Types Of Hypospadias Research Articles

Comparative study between modified Koyanagi and Snodgrass techniques in management of proximal types of hypospadias

الملخص أهداف البحث: مازال الجدل قائما بشأن الأسلوب الأمثل للإصلاح في حالات الإحليل التحتاني (المبال التحتاني) الشديدة. فقد زاد في الآونة الأخيرة الاهتمام بإصلاح جميع حالات الإحليل التحتاني على مرحلة واحدة بما فيها الحالات الشديدة. ويفضل إجراء العملية الجراحية بين سن 6 و18 شهرا. وطريقة وطريقة المعدلة هما طريقتان لإصلاح الإحليل التحتاني. وتهدف هذه الدراسة إلى مقارنة بين طريقة كوياناجي المعدلة وطريقة سنودجراس في علاج أنواع الإحليل التحتاني الدانية فيما يتعلق بزمن العملية، ومدة الإقامة في المستشفى، ومعدل النجاح، والمضاعفات بعد الجراحة والنتائج من الناحية التجميلية. طرق البحث: ضمت الدراسة 50 مريضا ذكرا لديهم أنواع مختلفة من الإحليل التحتاني الداني؛ خضعوا للترميم الجراحي باستخدام طريقة كوياناجي المعدلة وطريقة سنودجراس خلال الفترة بين عامي 2010م و 2012م في وحدات جراحة الأطفال في مستشفيات جامعة الأزهر (القاهرة ودمياط). أخذ التاريخ المرضي المفصل، والفحص السريري الكامل، لجميع المرضى. وتم توزيع الخمسين مريضا بصورة عشوائية إلى مجموعتين؛ (ن = 30) وخضعت لطريقة سنودجراس ومجموعة (ن = 20) خضعت لطريقة كويانجي. مع متابعه لمدة من 4 إلى 8 أشهر وبمتوسط 6 أشهر. النتائج: كان زمن إجراء العملية أقل في المجموعة أ بفرق واضح مقارنة بالمجموعة ب (83.30 ± 6.51 مقابل 158.25 ± 22.78 دقيقة) وأيضا كانت فترة الإقامة في المستشفي أقل في المجموعة أ بالمقارنة مع المجموعة ب(9.56 ± 1073 مقابل 17.80 ± 2.26 يوما). وكان معدل النجاح في المجموعة أ70.0٪ مقارنة بـ 60.0٪ في المجموعة ب. وبالنسبة للمضاعفات فكان الناسور أكثر في المجموعة أ مقارنة بالمجموعة ب كما كان ضيق فتحة البول أكثر في المجموعة أ وكان تهتك الترميم كليا متساويا في كلا المجموعتين. الاستنتاجات : يمكن اعتبار كلا طريقتي سنودجراس وكوياناجي المعدلة مقبول وفعال لإصلاح الإحليل التحتاني في الحالات المتقدمة، شريطة أن يكون انتقاء الحالات جيدا لكل نوع من الإصلاح. وتطبق طريقة سنودجراس على حالات انحناء القضيب الخفيفة أو عندما يكون حجم لوحة مجرى البول كافيا بينما يفضل استعمال طريقة كويانجي المعدلة في حالات صغر حجم القضيب وحالات انحناء القضيب الشديدة أو ضيق لوحة مجرى البول الكلمات المفتاحية : طريقة كويانجي المعدلة, طريقة سنودجراس, الإحليل التحتاني.

Objective Scoring Evaluation and Uroflowmetry Assessment of Two-Stage Hypospadias Repair: Single Center Experience

