Subcoronal Hypospadias Research Articles

Bypassing The Cuffing Effect In Adult Hypospadias Surgery Diversion

Introduction Urethral stents are frequently used for urinary diversion after hypospadias surgery. The foley catheter is not generally preferred, for the formation of a ‘cuff ’ on deflation of the balloon of all foley catheters that causes difficulty in removal (cuffing effect of balloon). In the literature, there is not comprehensive study on the usage of foley catheter for adult hypospadias surgery. We have recently been using the modified foley catheter that we designed in our patients. In this study, we aim to compare the results of no-balloon catheter (nelaton catheter) and modified foley catheter usage after TIPU operations in adults. Patients and methods The medical records of 53 adult patients who applied TIPU for subcoronal or midpenile hypospadias between November 2008 and September 2012 were evaluated retrospectively. Patients were evaluated in two groups based on the performed urinary diversion. Group 1 was composed of 29 patients to whom 16 F nelaton catheter was used for urinary diversion between November 2008-December 2010, whereas Group 2 consisted of 24 patients to whom 12 F foley catheter coated by 16 F nelaton catheter by half was used for urinary diversion between February 2011 – September 2012. Results There was no statistically significant difference between Group 1 and Group 2 in terms of age, the location of the mea, the number of secondary cases, the length of the neourethra, fistula and urethral stricture (p>0.05). Surgery success rate was 79.3% in Group 1 and 79.1% in Group 2 (p>0.05). At the 6th month follow-up, no statistically significant difference was found between two groups regarding fistula and urethral stricture. In terms of postoperative patient comfort, Group 2 were better than Group 1 (p

Should We Routinely Test for Chordee in Patients with Distal Hypospadias?

The aim of this study was to determine the incidence of chordee in distal hypospadias and compare our intraoperative findings with those reported by the families of patients and to determine if routine testing for chordee should be performed in patients with distal hypospadias. Surgical reports and medical files of distal hypospadias patients operated from January 2008 to January 2013 were prospectively reviewed. The type of hypospadias, family's report of chordee, intraoperative finding of chordee and its degree were noted. All patients were tested for chordee intraoperatively after degloving. A total of 156 patients of which 27 had glandular, 61 coronal, and 68 subcoronal hypospadias were included in the study. Chordee was found in 52 patients (33.3%) intraoperatively, whereas only 15 families (9.6%) reported chordee preoperatively. There is risk of chordee in patients with distal hypospadias that needs to be accurately identified and corrected. Families are not always aware of the presence of chordee.

Short Term Outcome of Urethroplasty for Distal Hypospadias with Interrupted Suture Compared to continuous Suture

Background: Hypospadias is one of the most common congenital anomalies, occurring approximately 1in 200 to 1in 300 live birth. Urethrocutaneous fistula (U-C fistula), and meatal stenosis are the most common complication of hypospadias surgery. To reduce these complications there are different surgical procedures. Snodgrass technique is now the popular technique for its low complication rate and better cosmetic outcome. Objective: To explore the short term outcome of interrupted suture compared to continuos suture in snodgrass technique urethroplasty for distal penile hypospadias. Method: It was a randomized control trial study carried out in the department of Paediatric surgery, BSMMU during the period of June 2008 to September 2009. 32 patients with distal penile hypospadias were selected according to set inclusion and exclusion criteria. Subjects who included in the study were randomly distributed in two groups. In group A odd number of patients and in group B even number of patients were included for randomization. Group A (interrupted suture) was treated as interventional group and Group B (continuous suture) as control group. Penile stent was removed on 8th and 10th POD after snodgrass technique of urethroplasty in coronal and subcoronal hypospadias respectively and observed for 4 weeks for two common complications- Urethrocutaneous fistula (U-C fistula), and meatal stenosis. Unpaired t test, Fisher’s exact test were used to see the level of significance. Result: In group A out of 16 subjects; 2 subjects (12.5%) develop Urethrocutaneous fistula and 1 subject (6.3%) had developed meatal stenosis. In group B out of 16 subjects 6 subjects (37.5%) had developed Urethrocutaneous fistula and 3 subjects (18.8%) developed meatal stenosis. Conclusion: Urethrocutaneous fistula (U-C fistula), and meatal stenosis are the most common complication of hypospadias repair and the occurrence of these two complications are less in interrupted suture than that of continuous suture in Snodgrass technique urethroplasty for distal hypospadias. DOI: http://dx.doi.org/10.3329/jpsb.v2i1.15160 Journal of Paediatric Surgeons of Bangladesh (2011) Vol. 2 (1): 26-30

