.7% (104 patients), 18.8% (12) and 53.8% (129, p<0.0001) for distal, mid shaft and proximal hypospadias repair, respectively. Only 47% of complications were detected within the first year postoperatively. Median time to complication for all repair types was 69.2 months (IQR 23 to 131.9), ie 83.1 months (IQR 42.0 to 131) for patients undergoing distal repair and 29.4 months (IQR 11.9 to 82.1) for patients undergoing proximal repair (p <0.001). In our large single institution series of pediatric patients undergoing hypospadias repair fewer than half of the complications presented within the first year postoperatively. Long-term followup is recommended for patients undergoing hypospadias repair to adequately detect and address complications.

A comparative analysis of Bracka and Duckett in the treatment of primary proximal hypospadias repair

Objective To compare the efficacy of Bracka method and Duckett method in the treatment of proximal hypospadias. Methods Forty patients with hypospadias were treated by 2 stages(Bracka), 42 patients treated by transverse preputial island flap (Duckett) from January 2014 to January 2016. Mean age at first stage surgery were (19.70±6.62) months and (20.33±5.03) months in Bracka group and Duckett group, respectively. There were 10 cases of proximal penile type, 25 cases of penoscrotal type, 5 cases of perineal type in group 1. There were 11 cases of proximal penile type, 27 cases of penoscrotal type, 4 cases of perineal type in group 2. There was no significant difference in age and hypospadias classification between the two groups(P>0.05). All operations were performed by the same doctor. Urethral plate reconstruction with preputial graft was performed in group 1; stage Ⅱ Duplay urethroplasty repair was carried out 6-8 months after stage Ⅰ. Results Urine tube was placed for 2 weeks after operation and followed up for 36-63 months(mean 47.6 months). After stage I repair, penile straightening and wide, smooth appearance of graft were confirmed. There was no fistula, split, urethral diverticulum or other complications, one case with urethral opening stenosis who was restored after urethral dilatation .After stage II repair, urethral fistula was noted in 3 cases(7.5%), stricture in 1 cases(2.5%). No other complications occurred . The total rate of complications was 10%(10/40). Urethral fistula was noted in 7 cases(16.7%), stricture in 3 cases(7.1%), penile head dehiscence in 3 cases(7.1%) and diverticulum in 1 case(2.4%) in group 2. The total rate of complications was 33.3%(14/42). The incidence of total complications between the two groups was statistically significant (P=0.011). Conclusions Bracka method can be used to treat proximal hypospadias. It has high safety and low incidence of complications. Key words: Hypospadias; Proximal; Staged repair; Autograft repairt

Chronological Changes In Uroflowmetry After Hypospadias Repair: An Observational Study.

AimUrinary flow after urethroplasty is of paramount importance. The aim of this study is to evaluate the progression of uroflowmetry (UF) parameters after different distal and proximal hypospadias repair techniques.MethodsIn this cohort study, cases that underwent primary hypospadias repair at our institution between March 2010 and December 2018 were included when uncomplicated, asymptomatic and toilet-trained. UF findings and post void residual were described after each specific technique.ResultsIn all, 88 patients were eligible. Time to last UF ranged from 35 to 138 months postoperatively. Significant increase started 36 months after distal tubularized incised plate urethroplasty (TIP) and afterwards than Mathieu technique. While was noticed 24 and 36 months after Onlay technique and proximal TIP, respectively; however, TIP showed steady significant increase atall time intervals. Duckett repair exhibited insignificant change in maximum flow rate (Qmax) values, buccal mucosal graft (BMG) and inner preputial graft (IPG), significant increase in the Qmax values after 6 and 24 months, respectively, then remained steady high. Transposed preputial flap (TPF) showed significant increase at 6–12 months only, then remained steady lower than the other two techniques. Obstructed flow was 37% after distal TIP, 30% after Mathieu, 25% after proximal TIP, 66.7% after Duckett repair, and 33.3% after TPF. There were no obstructed cases after BMG and IPG.DiscussionImprovement by time varied between techniques. After repair most cases are below the 50th percentile, implying that the reconstructed urethra is not functioning as a normal urethra. Staged repair for proximal hypospadias is preferable to a heroic one-stage procedure.ConclusionChoice of the surgical technique for hypospadias repair had impact on the improvement of Qmax values. TIP improved 36 months postoperatively. However, for proximal cases staged graft repair had earlier improvement and higher Qmax values than proximal TIP and Onlay techniques.

