Hypospadias Repair Research Articles

Adult non-urethral complications after hypospadias repair in childhood: presentation, treatment and outcomes.

This study aimed to evaluate a group of adult patients with non-urethral complications after hypospadias repair in childhood, their surgical treatment, and outcomes. We analyzed 97 patients, mean age 22.5 years, who were treated in our center between January 2009 and December 2020, for non-urethral complications after previous hypospadias repair in childhood. Non-urethral complications were defined as glans deformity, residual curvature and trapped penis due to insufficient penile skin. A radical surgical approach was used to correct all deformities, in a one-stage or a two-stage procedure. A successful outcome was defined as a straight penis with good length, anatomically regular glans, and cosmetically acceptable appearance, without need for additional surgeries. Sexual function was evaluated using International Index of Erectile Function. Mean follow-up was 75 months (ranged from 24 to 168 months). One-stage and two-stage repair were performed in 85.5% and 14.5% of cases, respectively. A higher success rate was noted after one-stage repair (94% compared to 86%). Complications included four cases of penile curvature with late onset, one case of glans dehiscence and partial skin necrosis. Erectile dysfunction was determined in 24% of patients. Non-urethral complications may occur many years after primary hypospadias repair, with a strong impact on the quality of life. Treatment is individualized and usually involves a radical surgical approach to correct all associated deformities and to achieve successful cosmetic and psychosexual outcomes.

Double versus single diaper technique after hypospadias repair, does it really matter?

Double-diaper technique with an open-drainage catheter is a common practice after hypospadias repair. However, double-diapering may increase the burden of postoperative care and has not been compared to single-diapering with an open-drainage catheter. This study investigates whether the single-diaper technique is associated with inferior surgical outcomes compared to the double-diaper technique. A single surgeon database was retrospectively reviewed for patients who underwent hypospadias repair between 2013 and 2021. Patients who were lost to follow-up and those in whom the type of diaper care (single- or double-diaper) was not documented were excluded. Patients in the single-diaper technique received the same type of dressing and discharge instructions, as those in the double-diaper group, except for leaving the catheter freely draining into a single-diaper. Short-term complications including surgical site infection (SSI), urinary tract infection (UTI) and wound dehiscence, were the primary outcome; whereas the long-term urethroplasty complications (urethrocutaneous fistula and meatal stenosis) were secondary outcomes. Outcomes were analyzed according to the type of diaper care. Among 323 patients reviewed, 219 patients met the inclusion criteria (72 patients in the double-diaper and 147 in the single-diaper group). Both study groups were similar regarding patient demographics, hypospadias characteristics and surgical technique. Looking at the primary outcomes, there was no statistically significant difference in SSI, UTI or wound dehiscence. For the secondary outcomes, the incidence of meatal stenosis (8.3 vs. 1.4%, p=0.044), and fistula formation (15.3% vs 5.4%, p=0.037) was significantly higher in the double-diaper than the single-diaper group, respectively (Table 2). Single-diaper technique following hypospadias repair is not associated with increased risk of complications compared to double-diaper technique.

Impact of Two Urethral Stent Types on Complications after One-Stage Hypospadias Repair Using the Duckett Procedure.

The authors evaluated whether the new nickel-titanium alloy stent (NTAS) is superior to the traditional silicone stent used in hypospadias repair surgery in preventing complications such as urinary fistula. This retrospective cohort study included 576 patients with hypospadias who underwent NTAS or traditional silicone stent placement after hypospadias surgery between March of 2002 and August of 2019. The primary outcome was the rate of urinary fistula occurrence at 4 weeks (stent removal time), and the secondary outcomes were the rate of other complications, such as urethral stricture, urethral diverticulum, infection, and so on. The occurrence of complications in both groups was compared, and the important contributing factors of urinary fistula and urethral stricture were determined. Among 576 patients, 398 were assigned to the NTAS group, and 178 were assigned to the silicone group. Thirty-five patients in the NTAS group and 30 in the silicone group developed urinary fistula, with a rate of 8.8% and 16.9%, respectively ( P = 0.005). Subgroup analysis showed that the differences were mainly in preschool patients (6 years or younger) ( P = 0.004) and those with the penile type of hypospadias ( P = 0.008). In addition, urethral stricture complicated five patients in the NTAS group and two in the silicone group, with a rate of 1.3% and 1.1%, respectively ( P = 1.000). Logistic regression showed that hypospadias type ( P = 0.001) and stent type ( P = 0.001) are the important risk factors for urethral fistula. The NTAS reduced the occurrence of urinary fistula complications after hypospadias repair in preschool patients, and can be presented as a better choice for hypospadias surgery. Therapeutic, III.