Multiple urethral anomalies: Anterior urethral diverticulum, posterior urethral valves, and distal hypospadias

We report an infant with antenatally detected bilateral hydroureteronephrosis and a penile cyst who was eventually diagnosed with an anterior urethral diverticulum (AUD), subcoronal hypospadias, and posterior urethral valves (PUV) after birth. To our knowledge, there are no reports where all three anomalies have been found to coexist. As per urethral catheterisation was difficult, cystoscopy-guided catheterisation was performed. On retracting the complete foreskin, a subcoronal hypospadias was identified. The AUD was resected partially, and during a cystoscopy for completion of AUD resection, a dilated anterior urethra was found collapsed, and thin PUV were identified and divided. He remains well at nine months with an improving renal cortical thickness. The vesicoureteric reflux had resolved.

1192 POST-PUBERTAL OUTCOME AFTER DISTAL HYPOSPADIAS REPAIR IN CHILDHOOD USING THE MEATAL MOBILIZATION (MEMO) TECHNIQUE

You have accessJournal of UrologyPediatrics: Reconstructive Surgery1 Apr 20111192 POST-PUBERTAL OUTCOME AFTER DISTAL HYPOSPADIAS REPAIR IN CHILDHOOD USING THE MEATAL MOBILIZATION (MEMO) TECHNIQUE Joerg Seibold, Maren Werther, Saladin Alloussi, Karl-Dietrich Sievert, Arnulf Stenzl, and Christian Schwentner Joerg SeiboldJoerg Seibold Tuebingen, Germany More articles by this author , Maren WertherMaren Werther Tuebingen, Germany More articles by this author , Saladin AlloussiSaladin Alloussi Tuebingen, Germany More articles by this author , Karl-Dietrich SievertKarl-Dietrich Sievert Tuebingen, Germany More articles by this author , Arnulf StenzlArnulf Stenzl Tuebingen, Germany More articles by this author , and Christian SchwentnerChristian Schwentner Tuebingen, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.825AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Meatal mobilization (MEMO) after distal urethral preparation can be used for distal hypospadias repair with or without chordee. Initial data yielded promising cosmetic and functional results. However, nothing is yet known about the postpubertal outcome, patients' self perception and importantly sexual function. Herein, we present a cohort of patients who have reached adulthood after hypospadias repair in childhood focussing on the abovementioned items. METHODS 286 patients who underwent glandular, coronal or subcoronal hypospadias repair using the meatal mobilization (MEMO) technique were retrospectively identified. Of those 25 are older than 18 years. This cohort was invited by phone or mail and was specifically investigated using uroflow, residual urine measurement, sexual function (IIEF) and quality of life (QoL). Finally, the so-called HOSE-score (objective hypospadias symptom score) was applied. RESULTS All 25 patients were available for follow-up. No additional findings were documented in terms of cosmesis or fistula formation (0/25). All had a negative urine culture and no post-void residual. Uroflow-patterns were bell-shaped in all 25 men. Median HOSE-score was 15 (of maximum 16 points). All had a straight erection of the penis. IIEF-scores were normal in all men. CONCLUSIONS Using the MEMO technique for correction of distal hypospadias, complications are minimal while the cosmetic results remain excellent over time. In the long-term follow-up no additional fistula or meatal stenosis occurred. Sexual function and quality of life after puberty are comparable to healthy age matched individuals. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e478 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joerg Seibold Tuebingen, Germany More articles by this author Maren Werther Tuebingen, Germany More articles by this author Saladin Alloussi Tuebingen, Germany More articles by this author Karl-Dietrich Sievert Tuebingen, Germany More articles by this author Arnulf Stenzl Tuebingen, Germany More articles by this author Christian Schwentner Tuebingen, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