Background: Hypospadias is a common congenital anomaly affecting the penis, two-stage repair becoming more interesting in era of tubularized –incised urethral plate (TIP). Functional outcome of hypospadias repair either single or two stage is as important as cosmetic outcome. In contemporary series , structured scoring systems (Hypospadias Objective Scoring Evaluation-HOSE and Pediatric Penile Perception Scoring -PPPS), evaluation of photographs and uroflowmetry, were used to assess results of hypospadias repair. Objectives: We have assessed outcomes of two-stage hypospadias repair using Hypospadias Objective Scoring Evaluation(HOSE) and uroflowmetry. Material and Methods: Over a period of eight years, from January 1997 to December 2004, One hundred and twenty six hypospadias patients were treated, ninety of them had two-stage repair and36 single-stage repairs. The HOSE questionnaire and uroflowmetry were obtained to evaluate the long term outcome of two –stage hypospadias repair. Results: The age at time of assessment ranged from 8 to 23 year-old, with mean follow up of 39.78months. Thrifty five patients had proximal hypospadias and 20 had distal varieties of hypospadias. Operations performed were 37 Bracka?s and 18 Byar?s procedures. Of the 55 patients had complete two stage hypospadias repair and agree to participate in the study , Nineteen patients had acceptable HOSE and 36 had non-acceptable score. Uroflow rates of 43 subjects were below the fifth centile in three patients ,equivocal (between 5th and 25th centile ) in four patients and above 25th centile in 36 subjects. Conclusion: Two –stage repair is a suitable technique for all types of hypospadias with versatile outcomes. HOSE and uroflowmetry are simple, easy, non invasive and non expensive tools to assess long term outcomes objectively. Bangladesh Journal of Medical Science Vol. 12 No. 02 April’13 Page 133-139 DOI: http://dx.doi.org/10.3329/bjms.v12i2.14940

Minor Hypospadias: The “Tip of the Iceberg” of the Partial Androgen Insensitivity Syndrome

BackgroundAndrogens are critical in male external genital development. Alterations in the androgen sensitivity pathway have been identified in severely undermasculinized boys, and mutations of the androgen receptor gene (AR) are usually found in partial or complete androgen insensitivity syndrome (AIS).ObjectiveThe aim of this study was to determine whether even the most minor forms of isolated hypospadias are associated with AR mutations and thus whether all types of hypospadias warrant molecular analysis of the AR.Materials and MethodsTwo hundred and ninety-two Caucasian children presenting with isolated hypospadias without micropenis or cryptorchidism and 345 controls were included prospectively. Mutational analysis of the AR through direct sequencing (exons 1–8) was performed. In silico and luciferase functional assays were performed for unreported variants.ResultsFive missense mutations of the AR were identified in 9 patients with glandular or penile anterior (n = 5), penile midshaft (n = 2) and penile posterior (n = 2) hypospadias, i.e., 3%: p.Q58L (c.173A>T), 4 cases of p.P392S (c.1174C>T), 2 cases of p.A475V (c.1424C>T), p.D551H (c.1651G>C) and p.Q799E (c.2395C>G). None of these mutations was present in the control group. One mutation has never been reported to date (p.D551H). It was predicted to be damaging based on 6 in silico models, and in vitro functional studies confirmed the lowered transactivation function of the mutated protein. Three mutations have never been reported in patients with genital malformation but only in isolated infertility: p.Q58L, p.P392S, and p.A475V. It is notable that micropenis, a cardinal sign of AIS, was not present in any patient.Conclusion AR mutations may play a role in the cause of isolated hypospadias, even in the most minor forms. Identification of this underlying genetic alteration may be important for proper diagnosis and longer follow-up is necessary to find out if the mutations cause differences in sexual function and fertility later in life.

1586 Minor Hypospadias: The “Tip of the Iceberg” of the Partial Androgen Insensitivity Syndrome

Background and AimsAlterations in the androgen sensitivity pathway have been identified in severely undermasculinized boys, and mutations of the androgen-receptor gene (AR) are usually found in partial or complete androgen...

A New Surgical Stabilizing Instrument for Hypospadias Repair

Conclusion In the past 40 years, there have been a limited number of prototypes or improvisations developed to give retraction during hypospadias surgery.[1] [2] [3] [4] [5] [6] [7] [8] These efforts have not been adequately accepted by the medical community either because they can be harmful to tissues or result impractical. Our novel surgical retractor is a proposal for hypospadias repair and we believe it could aid and facilitate hypospadias repair. The main characteristic of this retractor is the capability to maintain a steady position and give exposure of all sides of the penis with easy movements. This new surgical instrument has demonstrated to us its adaptability, feasibility, and safety in all types of hypospadias repairs. We believe it will be of great assistance to all surgeons that deal with this malformation as it has been advantageous to us. Currently, it is mainly being used in hypospadias repair, but we think it might have other uses for other penile surgery.