COMPARISON OF DEXMEDETOMIDINE AND CLONIDINE AS ADDITIVE WHEN GIVEN SEPARATELY, PREMIXED WITH 0.25% ROPIVACAINE IN PEDIATRIC CAUDAL BLOCK, ON INTRA OPERATIVE ANESTHETIC/ ANALGESIC DRUG REQUIREMENT AND DURATION OF POST OPERATIVE ANALGESIA IN HYPOSPADIAS REPAIR SURGERIES

Aim:Comparison of dexmedetomidine and clonidine as additive when given separately, premixed with 0.25% ropivacaine in pediatric caudal block,on intra operative anesthetic/ analgesic drug requirement and duration of post operative analgesia in hypospadias repair surgeries. Methods and Materials:Children,whose parents or guardians,were willing to give consent and fulfilled inclusion criteria were selected for the study.Thepatients were randomly allocated, by double blinding into two groups. Group RD received 0.25% ropivacaine 1 ml/kg +2µg/kg dexmedetomidine (in 0.5 ml volume).Group RC received 1 ml/kg of 0.25% ropivacaine + 1 µg/kg of clonidine (in 0.5 ml volume). Results:Mean age of patients receiving dexmedetomidine and clonidine was 3.20±1.821 and 4.47±1.727 years respectively. No significant difference was obtained in terms of mean age.Blood pressure,Heart rate and Saturation was maintained by both dexmedetomidine and clonidine similarly as revealed by the insignificant p value of >0.05 across the time points during hypospadias repair surgeries.Requirement of adjuvant analgesics intraoperativery and post operative complicationsand was found to be similar in both the groups as revealed by the insignificant P value of 0.309. Time for rescue analgesic postoperatively (min) was significantly (p<0.001) longer among patients receiving dexmedetomidine (706.73±107.428) than clonidine (504.33±97.573). Conclusion:We observed that a single caudal injection of dexmedetomidine (2µg/kg) added to ropivacaine 0.25% offers an advantage over a similar injection of clonidine (1µg/kg) added to ropivacaine 0.25% for postoperative pain relief in children undergoing hypospadias repair surgeries without increase in post operative complications.

Editorial Comment.

No AccessJournal of UrologyPediatric Article31 May 2023Editorial CommentThis article comments on the following:Does Preoperative Testosterone Administration Decrease Complications in Distal Hypospadias Repair With Urethroplasty? Rafael Tua-Caraccia and Jonathan C. Routh Rafael Tua-CaracciaRafael Tua-Caraccia Department of Urology, Duke University School of Medicine, Durham, North Carolina More articles by this author and Jonathan C. RouthJonathan C. Routh Department of Urology, Duke University School of Medicine, Durham, North Carolina More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003548.02AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, Publish Ahead of Print, pp. REFERENCES 1. Does preoperative testosterone administration decrease complications in distal hypospadias repair with urethroplasty?J Urol. 2023; 210(2):000. Google Scholar 2. EAU Guidelines on Paediatric Urology. 2023 Update. Accessed May 11, 2023. https://uroweb.org/guidelines/paediatric-urology Google Scholar Submitted March 6, 2023; accepted May 4, 2023; published 000. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology17 May 2023Does Preoperative Testosterone Administration Decrease Complications in Distal Hypospadias Repair With Urethroplasty? Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rafael Tua-Caraccia Department of Urology, Duke University School of Medicine, Durham, North Carolina More articles by this author Jonathan C. Routh Department of Urology, Duke University School of Medicine, Durham, North Carolina More articles by this author Expand All Submitted March 6, 2023; accepted May 4, 2023; published 000. Advertisement PDF downloadLoading ...