602 REDO HYPOSPADIAS REPAIR–SURGICAL PROBLEMS FACED IN 223 ADULT PATIENTS

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease1 Apr 2011602 REDO HYPOSPADIAS REPAIR–SURGICAL PROBLEMS FACED IN 223 ADULT PATIENTS Rados Djinovic, Guido Barnagli, Salvatore Sansalone, Giusepe Romano, Sasa Tomovic, and Nikola Stanojevic Rados DjinovicRados Djinovic Belgrade, Yugoslavia More articles by this author , Guido BarnagliGuido Barnagli Arezzo, Italy More articles by this author , Salvatore SansaloneSalvatore Sansalone Rome, Italy More articles by this author , Giusepe RomanoGiusepe Romano Arezzo, Italy More articles by this author , Sasa TomovicSasa Tomovic Belgrade, Yugoslavia More articles by this author , and Nikola StanojevicNikola Stanojevic Belgrade, Yugoslavia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1434AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Failed hypospadias repair present difficult problem with growing number of adult patients needing surgical treatment. Treatment is often challenging because majority had multiple previous surgeries with lack of quality tissue for repair. We present our experience and principles of treatment in 223 patients. METHODS Between January 2003 and December 2008, 223 patients aged between 18 and 59 years (mean 28) were treated for complications of previously failed hypospadias repair: urethral stricture–168, followed by short penile skin–55, residual ventral curvature–53, urethral fistula–34, peno-scrotal transposition–17, urethral diverticulum in 12. Unsatisfactory esthetic appearance of external genitalia was in 143 patients. Majority of patients had several complications and treatment was individual according to the finding. One or two-stage buccal mucosa inlay was the mainstay of stricture management–131 patients. In remaining 37 local penile skin/praeputial flaps were used. Curvature repair was done by tunical attenuation -modified Nesbit procedure. In patients with excessive chordee three-stage repair was used with ventral grafting in the first stage and 2-stage buccal mucosa urethropalsty in the next two. Diverticulum was treated by tapering and placation of surrounding tissue. Scrotal skin flaps were used for reconstruction of missing penile skin with correction of peno-scrotal transposition when present. RESULTS The mean follow−up was 54 months (23−94). Successful repair was achieved in 209 patients. 7 patients developed postoperative fistula and 6 of them were treated successfully by additional surgery and in one fistula closed spontaneously. Urethral stricture developed in 4 patients who were treated surgically. 2 patients had small residual curvature that didn't require additional repair. One patient remained with subcoronal hypospadias dut to previous glans injury. CONCLUSIONS Successful surgical treatment of failed hypospadias requires appropriate estimation of all remaining deformities i.e.: urethra, cavernosal bodies, glans and penile skin as well as their treatment using individual approach. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e242-e243 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rados Djinovic Belgrade, Yugoslavia More articles by this author Guido Barnagli Arezzo, Italy More articles by this author Salvatore Sansalone Rome, Italy More articles by this author Giusepe Romano Arezzo, Italy More articles by this author Sasa Tomovic Belgrade, Yugoslavia More articles by this author Nikola Stanojevic Belgrade, Yugoslavia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A New Technique for Correction of Distal Penile Hypospadias

The major aims of correction of hypospadias include construction of a neourethra, removal of the chordee, and reduction of the probability of postoperative fistulization. Here, we describe a new technique that can be easily used in cases with subcoronal distal penile hypospadias (even those with chordee) for the construction of the urethra using meatus-based transverse flaps. This new technique was used in 10 patients (mean age, 4.6 years). There were no complications such as fistula formation, chordee recurrence, hematoma formation, or flap necrosis during the follow-up period (mean follow-up period, 13.4 months). We believe that this surgical technique can be used in cases with chordee, carries a low risk of fistula formation, has the advantage of the use of richly vascular flaps for construction of the urethra, and yields a better cosmetic result. Hence, it can safely be used for surgical correction of distal hypospadias.