Acquired Undescended Testes in Boys With Hypospadias

We determined the incidence of acquired undescended testes in boys with hypospadias. We retrospectively reviewed the records of 566 boys with hypospadias who were referred to our outpatient clinic between January 2000 and September 2009. Acquired undescended testes were defined as testes that were documented at the bottom of the scrotum at least once after birth by the pediatric urologist at our institution but were subsequently documented to have moved from a satisfactory scrotal position by the same pediatric urologist or an equally experienced pediatric urologist. However, this definition did not include undescended testes after inguinoscrotal surgery. We excluded boys with gender development disorders with testicular dysgenesis, those who underwent bilateral inguinoscrotal surgery and those without congenital cryptorchidism who were followed less than 3 months. Of the 566 boys with hypospadias 100 met study exclusion criteria. Of the 466 boys included in analysis 29 (6.2%) had congenital cryptorchidism and 15 (3.2%) had acquired undescended testes. Urethroplasty was performed in 413 boys, including 91 with distal, 132 with mid and 181 with proximal hypospadias. The incidence of congenital cryptorchidism and acquired undescended testes in boys with proximal hypospadias was significantly higher than that in boys with other types of hypospadias (p = 0.03 and 0.001, respectively). Boys with proximal hypospadias are at a higher risk for acquired undescended testes than those with other mild types of hypospadias. Thus, testicular location should be monitored regularly until after puberty.

A modified tubularised incised plate urethroplasty technique and a revised hypospadias algorithm.

To simplify and standardize surgical management of hypospadias, a modified tubularised incised plate (TIP) urethroplasty (Snodgrass) technique has been described and a revised hypospadias management algorithm has been formulated. The study aims to evaluate the viability of the described procedure in different types of hypospadias and tests the validity of the algorithm. The modification described is recruitment of penile and glandular skin lateral to the urethral plate to facilitate tubularisation. The algorithm starts with penile degloving with preservation of urethral plate. Snodgrass repair was done in cases with no chordee and where skin chordee resolved by skin take down. Modified Snodgrass repair was done in cases where urethral plate was narrow. Another modification proposed by us is single layer penile skin closure instead of an added dartos flap, which was done in both classical and modified Snodgrass repair. Cases of severe chordee not resolved by skin take down were repaired by transverse preputial island flap (TPIF) and Bracka's technique. Dorsal plication was not used as an orthoplasty modality. It was possible to repair 68.89% of the cases by Snodgrass repair. These patients either had no chordee or had superficial skin tethering (skin chordee) which resolved on degolving. All these cases were coronal, distal and mid penile hypospadias. Remaining cases were mid, proximal and penoscrotal with true fibrous chordee and were repaired by TPIF or Bracka's technique. The Snodgrass technique had a fistula rate of 9.67%. Acceptably, low fistula rate and simple execution make the proposed modification of classical Snodgrass repair a viable option. The proposed algorithm proves to be a useful tool for standardised and logical preoperative decision making. It also defines indications of the three techniques vis-à-vis the type of hypospadias.

Modified Koyanagi Technique in Management of Proximal Hypospadias

Background/Purpose: One stage urethroplasty with parameatal foreskin flap (OUPF) applicable to all types of hypospadias was first described by Tomohiko Koyanagi, however high complication rates were reported .The aim of this study is to analyze the results of a modification of the Koyanagi technique as a one-stage repair of proximal hypospadias. Patients and Methods: During the period of from March 2008 to March 2009, 30 patients underwent treatment of proximal hypospadias using the modified Koyanagi technique. Patient age at the time of surgery ranged from 6 to 24 months. In all cases, the urethral opening was at or just proximal to the penoscrotal junction. Follow up ranged from 3 months to 1 year. Results: Primary success occurred in 27 cases (90%) with accepted cosmetic appearance. Complications occurred in 3 cases (10%). Urethrocutaneous fistula occurred in 2 cases (6.7%). Meatal recession occurred in 1 case (3.3%). There was no incidence of meatal stenosis, urethral stricture, residual chordee or complete flap necrosis.