Editorial Comment.

No AccessJournal of UrologyPediatric Article31 May 2023Editorial CommentThis article comments on the following:Does Preoperative Testosterone Administration Decrease Complications in Distal Hypospadias Repair With Urethroplasty? Siam Oottamasathien Siam OottamasathienSiam Oottamasathien Department of Surgery, Boston Children’s Hospital/Harvard Medical School, Boston, Massachusetts More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003548.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, Publish Ahead of Print, pp. REFERENCE 1. Does preoperative testosterone administration decrease complications in distal hypospadias repair with urethroplasty?J Urol. 2023; 210(2):000 Google Scholar Submitted March 6, 2023; accepted May 4, 2023; published 000. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology17 May 2023Does Preoperative Testosterone Administration Decrease Complications in Distal Hypospadias Repair With Urethroplasty? Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Siam Oottamasathien Department of Surgery, Boston Children’s Hospital/Harvard Medical School, Boston, Massachusetts More articles by this author Expand All Submitted March 6, 2023; accepted May 4, 2023; published 000. Advertisement PDF downloadLoading ...

Reply by Authors.

No AccessJournal of UrologyPediatric Article31 May 2023Reply by Authors Karl F. Godlewski, Sameer Mittal, Nathan Hyacinthe, Katherine Fischer, John Weaver, Jason Van Batavia, Dana Weiss, Arun Srinivasan, Aseem Shukla, Stephen Zderic, Thomas Kolon, Mark Zaontz, and Christopher Long Karl F. GodlewskiKarl F. Godlewski *Correspondence: Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19123 telephone: 215-590-4690; E-mail Address: [email protected] Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , Sameer MittalSameer Mittal Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , Nathan HyacintheNathan Hyacinthe Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , Katherine FischerKatherine Fischer Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , John WeaverJohn Weaver Rainbow Babies and Children’s Hospital, Cleveland, Ohio More articles by this author , Jason Van BataviaJason Van Batavia Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , Dana WeissDana Weiss Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , Arun SrinivasanArun Srinivasan Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , Aseem ShuklaAseem Shukla Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , Stephen ZdericStephen Zderic Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , Thomas KolonThomas Kolon Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , Mark ZaontzMark Zaontz Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author , and Christopher LongChristopher Long Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003548.03AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Reply by Authors." The Journal of Urology, Publish Ahead of Print, pp. REFERENCE 1. Does preoperative testosterone administration decrease complications in distal hypospadias repair with urethroplasty?J Urol. 2023; 210(2):000. Google Scholar Submitted March 6, 2023; accepted May 4, 2023; published 000. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Karl F. Godlewski Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania *Correspondence: Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19123 telephone: 215-590-4690; E-mail Address: [email protected] More articles by this author Sameer Mittal Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author Nathan Hyacinthe Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author Katherine Fischer Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author John Weaver Rainbow Babies and Children’s Hospital, Cleveland, Ohio More articles by this author Jason Van Batavia Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author Dana Weiss Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author Arun Srinivasan Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author Aseem Shukla Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author Stephen Zderic Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author Thomas Kolon Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author Mark Zaontz Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author Christopher Long Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania More articles by this author Expand All Submitted March 6, 2023; accepted May 4, 2023; published 000. Advertisement PDF downloadLoading ...

Modified Pediatric Penile Perception Scale to Evaluate Cosmetic Outcome in Children With Hypospadias Repair

Modified Pediatric Penile Perception Scale to Evaluate Cosmetic Outcome in Children With Hypospadias Repair

Comparison of Simple Penile Dressings following Hypospadias Repair: does it really matter?