Failed Hypospadias Repair – Retrospective Analysis in 223 Patients

Purpose Failed Hypospadias repair present difficult problem with growing number of patients needing surgical treatment which is often challenging because majority had multiple previous surgeries with lack of quality tissue for repair. Material and Methods Between January 2003 and December 2008, 223 patients aged between 18 and 59 years (mean 28) were treated for complications of previously failed Hypospadias repair: urethral stricture 168, short penile skin 55, residual ventral curvature 53, urethral fistula 34, peno-scrotal transposition 17 and urethral diverticulum in 12. Unsatisfactory esthetic appearance of external genitalia was in 143 patients. Majority of patients had several complications and treatment was individual according to the finding. One or two-stage buccal mucosa inlay was the mainstay of stricture management – 131 patients. In remaining 37 local penile skin/praeputial flaps were used. Curvature repair was done by tunical attenuation -modified Nesbit procedure. In patients with excessive chordee three-stage repair was used with ventral grafting in the first stage and 2-stage buccal mucosa urethropalsty in the next two. Diverticulum was treated by tapering and placation of surrounding tissue. Scrotal skin flaps were used for reconstruction of missing penile skin with correction of peno-scrotal transposition when present. Results The mean follow−up was 41 months (9−80). Successful repair was achieved in 209 patients. 7 patients developed postoperative fistula and 6 of them were treated successfully by additional surgery and in one fistula closed spontaneously. Urethral stricture developed in 4 patients who were treated surgically. 2 patients had small residual curvature that didn't require additional repair. One patient remained with subcoronal Hypospadias dut to previous glans injury. Conclusions Successful surgical treatment of failed Hypospadias requires appropriate estimation of all remaining deformities i.e.: urethra, cavernosal bodies, glans and penile skin as well as their treatment using individual approach.

523 LONG-TERM RESULTS OF BUCCAL MUCOSA ONLAY GRAFTS IN HYPOSPADIAS REPAIR

The mean follow up was 41 months (9 80). Successful repair was achieved in 209 patients. 7 patients developed postoperative fistula and 6 of them were treated successfully by additional surgery and in one fistula closed spontaneously. Urethral stricture developed in 4 patients who were treated surgically. 2 patients had small residual curvature that didn’t require additional repair. One patient remained with subcoronal Hypospadias dut to previous glans injury. CONCLUSIONS

Single vs. Double Dartos Interposition Flaps in Preventing Urethrocutaneous Fistula after Tubularized Incised Plate Urethroplasty in Primary Distal Hypospadias: A Prospective Randomized Study

Introduction: This prospective study was designed to compare symmetrical overlapping double flaps with a single dartos flap in regard to fistula formation as an adjunct to tubularized incised plate urethroplasty (TIPU). Patients and Methods: 77 consecutive children with primary coronal or subcoronal hypospadias were randomized into 2 groups. A single layer dartos flap was used to cover the anastomotic site in the first group (37 patients). A wider dorsal dartos flap bisectioned in the midline was utilized in the second group of 40 patients. The complication rates were compared. Results: There was no difference between the 2 groups in terms of age, and meatal location. Postoperative median follow-up was 34 months. Urethrocutaneous fistula occurred in 3 patients (8.1%) of the monolayer group. No fistula developed in the second group with double flaps. Conclusions: The current study proposes that the use of double dorsal flaps, although statistically not significant, better prevents fistula formation compared to monolayer dartos flaps following TIPU operation.

