Underwent Hypospadias Repair Research Articles

CYSTOSTOMY DIVERSION REDUCED COMPLICATIONS FOLLOWING HYPOSPADIAS REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: This study aims to investigate the associations between the use of cystostomy diversion and the incidence of complications following hypospadias repair. Material & Methods: An extensive search of PubMed, ScienceDirect, Embase, and the Cochrane Library, was performed to identify studies that assessed the impact of cystostomy diversion on complication rates after hypospadias repair. To evaluate potential biases, the RoB 2 tool was applied for randomized controlled trials (RCTs), while the ROBINS-I tool was used for observational studies. Data analysis was conducted using Review Manager 5.4. Results: This review included ten studies involving 1.120 patients who underwent hypospadias repair. The overall complication was 16.9%. The meta-analysis revealed that opting against cystostomy diversion after hypospadias repair led to a notably increased risk of complications, as evidenced by a pooled odds ratio (OR) of 1.48 (95% confidence interval (CI) 1.07–2.03). The significant negative effect of not performing cystostomy on the risk of complications was consistent in sub-analysis of distal hypospadias (OR 1.97; 95% CI 1.11–3.51) and primary hypospadias repair (OR 1.80; 95% CI 1.19–2.73). In the funnel plot, there was no significant publication bias identified. Conclusion: Our meta-analysis demonstrated that cystostomy diversion reduces the incidence of complications following hypospadias repair. The positive effects were consistent in both distal hypospadias and primary hypospadias repair. Keywords: Complications, cystostomy, hypospadias.

Adulthood cosmetic and sexual outcomes of the patients who underwent hypospadias repair in childhood.

This study aimed to assess the cosmetic and sexual outcomes of childhood hypospadias repair after puberty. Among 672 patients who underwent hypospadias repair between 2001 and 2017, 243 sexually active patients were included in the study. At their last visit, cosmetic and sexual evaluation were done through the Penile Perception Score, the Hypospadias Objective Scoring Evaluation, IIEF, MSHQ-EjD. The levels of erectile dysfunction(ED) severity were determined according to erectile function domain of IIEF. The median follow-up after the last surgery was 16 [IQR (13-18)] years, and median patient age at the time of study was 19.67 [IQR(18-22)] years. Patients were divided into two subgroups as follows: Group I; Repairs using grafts (n = 120, 49.4%) and Group II; Graft-free repairs (n = 123, 50.6%). The rate of dissatisfaction with penile appearance was higher in Group I (16.7% vs. 4.9%, p = 0.003). Mild ED was more frequent in Group I (14.2% vs. 3.3%, p = 0.007); while none of the patients had either moderate or severe ED. Other domains of sexual function were observed to be similar in both groups. The need for unwanted interventions due to complications, and surgeries requiring grafts were found to be risk factors for ED development and dissatisfaction with penile appearance in adulthood. Those who underwent graft-free hypospadias repair experience better cosmetic and sexual outcomes when compared to grafted repairs, yet, satisfactory results were achieved in almost 90% of the grafted repairs.

Long-term Functional, Sexual, and Cosmetic Outcomes in Adult Patients Who Underwent Hypospadias Repair During Childhood at a Highly Specialized Italian Pediatric Hospital.

This study aims to evaluate long-term functional, sexual, and cosmetic outcomes in adult patients who underwent hypospadias repair during childhood at a national highly specialized pediatric hospital. Medical records of pediatric patients who had undergone surgical repair of hypospadias between 1993 and 2004 at Meyer Children Hospital of Florence were reviewed. Adult patients were contacted by telephone between July and August 2021 and invited to participate. Long-term surgical outcomes were assessed focusing on complications and reinterventions, and 3 validated questionnaires on urinary function, erectile function, and penile cosmetic appearance were administered. From January 1993 to December 2004, a total of 799 patients with hypospadias underwent repair surgery. Two hundred thirty-nine patients gave consent to be included in the study. Follow-ups occurred between 17 and 28 years after the first surgery. Most patients had anterior localization of hypospadias (210/239) and associated penile curvature (132/239). The most frequent surgery for hypospadias repair was meatal advancement and glanduloplasty incorporated (MAGPI) (88/239), and the most used surgical treatment for penile curvature was the Nesbit technique (49/132). The complication rate was 27% (65/239) in an average time of 4.7 years, and 48 surgical procedures have been performed to treat them. At follow-up, the mean IPSS was 0.96± 1.97, the mean IIEF-5 score was 24.10 ± 1.02, and the mean HOSE score was 15.47 ± 0.45. Patients who underwent reintervention reported a lower IPSS than those who underwent only 1 surgery (0.29 vs. 1.16). Hypospadias repair during childhood leads to rather normal urinary and sexual function and penile cosmetic appearance in adolescence and adulthood.

Time to complication after primary pediatric hypospadias repair with transverse preputial island flap urethroplasty.

Hypospadias is one of the most common congenital malformations in men. The transverse preputial island urethroplasty is widely used in China, especially for moderate and severe cases due to its convenient prepuce of the penis. This analysis aims to delineate the time to first complication following transverse preputial island urethroplasty. We analyzed the clinical data and follow-up results of children who underwent hypospadias repair by transverse preputial island urethroplasty in Beijing Children's Hospital, Capital Medical University from December 2018 to December 2019 retrospectively. Postoperative complications included urethral fistula, urethral diverticulum, urethral stricture, persistent chordee. Univariate analysis of clinical variables and time to complication was performed using Kaplan-Meier survival curve. One hundred and sixty-five patients were identified. During the follow-up period, complications occurred in 101 cases (61.2%). Ninety-four percent of complications occurred within 1 year. Among children who experienced complications, Kaplan-Meier survival analysis showed that age less than 18 months and the severity of hypospadias were statistically significant (P=0.005 and P=0.04, respectively). The time to urethral diverticulum was significantly longer than that of urethral fistula and urethral stricture. More than 90% of complications after the transverse preputial island urethroplasty of hypospadias occurred within 1 year, with those related to proximal hypospadias presenting earlier than those of midshaft/distal hypospadias. Surgeons may consider a more frequent follow-up within the first year after surgery to detect these complications as early as possible.