Reoperative Urethroplasty after Failed Hypospadias Repair

AbstractBackground: Reported reoperation rates after primary hypospadias repair can exceed 50%. Failed hypospadias occurs when the primary surgery does not achieve the cosmetic and functional goals of a straight penis with glanular meatus that enables normal urinary and sexual function. Treatment of patients with failed hypospadias repair can be a challenging task in the majority of cases and the selection of the most appropriate technique for this repair is the corner stone for success in these cases.Aim of Study: Is to evaluate the results and success rate of some common techniques for redo urethroplasty in cases with failed hypospadias repair.Patients and Methods: The study included forty two patients with recurrent hypospadias and their ages ranged from 2-15 years. The final position of the external urethral meatus after release of chordee, was subcoronal (13 cases), distal penile (13 cases), mid-penile (13 cases) and penoscrotal (3 cases). TIP technique was applied in 12 cases, Mathieu technique in 10 cases, transverse dorsal preputial onlay flap in 10 cases and two-stage repair with buccal mucosa graft in 10 cases. The operative technique was selected according to the status of the urethral plate and the nearby penile skin.Results: Our overall results showed that 24 patients (57.14%) had successful repair while failed repair was reported in 8 patients (19.04%). Minor complications were also reported in 10 cases (23.80%) which included urethrocutaneous fistula, meatal stenosis and urethral diverticulum. The success rates of TIP, Mathieu, transverse dorsal preputial onlay flap and the two-stage repair were 58.33%, 50%, 50% and 70% respec-tively.Conclusion: TIP urethroplasty is an effective technique for redo hypospadias repair if the patient has a non-scarred and wide urethral plate. Similar results can also be achieved by Mathieu's repair or transverse onlay flap in patients with narrow and non-scarred urethral plate. However, patient with scarred unhealthy urethral plate should have a two stage repair with buccal mucosa graft.

Assessment of the outcome of the tubularized incised plate (T.I.P) tech-nique in the management of distal hypospadias; prospective single-centre study

To assess the consequence of tubularized incised plate urethroplasty on primary hypospadias repair. Total of 42 male patients underwent hypospadias repair in AL-Diwaniyah Teaching Hospital/Iraq. from April 2016 to April 2018. The levels of the hypospadias defect, age at operation, type of sutures and dressing, type of catheter and time of removal and complications were verified. Tubularized incised plate urethroplasty done for all patients and mean patients age at operation was 4.4 years (range 1 year to 8year). Postoperative follow up was 1 to 3 months. Generally, meatal stenosis, dehiscence due to infection and an urethrocutaneous fistula occurred in 3,2and 6 patients, respectively. T.I.P. urethroplasty has come to be the favourite surgical procedure of distal hypospadias cases at our hospital. The technique has a small number of complications in addition to prove success and adaptability that continue to increase its application.

Analgesic efficacy and impact of caudal block on surgical complications of hypospadias repair: a systematic review and meta-analysis

Background and objectivesis commonly used for children undergoing hypospadias repair. However, the safety of caudal block for hypospadias repair in children is controversial in terms of surgical complications such as...