Background: Hypospadias repair requires an appropriate wound dressing to prevent complications, but there is a lack of studies comparing the efficacy of different dressings. Aim: To compare the clinical outcomes of occlusive hydrocolloid dressing and petroleum-impregnated gauze with zinc oxide adhesive plaster, and recommend an appropriate dressing based on efficacy, availability, and cost-effectiveness. Methods: We performed a retrospective cohort study on paediatric patients who had undergone hypospadias repair between August 2017 and November 2020 at Dr. Ruth K. M. Pfau Civil Hospital Karachi, Pakistan. All the patients receiving one of the two wound dressings, occlusive hydrocolloid dressing (group A) or petroleum-impregnated gauze with zinc oxide adhesive plaster (group B) during primary or secondary hypospadias repair, operated by the same paediatric surgeon were included in this study. Patients with missing data were excluded. There was only one patient lost to follow up in this study. Results: A total of 64 male hypospadias patients with a mean age of 6.0 ± 3.4 years were included in this study. Group A patients (n=37) received a thick 10 x 10 cm occlusive hydrocolloid dressing whereas, in Group B patients (n=27), a 2.5 x 10 cm petroleum-impregnated gauze with zinc oxide adhesive plaster was applied over the wound. In group A, five patients (13.5%) suffered post-operative fistula and wound dehiscence. Whereas, in group B, the post-operative fistula was seen in three patients (11.1%). This study provides evidence-based information to clinicians and healthcare providers regarding the use of wound dressings for hypospadias repair. By demonstrating the efficacy of a cheaper and more accessible dressing, this study could help improve access to care and reduce costs for patients, especially in resource-limited settings. Conclusion: Occlusive hydrocolloid dressing and petroleum-impregnated gauze are equally effective in the healing of hypospadias repair wounds. The simpler and cheaper petroleum-impregnated gauze may be preferable in resource-limited settings. Keywords: Hydrocolloid dressing; Petroleum impregnated gauze; Paraffin gauze; Hypospadias

(199) Anterolateral Thigh Flap Phalloplasty for Micropenis

Abstract Introduction Congenital micropenis is defined as a normally formed penis with a stretched penile length less than 2.5 standard deviations below the mean for that man’s age and ethnicity. Micropenis may present as an isolated condition or with other genital or multi-system abnormalities. Penile reconstruction or phalloplasty may be required where topical and systemic hormonal treatment have failed. The most common flap used for phalloplasty is the radial artery forearm free flap phalloplasty. Other alternatives include the anterolateral thigh (ALT), musculocutaneous latissimus dorsi and abdominal flaps. Objective The aim of this video is to illustrate the technique for penile reconstruction using a pedicled ALT flap without integrated urethra. Methods A 21-year-old man with micropenis and hypospadias from a disorder of sexual differentiation (46XY) presents for penile reconstruction following multiple failed attempts at hypospadias repair. He requested an ALT flap without integrated urethra because he is dependent on a long-term suprapubic catheter due to a hypocontractile bladder. Intraoperative vascular doppler identified 3 perforators from the descending branch of the lateral circumflex iliac artery of the left leg. The flap was designed centred on the perforators with dimensions of 14cm (length), 13cm (width at base) and 12cm (width at tip). The flap was raised carefully and transferred to the recipient groin. The neophallus was constructed and microsurgical anastomosis of the lateral cutaneous of the thigh to one of the dorsal penile nerves with 8/0 nylon was completed. The partially divided left vastus lateralis muscle was re-approximated and the skin edges drawn in and flattened. The left thigh was then resurfaced with a 14/1000 of an inch split-thickness skin graft from the contralateral thigh. All wounds were dressed. Results The man had an uneventful post-operative course with careful vascular monitoring, and he was discharged on day 10. He is currently awaiting glans-sculpting and will eventually proceed with insertion of an inflatable erectile device. Conclusions Penile reconstruction using an ALT flap can be offered to a well-informed and motivated man with a micropenis following appropriate assessment. As shown, the technique requires careful dissection of the perforator vessels and can usually be transferred as a pedicled flap. Pedicled flaps do not require microvascular anastomosis and therefore have a lower risk of vascular compromise. Further esthetic and functional refinements like the insertion of an erectile device are possible in later stages, if desired. Disclosure No

Does Preoperative Testosterone Administration Decrease Complications in Distal Hypospadias Repair With Urethroplasty?