Double-Cross Flap Protection: New Technique for Coverage of Neourethra in Hypospadias Repair

We analyzed a new urethra preserving approach, double-cross flap protection, during tubularized incised plate urethroplasty. We compared the results of 57 patients treated with this new procedure and 80 patients treated with 2 different techniques. We studied 137 patients with hypospadias between October 2002 and March 2008. Patients were divided into 3 groups. Group 1 consisted of 40 patients (mean age 50 months) undergoing tubularized incised plate urethroplasty. Group 2 included 40 patients (mean age 48 months) undergoing tubularized incised plate urethroplasty with dorsal subcutaneous flap. Group 3 consisted of 57 patients (mean age 39 months) undergoing tubularized incised plate urethroplasty with 2 de-epithelialized preputial flaps twisted ventrally and sutured individually over the neourethra. All patients were operated on by the same surgeons. Statistical analysis of postoperative complications was performed by ANOVA and chi-square test. In Group 1 fistula developed in 6 patients (15%) and was associated with stenosis of the neourethra in 4 (10%). In Group 2 fistula developed in 4 patients (10%). In Group 3 no fistula was observed, but mild stenosis of the neomeatus developed in 3 patients (5.3%), which was treated with dilation. Thus, the incidence of fistula in group 3 was significantly less (p = 0.015). Double-cross flap protection is safe and significantly reduces the incidence of postoperative fistula.

Anterior and posterior urethral valves with subcoronal hypospadias: a rare association

Association of the anterior and posterior urethral valve is a rare congenital anomaly which can lead to various urinary tract symptoms. An 8-year-old boy was referred by his primary care physician for urinary dribbling, straining at micturition, and recurrent febrile urinary tract infection since the age of 2 years. Clinically, the bladder was palpable; both testes were normal, and, in addition, he had a subcoronal hypospadias. Diagnosis was confirmed by retrograde urethrogram and voiding cystourethrogram (micturating cystourethrogram) and urethroscopy. Cystoscopic ablation of both valves was done by electrocautery hook using low current at 5 o'clock and 7 o'clock directions. He voided with good flow and to completion. Urinary dribbling had completely subsided and renal function was normal at a follow-up period of 36 months with freedom from recurrent urinary tract infection. Both the anterior and posterior urethral valves develop from different embryological sources; thus, this association is rare. A case with this association has not been reported previously in the literature.

Mutations of CXorf6 are associated with a range of severities of hypospadias

Mutations in chromosome X open reading frame 6 (CXorf6), a recently described candidate gene involved in the development of male genitalia, have been found in patients with complex 46,XY disorders of sexual development (46,XY DSD) including micropenis, bifid scrotum, and penoscrotal hypospadias. The objective of this work was to identify genomic variants of CXorf6 in patients with isolated hypospadias, severe or non-severe. Forty-one patients with glandular to perineal hypospadias and thirty controls were studied. Direct sequencing for coding exons 3-6 of CXorf6 and their flanking splice sites was performed on DNA extracted from foreskin collected from surgery. Secondary and tertiary structures of the protein were predicted using NNpredict and Protein Homology/analogY Recognition Engine engines. Four mutations (9.7% of cases) were identified. One missense mutation (1295T>C, V432A) and two deletions (325delG, predicted to cause a stop codon L121X) occurred in patients with penoscrotal and proximal hypospadias. One patient with subcoronal hypospadias had CAG-repeat amplification in the second polyglutamine domain of CXorf6. Secondary structure prediction indicated that this insertion occurred in a helix element of the protein. The tertiary structure prediction showed an alteration of the shape of the protein and crowding between domains. CXorf6 mutations are associated with isolated hypospadias of varying severity. However, the pathophysiology of these mutations and the function of the CXorf6 gene product remain to be investigated.