Single stage repair with buccal mucosal graft in hypospadias cripple patients

Background: Hypospadias surgery has developed into a well-defined art and science. Surgeons dealing with this anomaly should have detailed understanding of various basic surgical principles and experience with delicate, precise optically assisted techniques and maintain a clinical workload that is sufficient to obtain consistently good results. Objective of this study was to evaluate the outcome of using buccal mucosal graft for single stage repair in adult hypospadias cripples.Methods: All patients with prior failed hypospadias repair after multiple surgeries presenting in MLN Medical College, Allahabad were included in study. Dorsal onlay buccal mucosa graft with parallel turn over flap from penile skin for ventral surface method was used.Results: Total 20 patients were included in study. Among these 12 patients presented with complete dehiscence of repair, 5 patients presented with multiple urethrocutaneous fistulas, 3 patients presented with extensive stricture formation. Same surgeon performed procedure of dorsal onlay buccal mucosa graft urethroplasty to reduce the bias. Success rate of dorsal onlay substitution free buccal mucosal graft urethroplasty in single stage is affected by scarring of surrounding penile skin. Most common complication related to donor site are transient pain and swelling and to graft site are stricture and fistulas.Conclusions: Single stage repair with buccal mucosal graft in hypospadias cripple patients is an excellent free graft urethroplasty in cases with prior failed primary repair of hypospadias, in whom the preputial skin was lacking or insufficient and a longer urethral tube needed to be constructed.

Secondary hypospadias repair using Buccal mucosa graft: case series of 50 patients

Background: The aim of the study was to assess the various complications noticed following primary hypospadias repair and to evaluate the impact of preoperative, perioperative and postoperative study of primary hypospadias repair on patients’ quality of life, independence, and complication rates. Objective of this study was to assess the success of buccal mucosa graft in secondary hypospadias repair and study the incidence and severity of complications both to the donor and recipient sites.Methods: A total of 50 patients with previous failed hypospadias repair were included in the study who were admitted in plastic surgery unit from August 2013 to December 2016. The age of patients studied ranged from 8 to 16 years, in which about 60% cases that were presented with previous hypospadias repair were in age group 11-14 years. Patients in this study had undergone multiple previous surgeries for hypospadias repair. Ten patients had 1-2 surgeries and 40 patients had undergone 3 or more procedures for hypospadias repair.Results: In study of 50 patients only 12 had complications following buccal mucosa graft urethroplasty.Conclusions: Overall it showed that buccal mucosal graft urethroplasty had better results in hypospadias cripples.

COMPARATIVE STUDY OF TWO DIFFERENT PROCEDURES FOR PRIMARY HYPOSPADIAS REPAIR.

04Feb 2018 COMPARATIVE STUDY OF TWO DIFFERENT PROCEDURES FOR PRIMARY HYPOSPADIAS REPAIR. Abdulraheem Ali bakheet , al-Gaysi Sami Hamad , Oleiwi Masaoodi and Faris M. AL-badran. (F.I.M.S) special urologist urological Department AL-karama Teaching Hospital. (F.I.M.S) special urologist urological Department AL-Karama Teaching Hospital. (F.E.B.U,F.I.M.S) AL-Hussain teching hospital, Karbala, Iraq.

COMPARATIVE STUDY OF TWO DIFFERENT PROCEDURES FOR PRIMARY HYPOSPADIAS REPAIR.

COMPARATIVE STUDY OF TWO DIFFERENT PROCEDURES FOR PRIMARY HYPOSPADIAS REPAIR.

A 1-year randomized controlled trial to compare the outcome of primary repair of hypospadias with vascular cover using tunica vaginalis flap with those using preputial dartos fascia.

Background:Tubularized incised plate (TIP) urethroplasty is the most common technique noted to correct hypospadias. However, urethrocutaneous fistula (UCF) is still one of the most common complications of this technique. Several techniques of providing vascularized flaps to the neourethra have been recommended to decrease this complication rate. The aim of the study was to assess the outcome of primary repair of hypospadias using tunica vaginalis (TV) flap with those using preputial dartos (PD) fascia.Patients and Methods:Children diagnosed with hypospadias between the age group of 9 months to 18 years, who fulfilled the criteria were randomly divided into two groups by computerized randomization technique. Initially, TIP urethroplasty was done. Children with PD vascular cover were included in Group A and those with TV vascular cover were included in Group B. All the patients were followed up for a minimum of 6 months after surgery.Results:Two (10%) patients in Group A developed UCF and one (5%) patient developed stricture urethra in the follow-up period. None of the patients developed UCF in the Group B. One (5%) patient had stricture urethra in Group B. Two (10%) patient developed meatal stenosis in Group A. Two (10%) patient in Group B developed meatal stenosis.Conclusions:TV flap could be an alternative to PD flap as a vascular cover of neourethra in patients undergoing primary hypospadias repair by TIP urethroplasty.