Testosterone administration prior to hypospadias repair is common practice among pediatric urologists; however, its impact on surgical outcomes remains controversial. We hypothesize that testosterone administration prior to distal hypospadias repair with urethroplasty significantly decreases postoperative complications. We queried our hypospadias database for primary distal hypospadias repairs with urethroplasty from 2015 to 2021. Patients undergoing repair without urethroplasty were excluded. We collected information on patient age, procedure type, testosterone administration status, initial visit and intraoperative glans width, urethroplasty length, and postoperative complications. To determine the role of testosterone administration on incidence of complications, a logistic regression adjusting for initial visit glans width, urethroplasty length, and age was performed. A total of 368 patients underwent distal hypospadias repair with urethroplasty. One hundred thirty-three patients received testosterone and 235 did not. Initial visit glans width was significantly larger in the no-testosterone vs testosterone group (14.5 mm vs 13.1 mm, P = .001). Testosterone patients had significantly larger glans width at the time of surgery (17.1 mm vs 14.6 mm [no-testosterone group], P = .001). On multivariable logistic regression analysis after controlling for age at surgery, preoperative glans width, testosterone status, and urethroplasty length, testosterone administration did show significant association with reduced odds of postoperative complications (OR 0.4, P = .039). This retrospective review of patients shows that on multivariable analysis there is significant association between testosterone administration and decreased incidence of complications in patients undergoing distal hypospadias repair with urethroplasty. Future studies on testosterone administration should focus on specific cohorts of patients with hypospadias as benefits of testosterone may be more evident in some subgroups than others.

Expression of Rab25 is down-regulated in the foreskin of children with hypospadias

Hypospadias, a congenital malformation of the penis, is one of the newborns' most common developmental defects. The incidence of hypospadias is increasing yearly, and its pathogenesis is closely related to genetic susceptibility and environmental exposure to endocrine disruptors. Exploring the hypospadias' key molecular regulatory mechanism is crucial to reducing its incidence. To examine the differential expression of Rab25 in hypospadias and normal penile tissue and to identify whether it is a candidate gene for exploring the mechanism of hypospadias. This study included 18 children aged 1-6 years undergoing hypospadias repair surgery at the Children's Hospital of Chongqing Medical University, and foreskin samples were collected. Children diagnosed with cryptorchidism, intersex status, or endocrine abnormalities were excluded from this study. Another 18 children aged 3-8 years with phimosis were included in the control group. The specimens were used for immunohistochemistry, western blotting, immunofluorescence, and polymerase chain reaction to assess the expression of Rab25. Rab25 protein expression was lower in the hypospadias group than in the control group [ (2.101±0.1845), (0.7506±0.1779), p=0.0008<0.05). The hypospadias group showed decreased expression of Rab25 protein in the epithelial cell layer. Rab25 mRNA levels were downregulated in the foreskin of children with hypospadias compared with controls [(1.697±0.2005), (0.7687±0.2130), p=0.0053<0.05)]. Rab25 mRNA and protein expressions in the hypospadias group were significantly downregulated compared with the control group. This was consistent with the results of single-cell sequencing of fetal mice reproductive nodules at 15.5 days of gestation (Zhang Z, Liu Z, Zhang Q, etal., unpublished observations). Our study represents the first report of abnormal Rab25 expression in the foreskin tissue of patients with hypospadias. More detailed research on the relationship between Rab25 and urethral development could be conducted to reveal the molecular mechanism of hypospadias. The expression of Rab25 in foreskin tissue was lower in the hypospadias group than in the control group. Rab25 is involved in the formation of the urethral seam and the occurrence of hypospadias. The potential mechanism by which Rab25 affects the canalization of the urethral plate needs to be further investigated.

A novel corporoplasty technique with a urethral plate flap in hypospadias repair.

To report a novel corporoplasty technique with a urethral plate flap in hypospadias repair and evaluate its safety and efficacy for ventral lengthening. Data were retrospectively collected from consecutive patients with hypospadias who underwent urethral plate flap corporoplasty between July 2021 and March 2022. All patients underwent hypospadias repair using the Duckett technique. The corporoplasty procedure involved the following key steps: the half-spongiosum of the urethral plate was harvested as a flap (with a pedicle attached to the corpus cavernosum); a transverse incision of the tunica albuginea was made adjacent to the pedicle; and the flap was patched onto the corporal defect. The study included 10 patients, with a median age of 20 months. The initial meatal location was penile in two patients, penoscrotal in four patients, and scrotal in four patients. The median ventral curvature was 45° after degloving and urethral plate transection. The median ventral lengthening distance proportional to penis length was 0.21. During the median follow-up of 13.8 months, complications occurred in three cases, including two cases of fistula and one case of urethral stricture with secondary diverticulum. No cases of recurrent ventral curvature, meatal stenosis, or urethral dehiscence were noted. Postoperative ultrasonography showed a good continuation of the tunica albuginea and integrity of the stratum spongiosum at the corporoplasty site. Urethral plate flap corporoplasty is a simple and effective ventral lengthening procedure. The novel corporoplasty technique allows for anatomical and architectural repair of corporal disproportion.