Single Stage Single Layer Urethroplasty

A total of 153 patients underwent surgical repair of hypospadias by single stage single layer urethroplasty (Yadav's Technique) over last 26 years by a single surgeon. Medium age of the patients at the time of surgery was 4.7 years (range 1 year to 12 years). Associated chordee was corrected at the same stage followed by modified Denis Browne repair along with dorsal slit to release tension over the secure line. None of the cases had suprapubic diversion of urine. A 6F or 8F infant feeding tube was kept as stent earlier for 7 to 9 and now for 5 days only. The results were cosmetically good in 123 cases, satisfactory in 21 and poor in 9 patients. Urethrocutaneous fistulae were seen in 4.5% patients, distal breakdown of repair in 1.3% whereas none of the cases had stricture or residual chordee. This simple technique can be used for all types of hypospadias with low complication rate and good functional results. Moreover being a single stage technique, it is economical and with satisfactory results.

Long-Term Results of Preputial Reconstruction in Selected Cases of Hypospadias

Purpose To evaluate the long-term results of preputial reconstruction (PR) (instead of circumcision) in selected cases of hypospadias repairs. Material and Methods 216 consecutive primary hypospadias repairs performed before 01/01/2000 by 2 pediatric urologists in 1 institution were identified; 9 were lost for FU, the remainder had a mean FU of 93 (minimum: 60) months. PR was performed in all cases where this was both technically feasible and the parent's preference. Types of hypospadias repair were MAGPI in 98, Mathieu in 32, TIP in 26, onlay in 49 and 2-stage in 2 cases. PR was performed in 128 of 207 cases (62%); This was after MAGPI, Mathieu, TIP, Onlay and 2-stage type repairs in 85(87%), 21(66%), 20(77%), 2(4%) and 0(0%) repectively. Results Three specific types of complications can occur after PR which are avoided by primary circumcision: dehiscence of the PR, formation of a preputial fistula ( = minor partial dehiscence, not communicating with the urethra) or syptomatic / fibrotic phimosis. In this series, 16 boys (8%) had a specific PR-related complication leading to re-operation in 11(5%): 8 preputial fistulae (1 circumcision; 5 fistula-repairs; 2 no intervention) and 8 symptomatic and/or fibrotic phimosis (3 circumcisions; 2 preputioplasties; 3 conservative management). No preputial dehiscence occurred. No significant differences in PR-related complications were seen after different types of hypospadias repairs. The majority of PR-related complications occured during the first year after hypospadias repair. In the remaining 112 boys, the prepuce was fully retractible in 110 and partially retractible in 2 (without fibrosis or symptoms) at the last FU visit. Our results are comparable to the very scarce previous literature on this subject which has upuntill now only presented short-term results. Conclusions Preputial reconstruction is feasible in over 60% of hypospadias repairs (if this is the patient's/parent's preference) at the cost of a limited number of additional complications (8%) and re-operation rate (5%).

Versatility of tubularized incised plate urethroplasty in the management of different types of hypospadias: 5-year experience