Testosterone prior to hypospadias repair: Postoperative complication rates and long-term cosmetic results, penile length and body height

The use of hormonal therapy was first described in 1971 before hypospadias surgery, and it has been debated ever since. The long-term outcomes after puberty of patients treated with pre-operative testosterone in childhood are lacking. Possible long-term effects of testosterone are often asked about in daily practice. The current study investigated the long-term outcomes regarding height, penile length and penile cosmesis in adult men after hypospadias surgery in childhood with and without pre-operative testosterone. Adult men (n=121) who underwent primary hypospadias repair in childhood were included. Pre-operative penile appearance, judged by a paediatric urologist, determined the use of pre-operative testosterone. Data on hypospadias characteristics, healing complications, surgical repair, and testosterone use were collected retrospectively. At adult age, stretched penile length and body height were measured, and penile cosmesis was evaluated using the Pediatric Penile Perception Score (PPPS). Postoperative complication rates in patients (n=121) with and without testosterone were similar (50% vs. 43%; P=0.54). Sixty adult patients (50%) with a median age of 19.8 years and follow-up time of 18.3 years were examined at the outpatient clinic at adult age. Of this group, testosterone was applied in 12/43 patients with distal, 3/6 patients with midshaft, and 9/11 patients with proximal hypospadias. Adult stretched penile length (12.0cm vs. 12.4cm; P=0.47) and adult height (180.1cm vs. 179.0cmP=0.65) showed no difference between patients with and without testosterone treatment. Penile cosmesis was (very) satisfactory in all PPPS domains, and showed no difference between the testosterone group and the non-testosterone group. Univariate and multivariate analysis was conducted to determine if the hypospadias type or pre-operative testosterone therapy had more influence on the long-term outcomes. None of the long-term outcomes were significantly associated with pre-operative testosterone therapy on multivariate analysis. This was the first study reporting long-term outcomes of hypospadias patients after puberty who received pre-operative hormonal therapy. Validated instruments were used as much as possible. Shortcomings of this study were the 50% response rate, the retrospective design, and the lack of objective inclusion criteria reported to indicate pre-operative testosterone therapy. This study suggested that the long-term results of patients receiving pre-operative testosterone treatment, who often had more challenging hypospadias, were similar to those who did not. However, a randomised controlled study is needed to confirm these results.

A new modification of the Duckett technique for one-stage repairing urethral plate transected hypospadias: Another option for severe hypospadias?

The study aimed to evaluate the new modification of the Duckett technique in decreasing the incidence of urethral strictures for urethral plate transected hypospadias and also explored its clinical application. Thirty-three patients (aged 7months to 12years, mean age 2.8years) who underwent repair of primary hypospadias using the new one-stage urethroplasty were enrolled. Clinical data, including cosmetic and its complications, and uroflowmetry data were documented. Uroflowmetry data of 19 patients who underwent Duckett urethroplasty were used as a comparison. The length of the urethral defect ranged from 2.5 to 5.0cm. The postoperative follow-up was 14-30months. Ten patients (30.3%) had fistulas; no patients had strictures or diverticula. All ten fistulas were small (<0.5cm) and repaired with fistula repairing operation. The appearance of the penis remained satisfactory, and the meatus was located in the normal anatomic position. Among 17 patients who underwent uroflowmetry, all patients were bell-shaped or platforms, and Q max was 7.37±2.45ml/s. Compared with 14 of 19 patients who underwent Duckett urethroplasty, the urethral function achieved with new one-stage urethroplasty was significantly better (p<0.05). The incidence of strictures was dramatically lowered in patients with proximal hypospadias. Small fistulas are common complications and can be repaired easily. Based on the uroflow pattern results, the quality of neourethra and function of it were better than Duckett urethroplasty. These preliminary results suggested that the modified procedure seems to be reliable and can be a suitable option for proximal hypospadias.

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.