Does Testosterone Advance the Meatus in Children with Proximal Hypospadias?

Background: Pre-operative preparation of the children with hypospadias may involve the administration of testosterone to argument penile dimensions. However, the effect of testosterone on the urethral meatus is not established. The aim of this study was to prospectively evaluate the effect of testosterone on the location of the hypospadiac meatus. Materials and Methods: This was a prospective observational study of children, aged 15 years and younger, who are being prepared for hypospadias repair at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. This study covered a 5-year period. The following data were analyzed: age of the patients at presentation, type of hypospadias, proximal and distal penile measurements at onset and at 4 weeks after testosterone injection. Results: A total of 24 cases of proximal hypospadias were recruited into the study. The ages of the patients at presentation ranged from 1 month to 18 months with a median age of 3 months. Majority of the patients had mid-penile hypospadias. Regarding response to testosterone, proximal part of the penile shaft responded more than the distal part. However, statistical analysis showed no advancement in the location of the meatus. Conclusion: This is study has shown that a single dose of testosterone has no effect on the location of meatus in children with hypospadias.

Lateral incision 1-stage urethroplasty with oral mucosal graft for patients with penile urethral stricture after hypospadias repair—a preliminary report

PurposeTo report our early experience of a novel surgical approach for penile urethral strictures after hypospadias repair, using a lateral incision to keep the ventral tissue and vasculature of the penis intact and to avoid the need for tissue interposition.Patients and methodsA total of 21 patients underwent lateral incision 1-stage urethroplasty with oral mucosal graft. The median age of the patients was 21 years old (range, 13–47). The median number of prior procedures for hypospadias repair was 3 (range, 1–9) with 18 of 21 patients (85.7%) undergoing greater than 1 prior reconstructive procedure. The mean length of the penile urethral strictures was 4.5 ± 1.7 cm, with a range of 1.0 to 8.0 cm. Selection criteria for lateral incision 1-stage urethroplasty include: non-obliterative stricture, no or mild penile curvature and no urethrocutaneous fistula.ResultsMedian follow-up was 30 months (range, 6–73). Success was achieved in 17 of 21 patients (80.9%). The 4 (19.0%) patients with treatment failure developed recurrent urethral strictures. Of the 4 men with recurrent strictures, 3 were ultimately treated successfully by DVIU (2) or two-stage urethroplasty (1), and one patient chose repeated dilation.ConclusionsFor patients with penile urethral stricture after hypospadias repair with non-obliterative stricture, no significant penile curvature and no urethrocutaneous fistula, a lateral approach with oral mucosal graft is a simple technique that avoids the need for tissue interposition and keeps the penile ventral tissue and vasculature intact, resulting in a low risk of complications.

Urethral advancement and glanuloplasty versus tubularized incised plate urethroplasty for distal hypospadias repair: a prospective randomized study