Mutations of Cxorf6 Cause a Range of Severities of Hypospadias

PURPOSE Mutations in CXorf6, a recently-described candidate gene involved in the development of male genitalia, have been found in patients with 46, XY disorders-of-sexual-development (46, XY DSD) and severe hypospadias. To date, there has been no data regarding CXorf6 in isolated hypospadias without DSD. This study aimed to characterize the potential role of CXorf6 in such patients. MATERIAL AND METHODS Forty-one patients with isolated hypospadias of various severity, and 30 controls were included. DNA was extracted from excess foreskin collected during surgery. Direct sequencing for coding exons 3-6 of CXorf6 and their flanking splice sites was performed. Secondary and tertiary structures of the protein were predicted using NNpredict and PHYRE engines. RESULTS Four mutations (9.7%) were identified. One missense mutation (V432A) and two deletions (del324G, predicted to cause a stop codon L121X) occurred in patients with penoscrotal and proximal hypospadias. One patient with subcoronal hypospadias had a CAG repeat amplification in the second polyglutamine domain of CXorf6. Secondary structure prediction indicated that this insertion occurred in a helix element of the protein. The tertiary structure prediction showed an alteration of the shape of the protein and crowding between domains. We also found a high incidence of polymorphisms (12.2%) in hypospadiac patients, (haplotype N589S/P286S in 4 cases). CONCLUSIONS CXorf6 mutations occur not only in 46 XY DSD but also in isolated hypospadias of varying severity. We also describe the first CAG repeat amplification of CXorf6. However, the specific events associated with these mutations and the precise function of CXorf6 remain to be investigated.

“Limited” double dorsal dartos flap coverage. An effective alternative to conventional flap coverage of the neourethra following Mathieu repair for subcoronal hypospadias

Double dorsal dartos flap coverage of the neourethra has been reported to be superior to single flap coverage for the prevention of urethrocutaneous fistula following hypospadias surgery. Conventional flap coverage involves covering the entire neourethra with vascularised flap. We describe a "limited" double dorsal dartos flap coverage of the neourethra following Mathieu repair for subcoronal hypospadias. In a prospective study conducted between Feb 2003 and Feb 2007, 31 patients with primary subcoronal hypospadias who had a flat and narrow urethral plate with a healthy urethral meatus and minimal or no chordee underwent Mathieu hypospadias repair. A "limited" double dorsal dartos flap coverage of the neourethra was done in all patients. This involved covering only that portion of the neourethra which remained exposed after glans closure, i.e. the proximal neourethra. Primary surgical outcome assessed was the development of urethrocutaneous fistula following surgery. The mean age at the time of repair was seven years and mean follow up was eight months. There was no flap loss, urethrocutaneous fistula formation, or glanular dehiscence in any of the 31 patients. One patient developed meatal stenosis which was managed by dilatation. One patient developed superficial sloughing of the penile skin. Overall complication rate was 6.45%. "Limited" double dorsal dartos flap coverage of the neourethra seems to be an effective method to reduce the fistulous complication rate following Mathieu repair for subcoronal hypospadias. A larger comparative study needs to be done to evaluate conventional neourethral coverage with "limited" neourethral coverage.

Partial Penile Disassembly for Isolated Epispadias Repair

Isolated male epispadias defect is present in 10% of cases of epispadias-exstrophy complex. Surgical repair of epispadias malformation remains debatable as evident by the different techniques adopted. The current study presents our experience in partial penile disassembly for isolated epispadias repair. Epispadias repair was performed on 11 male patients aged 4 to 13 years. Two were penopubic, 6 penile, and 3 glanular. All cases were fresh. Extensive disassembly of penile components was performed to the corporal attachments down to the horizontal branches of pubic bones. The corporal bodies were separated with the urethral plate left attached to 1 corpus to preserve its blood supply. Urethral plate was tubularized and then transported from dorsal to ventral position by using corporal rotation technique. Glanuloplasty was then performed. Patients were followed up for 6 to 12 months. The penis had a satisfactory cosmetic appearance with no significant dorsal chordee. Two cases were transformed to subcoronal hypospadias, as it was difficult to bring the urethral plate to the tip of the glans because of its shortening. One child had a minute penopubic fistula that was repaired at a later stage. Partial penile disassembly technique restores the anatomic relationship of the penile components. Our repair of partial penile disassembly is a simple modification of the Mitchell technique for isolated epispadias repair.