The outcomes of urethroplasty in the management of different types of hypospadias have continued to improve since the introduction of the tubularized incised plate (TIP) urethroplasty (Snodgrass method). The aim of this study was to evaluate the feasibility and applicability of TIP urethroplasty in the management of different types of hypospadias. This work was carried out at Al-Azhar University Hospital, Cairo, Egypt in the period from January 2002 to December 2002 and King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia; in the period from January 2003 to January 2007 by the same authors. The medical records of 175 boys with different types of hypospadias, who underwent TIP urethroplasty, were critically reviewed. Their age ranged from 9 to 36 months (mean age; 22.72 +/- 7.75 months).The period of follow-up was ranged from 7 to 60 months (mean 34.42 +/- 15.41). All families were happy with penile aesthetic appearance. The total number of boys with different types of hypospadias was 175 (145 1ry and 30 2ry). Out of 175 cases, the overall urethrocutaneous fistula rate was 11 (6.29%), and the overall rates for glanular dehiscence, urethral stricture, meatal stenosis and meatal regression were 4 (2.29%), 5 (2.86%), 17 (9.71%), and 10 (5.71%), respectively. All cases of urethral stricture and most cases of meatal stenosis 12 (6.86%) responded well to regular urethral dilatation. Meatoplasty was performed in only 5 (2.85%) cases (1 of 1ry and 4 of 2ry cases). Secondary surgery for fistula repair and glans closure was successful in all patients. All children void with a single straight urinary stream in a forward direction, and have a rounded glans with vertical slit- like terminal glanular meatus. The mean hospital stay was 4.6 days. TIP urethroplasty with neourethral coverage using a vascularized pedicle of dartos flap is versatile and simple operation in management of different types of hypospadias. It has a good functional and cosmetic outcome.

Incidence of penile curvature in various forms of hypospadias

Hypospadias is a congenital anomaly of the penis, characterised by ectopically positioned urethral meatus and associated anomalies (cryptorchidism, inguinal hernia, penile curvature). Proximal forms of hypospadias, as severe cases, are particularly accompanied by penile curvature (chordee). Distal types are considered to be mild degrees. To determine the incidence of congenital curvature within various forms of hypospadias in order to signify preoperative and intraoperative diagnosis of chordee as a part of hypospadias repair. The total of 454 patients with hypospadias were treated surgically in a five-year period (2001-2006.) at the University Children's Hospital of Belgrade. The patients were divided into two groups according to the surgeon who had treated them. Only the first group of patients was tested for chordee as a part of standard procedure and complete treatment. In both groups we analyzed the number of patients treated for penile curvature within various types of hypospadias. We also compared scores in the two groups using Fisher test and chi2-test. Scanning retrospective, 104 cases (22.9%) of diagnosed and surgically corrected chordee were determined. In 31.6% of patients from the first group and 11.6% of patients from the second group we diagnosed and corrected some form of penile curvature was. Chordee was significantly more frequent in the first group, regarding hypospadias in general (p<0.01), as well as distal (p<0.05) and mid shaft forms (p<0.01). Penile curvature is not uncommon in hypospadias. In this study we report a significantly higher frequency as related to the patients in the second group who were not tested for curvature during hypospadias treatment. This is why standard techniques in hypospadias repair should definitely include the diagnosis and surgical correction of penile curvature.

Ten-year Experience of Adult Hypospadias Repairs at a Single Center

Purpose: We retrospectively evaluated the results and complications of urethroplasty in adult patients with hypospadias. Materials and Methods: Between February 1997 and June 2007, 21 adult patients with hypospadias underwent urethroplasty. The types of hypospadias were as follows: megameatus intact prepuce (MIP; n=4), subcoronal (n=5), distal penile (n=3), midshaft (n=2), penile (n=2), penoscrotal (n=2), and scrotal (n=3). Among the 21 patients, 13 were in the primary operative (group A) and 8 were in the re-operative (group B). Results: The mean age of the patients was 32.4±6.4 years (group A, 33.1±6.0 years; group B, 31.1±7.8 years). The mean duration of catheter drainage was 8.0±2.4 days (group A, 7.9±1.8 days; group B, 8.0±2.1 days). The surgical procedures included tubularized incised plate urethroplasty (n=14), Thiersch-Duplay (n=3), pyramid (n=3), and transverse preputial island flap (n=1). The overall success rate was 61.9% (group A, 92.3%; group B, 12.5%). Urethrocutaneous fistulas and a meatal stricture occurred in 6 and 1 patients, respectively, with both occurring in 1 patient (38.1% overall complication rate). Fistula repairs were performed successfully in 4 patients and another fistula resolved spontaneously. The meatal strictures were treated with simple dilatation. Conclusions: Our data demonstrated a very high success rate in the treatment of primary adult hypospadias. And more careful surgical procedure is needed in patients who had history of previous failure more than 2 times because of significantly high complacation rate. (Korean J Urol 2008;49:1144-1148) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