BackgroundAbout one in 200 to one in 300 male births has hypospadias. The prevalence of this congenital anomaly varies worldwide. The meatus is located distally in approximately 70% of cases. Several surgical techniques were described for distal hypospadias repair; despite this, there is no ideal approach. This study compares urethral advancement &glanuloplasty, and TIP techniques in terms of feasibility, duration of operation, and complications. Patients and.MethodsThis prospective randomized comparative study was conducted at Al-Azhar University Hospitals from April 2022 to October 2022. Fifty-seven cases with different types of hypospadias were assessed for eligibility. Among them, seven cases were excluded due to the presence of severe chordee (n = 3), proximal variant (n = 2), and recurrent cases of hypospadias (n = 2). Fifty cases were randomly divided into two groups using a 1:1 ratio (computer-generated randomization). Twenty-five cases were subjected to urethral advancement and glanuloplasty, and the rest were subjected to tubularized incised plate (TIP) urethroplasty.ResultsThe mean age of all studied cases was 4.2 years. Approximately 52% had coronal or sub-coronal meatus, whereas 48% had glandular meatus. Both groups were matched according to age and meatus location (p > 0.05). No statistically significant difference was observed between the two groups regarding duration of operation, postoperative pain, and postoperative hospital stay. In addition, both groups did not differ significantly in late complications (meatal stenosis, meatal retraction, fistula, and glans dehiscence).ConclusionsBoth urethral advancement &glanuloplasty, and TIP urethroplasty have comparable short-term outcomes. Urethral advancement and glanuloplasty is preferred in certain conditions, especially in circumcised children or those with a narrow urethral plate.Trial registrationThe study protocol was approved by the Pan African Clinical Trials Registry (number for the registry is: PACTR202211757905870) on (29/11/2022). All procedures were performed per the Helsinki Declaration.

The effect of the use of postoperative antibiotic prophylaxis compared with non-use for stented distal hypospadias repair wound: A meta-analysis.

A meta-analysis investigation to measure the influence of the usage of postoperative antibiotic prophylaxis (POP) compared with non-usage for stented distal hypospadias repair (SDHR). A comprehensive literature inspection till February 2023 was applied and 1067 interrelated investigations were reviewed. The 10 chosen investigations enclosed 1398 individuals with SDHR in the chosen investigations starting point, 812 of them were using POP, and 586 were not using POP. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the effect of the usage of POP compared with non-usage for SDHR by the dichotomous and continuous approaches and a fixed or random model. No significant difference was found between individuals using POP and not using POP in posthypospadias repair problem (PRP) (OR, 0.99; 95% CI, 0.42-2.34, P = .97) with moderate heterogeneity (I2 = 69%), posthypospadias repair infection problem (PRIP) (OR, 0.56; 95% CI, 0.30-1.06, P = .08) with no heterogeneity (I2 = 15%), and overall composite posthypospadias repair wound healing associated problem (OCPRWHAP) (OR, 1.27; 95% CI, 0.61-2.63, P = .53) with moderate heterogeneity (I2 = 59%) for SDHR. No significant difference was found between individuals using POP and not using POP in PRP, PRIP, and OCPRWHAP for SDHR. However, cautilised of the small sample sizes of several chosen investigations for this meta-analysis, care must be exercised when dealing with its values, for example, the low P-value of the PRIP.

Surgical Technique of Glans Wings Creation with Preservation of Glanular Vascular Arcade and Creating Flaps for Tension-Free Glansplasty in Hypospadias Repair.

The objective of this study is to report the technical nuances of glans wings creation in anatomical plane facilitating liberal glans wings mobilization with preservation of glanular vessels for tension-free glansplasty in surgery of hypospadias in primary and redo cases. Eighty-six primary hyposapdias and 7 cases of distal hypospadias, operated elsewhere and presented with glans and urethroplasty dehiscence, undergoing tubularized-incised-plate (TIP) repair were included after ethical approval. Technical points of glans wings creation in the subfascial plane included (i) creation of Buck's fascia window, just proximal and lateral to the point of bifurcation of corpus spongiosum, (ii) creation of subfascial-pret unical plane on the tunica albuginea of corpora cavernosa up to ventral limit of laid open glanular meatus, (iii) release of pillars of corpus spongiosum off the glans base keeping the basal lamina propria covering the vascular arcade intact, (iv) release of glans base off the tip of corpora cavernosa and composite flap of corpus spongiosum pillars with Buck's fascia off the corpora cavernosa, (v) approximation of glans wings over the tubularized-incised-plate covered with dartos, and (vi) approximation of fasciospongioplasty flaps at hypospadiac meatus. Outcome measurement included (i) intra and postoperative problems and (ii) elimination of glans dehiscence. There occurred 1 injury to the tunica albuginea of ventral corpora cavernosa and 1 button-hole injury to subcoronal mucosal collars. Flaps for fasciospongioplasty were short in 11. One glans dehiscence occurred in flat glans. This technique is effective in creating glans wings in the anatomical plane with the preservation of glanular vessels and flaps for fasciospongioplasty eliminating the possibility of glans dehiscence in both fresh and redo cases.