The meatal mobilization technique for coronal/subcoronal hypospadias repair

To describe meatal mobilization (MEMO) by distal urethral preparation as an improved surgical technique for distal hypospadias repair, including glanular, coronal and subcoronal location of the meatus, with or without chordee. From May 2002 to June 2006, 46 patients (mean age 3.8 years, range 1.5-14) had a repair of glanular, coronal and subcoronal hypospadias using the MEMO technique. A description of the procedure and the results are presented. The mean duration of surgery was 73 min; there were no complications during surgery in any of the patients. The follow-up was 28.5 months; after surgery one patient developed a haematoma, which resolved with no further treatment. There was neither recurrence nor any new episode of chordee or meatal stenosis. None of the patients developed a urethral fistula. In one patient the meatus retracted but remained in the glans. Complications were minimal and the cosmetic results excellent using the MEMO technique for correcting most of distal hypospadias.

Impact of patient age on distal hypospadias repair: A surgical perspective

Objectives To assess whether the age at which the initial hypospadias repair is performed influences the complication rate of hypospadias repair. Methods The records of 325 consecutive patients who underwent initial hypospadias repair were reviewed. The patients with glanular and coronal hypospadias underwent repair with either meatoplasty and glanuloplasty or a glans approximation procedure. Patients with subcoronal hypospadias and penile hypospadias underwent repair with tubularized incised plate urethroplasty. The patients were divided into 6-month age groups, and the complication rates were analyzed by age group using the chi-square test. Results A total of 325 hypospadias repairs were performed from January 1999 to January 2005 by a single surgeon. Of the 325 cases, 194 tubularized incised plate procedures were performed, 69 meatoplasty and glanuloplasty procedures were performed, and 53 glans approximation procedures were performed. Nine tubularized island flap urethroplasties performed for penoscrotal hypospadias were excluded because we did not perform a significant number of proximal urethroplasties. Nineteen patients (6.0%) developed urethrocutaneous fistulas and six (1.9%) demonstrated dehiscence. Overall, 2 patients (2.2%) who underwent surgical repair within the first 6 months of age developed complications compared with 23 patients (10.3%) who underwent initial hypospadias repair when they were older than 6 months of age ( P = 0.006). Conclusions Tubularized incised plate, meatoplasty and glanuloplasty, and glans approximation urethroplasty are all excellent options for the surgical correction of hypospadias in the appropriately selected patient. The results of our study have indicated that complications are minimized when hypospadias repair is performed when the patient is 4 to 6 months of age.

Urethral advancement technique for repair of distal penile hypospadias: A revisit

Abstract Background: Numerous ingenious methods have been described to repair hypospadias with variable results. The anterior urethral advancement technique reported by Chang[1] to repair distal hypospadias has shown encouraging results. We have reevaluated this technique with some modifications to improve its results.Materials and Methods: This study was done on 72 patients, 19 cases with glanular hypospadias, 20 cases with coronal hypospadias, 22 cases of subcoronal hypospadias,and 11 cases with anterior penile hypospadias in the period between September 1999 and October 2003. The patients′ age ranged from two years to twenty five years (median age 5.6) years. All the patients were operated using Chang′s technique with our modifications. Results: There were no major complications in any of our patients, no postoperative fistulae or urethral stricture. Three patients had meatal stenosis and preputial edema occurred in 83.3% in non-circumcised patients.Conclusion: Modifications of the anterior advancement technique has produced excellent Results. It is easy to do and learn and also offers good cosmetic and functional results.

Urethral advancement technique for repair of distal penile hypospadias: A revisit

Background: Numerous ingenious methods have been described to repair hypospadias with variable results. The anterior urethral advancement technique reported by Chang[1] to repair distal hypospadias has shown encouraging results. We have reevaluated this technique with some modifications to improve its results. Materials and Methods: This study was done on 72 patients, 19 cases with glanular hypospadias, 20 cases with coronal hypospadias, 22 cases of subcoronal hypospadias,and 11 cases with anterior penile hypospadias in the period between September 1999 and October 2003. The patients' age ranged from two years to twenty five years (median age 5.6) years. All the patients were operated using Chang's technique with our modifications. Results: There were no major complications in any of our patients, no postoperative fistulae or urethral stricture. Three patients had meatal stenosis and preputial edema occurred in 83.3% in non-circumcised patients. Conclusion: Modifications of the anterior advancement technique has produced excellent Results. It is easy to do and learn and also offers good cosmetic and functional results.