URETHROPLASTY

Objectives: To assess the results of Tubularized incised plate urethroplastyfor hypopadias repair and to find out the causes of failure. Design: Prospective randomized study. Place &amp; Durationof Study: Department of urology, Allied Hospital Faisalabad. From May 2001 to April 2003. Patients &amp; Methods: 20consecutive patients of Hypospadias were included in this study. All cases were managed by Tabularized incised platUrethroplasty (TIPU). Results: 12 cases presented with distal Hypospadias. 08 patients came with proximalHypospadias. Common age at presentation was below 5 years. Orthoplasty was done by Nasbit technique in 04patients. Overall success of tabularized incised plate urethroplasty for distal Hypospadias repair was seen in10(83.60%) cases. 01(8.30%) patients developed fistula and 01(8.30%) patient presented with total disruption. Meatalstenosis was observed in 01(8.30%) patient which responded well to regular dilatation. Overall success of TIPU forproximal Hypospadias repair was seen in 05(62.50%) patients. Fistula occurred in 02(25%) patients and total disruptionin 01(12.5%) patient. 01(12.5%) patient developed meatal stenosis which was managed by regular dilatation.Conclusion: TIPU can be applied as a valid option to treat all types of Hypospadias. Most of the complications canbe minimized by proper technique, prevention of hematoma formation and infection.

Long-Term Cosmetic and Sexual Outcome of Hypospadias Surgery: Norm Related Study in Adolescence

Even if performed early in life, hypospadias surgery may have a significant impact on self-esteem and sexual behavior in adolescence. We evaluated the long-term cosmetic and sexual outcomes of hypospadias surgery performed in childhood. A detailed questionnaire was mailed to 33 patients with hypospadias who were 18 to 26 years old and had undergone the first operation at age 6 years or younger. It was also mailed to 50 age matched controls. A total of 22 patients (66.7%) and 38 controls (76.0%) returned the questionnaire. Mean age in the hypospadias and control groups was 20.6 and 21.0 years, respectively. Eight of the 22 patients had mild hypospadias and 11 had severe hypospadias. Severity was unknown in 3 patients. Age at the first and final operations was 31 to 75 (mean 46) and 35 to 81 months (mean 53). The number of operation was 1 in 10 patients, 2 in 10 and 3 in 2. The rate of dissatisfaction with penile appearance was slightly higher in the hypospadias group than in the control group (40.9% vs 34.2%). The single reason for dissatisfaction in the hypospadias group was inadequate penile size, whereas in the control group penile size, phimosis and curvature were the major reasons for dissatisfaction (69.2%, 46.2% and 23.1%, respectively). Experience with masturbation (100% and 97.4%) and sexual intercourse (52.4% and 55.3%), and mean age at first masturbation (13.4 and 13.0 years) and first sexual intercourse (16.6 and 17.3 years) were similar in the hypospadias and control groups, respectively. Although patients with hypospadias had a slightly higher rate of dissatisfaction with penile size, their sexual behavior was not different from that in control subjects.

A technique for introducing looped sutures in flexor tendon repair

ABSTRACTThis is the author′s experience of hypospadias reconstruction using Bracka′s technique (mainly) over a period of three years. A total of 98 procedures related to hypospadias were done in three years. The surgical technique is described. In the author′s hand, Bracka′s technique gives good result both functionally and in appearance. Its versatility enables its use in all types of hypospadias with consistently reproducible results with minimal complications. At the end of the second stage a circumcised penis with natural looking vertical slit neo-meatus at the apex of the glans is produced.