Urethral strictures. Diagnosis and treatment

Urethral strictures represent the intrinsic and permanent narrowing of the urethral lumen with urodynamic effects and genitourinary complications resulting from obstruction in the path of urine and seminal fluid elimination. In men, urethral stricture refers to a narrowed segment of the anterior urethra caused by a process of fibrosis and scarring of the urethral mucosa and surrounding spongiosum tissue ("spongiofibrosis"). In the male posterior urethra, there is no spongiosum tissue, and the term stenosis is preferred in this location. The definition of meatal stenosis is accepted as a distal narrowing at the level of the meatus, without involving the navicular fossa. There is no universal definition of female urethral stricture. Female urethral stricture is defined by most authors as "a fixed anatomical narrowing" that leads to a reduction in urethral caliber. This reduced urethral caliber is defined as being between &lt;10 Fr and &lt;20 Fr, with most studies defining it as &lt;14 Fr, compared to the normal urethral caliber of 18-30 Fr. In transgender patients, the term stricture is used to define narrowing of the reconstructed urethra despite the absence of spongiosum tissue around it.[1] In men, a marked increase in incidence is observed after the age of 55, with a median age of 45.1 years. The estimated incidence is generally 229-627 cases per 100,000 men [2]. The anterior urethra is most commonly affected (92.2%), especially the bulbar urethra (46.9%) [3]. In women, 2-29% of patients with refractory lower urinary tract symptoms have obstructive flow at the level of the bladder, of which 4-20% will have urethral strictures [4]. There is a significantly increased incidence in women over 64 years of age. In children, most strictures are traumatic: iatrogenic causes account for 27.8-48% and external trauma for 34-72% of cases [1]. Congenital (13%), inflammatory (4%), or postinfectious (1%) strictures are less commonly observed. The bulbar urethra is the most frequently affected part of the urethra [1]. After hypospadias repair, meatal stenosis and urethral strictures are reported in 1.3-20% of cases, depending on the severity of hypospadias and the technique used [5]. There is a significantly higher incidence of this type of stricture in resource-rich countries due to a higher rate of surgical interventions. It has been reported that up to 18% of urethral strictures involving the meatus or navicular fossa are caused by surgical repair of hypospadias, lichen sclerosus, instrumental/traumatic causes, or idiopathic causes. Post-circumcision meatal stenosis has been reported in less than 0.2% of infants undergoing circumcision. In transgender patients ("trans men"), approximately 51% will suffer from a urethral stricture, while in "trans women" (male to female), the incidence is 14.4% [6].

The association between nurse continuity and hypospadias repair patient outcomes: A retrospective study.

Recently, nurse continuity, the intensity and consistency of a patient's exposure to nurses during hospitalization, has been shown to be associated with patient outcomes. However, little is known about how nurse continuity is related to patients' surgical outcomes. To examine the association between nurse continuity and outcomes of hypospadias repair to clarify the importance of nurse continuity as a nursing practice. This is a retrospective study. We analysed the data from electronic health records of patients under 1 year who had undergone proximal hypospadias repair between January 2014 and December 2016. Nurse continuity was measured using the Continuity of Care Index. Since approximately half of the patients reportedly needed further operations in the long term, the primary outcome was whether patients with proximal hypospadias repair had two or more additional operations within 3 years of discharge. The rate of undergoing two or more follow-up operations in 3 years was significantly higher in patients with low nurse continuity-38.6% versus 12.8% for high continuity. This study identified nurse continuity as an important factor related to patients' surgical outcomes. These findings suggest that nurse continuity be considered an important nursing strategy for patient outcomes and further research is needed on this topic. As empirical evidence regarding the association between nurse continuity and patient outcomes grows, nurse managers and policymakers should view nurse continuity as a critical factor for positive patient outcomes when considering nursing workforce regulations. The data for this study were obtained from electronic health records, and the entire process of this study did not involve patient or public participation.