Factors affecting the long-term results of hypospadias repairs

Purpose The aim of this study was to explore the relationships between the short- and long-term results of hypospadias repair and identify the factors that could affect the long-term results of hypospadias repair. Materials and Methods Between 1982 and 1988, 142 patients were operated for hypospadias and completed their treatment at Tongji Hospital (Wuhan, China). Their records were analyzed retrospectively, and a detailed questionnaire was mailed to them. Results One hundred two patients returned the questionnaire. Patients in the proximal hypospadias group, those using Denis-Browne technique, and those with early complications were markedly dissatisfied with the overall results of hypospadias repair and penile appearance. Moreover, their dissatisfaction grew with the number of operations they had. Thirty-nine (95.1%) of 41 patients using the Denis-Browne technique had voiding problems. Forty-nine (48%) of 102 patients felt inhibited in seeking girlfriends or sexual contacts. Moreover, there was a positive correlation between the level of sexual inhibition and operation times. A highly positive correlation was found between the age at the time hypospadias surgery was completed and the extent of being sexually inhibited. The patients in proximal hypospadias group had more erection and ejaculation problems. Conclusions The short-term results of hypospadias repair could affect the long-term results significantly, and good short-term results also predict long-term ones. The types of hypospadias, procedures, and complications have significant influences on predicting the long-term results of hypospadias repairs.

Three-year experience of hypospadias surgery: Bracka′s method

This is the author's experience of hypospadias reconstruction using Bracka's technique (mainly) over a period of three years. A total of 98 procedures related to hypospadias were done in three years. The surgical technique is described. In the author's hand, Bracka's technique gives good result both functionally and in appearance. Its versatility enables its use in all types of hypospadias with consistently reproducible results with minimal complications. At the end of the second stage a circumcised penis with natural looking vertical slit neo-meatus at the apex of the glans is produced.

Hypospadias repair: Byar's two stage operation revisited

Hypospadias is a congenital deformity characterised by an abnormally located urethral opening, that could occur anywhere proximal to its normal location on the ventral surface of glans penis to the perineum. Many operations had been described for the management of this deformity. One hundred and fifteen patients with hypospadias were treated at the Department of Plastic Surgery, Hospital Kuala Lumpur, Malaysia between September 1987 and December 2002, of which 100 had Byar's procedure performed on them. The age of the patients ranged from neonates to 26 years old. Sixty-seven patients had penoscrotal (58%), 20 had proximal penile (18%), 13 had distal penile (11%) and 15 had subcoronal hypospadias (13%). Operations performed were Byar's two-staged (100), Bracka's two-staged (11), flip-flap (2) and MAGPI operation (2). The most common complication encountered following hypospadias surgery was urethral fistula at a rate of 18%. There is a higher incidence of proximal hypospadias in the Malaysian community. Byar's procedure is a very versatile technique and can be used for all types of hypospadias. Fistula rate is 18% in this series.

Clinical results of one-stage urethroplasty with parameatal foreskin flap for hypospadias.

We investigated the usefulness of one-stage urethroplasty by the parameatal foreskin flap method (OUPF procedure), which is useful for repairing all types of hypospadias. Between June 1992 and March 2001, the OUPF procedure was performed on 18 patients with hypospadias: 10 patients with distal and 8 with proximal hypospadias. The follow-up periods ranged from 33-75 months, with an average of 52 months. The duration of surgery, the catheter indwelling period, and the postoperative complications of each patient were analyzed. The median age of the patients at the time of surgery was 3 years and 8 months. The length of surgery for OUPF II ranged from 150-230 min (average 186 min), and from 190-365 min (average 267 min) for OUPF IV. Postoperative complications were confirmed in 3 of the 18 patients (16.6%). Two patients had fistulas, and one had a meatal regression. The fistulas were successfully closed by the simple multilayered closure method. After adopting DuoDerm dressings instead of elastic bandages for protection of the wound, no fistulization occurred. DuoDerm dressings are useful in the healing of wounds without complications. To date, the longest follow-up period has been 75 months, and during that time there have been no late complications such as urethral stenosis or penile curvature. OUPF is a useful method in the treatment of hypospadias with a low incidence of early and late complications.