SOX9 regulates epithelial‐mesenchymal transformation by mediating the Wnt/β‐catenin signaling pathway in hypospadias

AbstractThe transcription factor SOX9 is crucial in the development and differentiation of various tissues and cells. However, the roles of SOX9‐dependent genes and pathways in normal urethral development and the mechanism of hypospadias are unclear. This study collected 15 foreskin tissue specimens from patients who underwent hypospadias repair surgery and compared them to normal foreskin tissue specimens obtained during circumcision. The expression levels of SOX9, WNT signaling pathway markers, and epithelial‐mesenchymal transition (EMT) markers were analyzed in both groups. It was found that mRNA and protein levels of SOX9, WNT signaling pathway, and EMT mesenchymal markers were significantly reduced in the hypospadias group compared to the normal foreskin group. In contrast, mRNA and protein levels of epithelial markers were significantly increased in the hypospadias group. Immunofluorescence confirmed the decrease in SOX9 expression. Experiments using siRNA to inhibit SOX9 expression in foreskin fibroblasts yielded similar results to the hypospadias group. The findings suggest that down‐regulation of SOX9 expression may contribute to the development of hypospadias by down‐regulating the WNT pathway and inhibiting EMT. These findings provide new insights into the embryonic development of the urethra.

A study on complications and outcome of hypospadias repair at tertiary care hospital

Background: The surgical procedure used to treat hypospadias varies widely in clinical practice due to several considerations. In light of this, we assessed the risks and results of many surgical techniques for correcting hypospadias. Methods: It was a prospective hospital-based study done for a period of 1 year. All patients with age greater than 12 months who underwent hypospadias repair in the surgery department of PMSSY super speciality hospital (KIMS, Hubballi) from January 2022 to December 2023 were included in the study. Approval from institutional ethical committee was taken before initiation of the study. Written informed consent was taken from the parents of the study participants. Total 42 patients with hypospadias were included in the present study. Results: The most common type of hypospadias was distal seen in 67% of patients among distal the most common site of urethral opening was distal penile in 43% followed by mild penile in 40%. Proximal type was second most common type seen in 24% and 7% were granular. TPIF repair was the most common choice of operation among surgeons in distal and proximal hypospadias due to ease of application and less complications and it was statistically significant followed by Snodgrass repair mostly seen in distal hypospadias. Conclusions: In this study, distal type hypospadias was the most prevalent form. Roughly one-third of the patients received TPIF surgery, whereas the same percentage had Snodgrass repair for their hypospadias.

Safety and Effectiveness of Triclosan-Coated Polydioxanone (PDS Plus) versus Uncoated Polydioxanone (PDS II) Sutures for Prevention of Surgical Site Infection after Hypospadias Repair in Children: A 10-Year Single Center Experience with 550 Hypospadias.

Triclosan is an antiseptic substance that has been shown in preclinical studies to reduce bacterial load in the wound and slow bacterial growth by inhibiting fatty acid synthesis. It is claimed that the coating protects against colonization of the tissue around the suture. This study aimed to compare the safety and efficacy of triclosan-coated polydioxanone versus uncoated polydioxanone sutures for the prevention of surgical site infections (SSIs) following hypospadias repair in children. The medical records of 550 children who underwent hypospadias repair between 1 January 2014 and 31 December 2023 were retrospectively analyzed. The patients included in the study were divided into two groups. The first group consisted of the patients in whom polydioxanone (PDS II) was used (n = 262), while in the patients of the second group (n = 288), triclosan-coated polydioxanone (PDS Plus) was used for hypospadias repair. Secondary outcomes were defined as the occurrence of early and late complications, the number of readmissions within 30 days after surgery (ReAd), unplanned return to the operating room (uROR), and repeat operations. The median age of all children enrolled in the study was 16 (IQR 14, 20) months. The patients in whom PDS Plus was used for hypospadias repair had a significantly lower number of SSIs than the patients in whom PDS II was used (n = 18 (6.9%) vs. n = 4 (1.4%), p < 0.001). Wound infection led to wound dehiscence in 10 of 18 patients from the PDS II group, while all four wound infections from the PDS Plus group led to wound dehiscence (p = 0.07). The number of postoperative urethrocutaneous fistulas was significantly lower in the patients in whom PDS Plus was used (13.7% vs. 8.3%, p = 0.042). The incidence of late complications did not differ between the study groups: meatal stenosis (p = 0.944), residual chordee (p = 0.107), urethral stricture (p = 0.196), scarring (p = 0.351) and urinary discomfort (p = 0.713). There were no cases of uROR in either group. The ReAd rate was low in both groups (n = 5 (1.9%) vs. n = 2 (0.6%), p = 0.266). The frequency of reoperations was lower in the group of patients treated with PDS Plus than in the group of patients treated with PDS II (11.1% vs. 20.6%; p = 0.03). The use of PDS Plus in hypospadias surgery significantly reduces the incidence of SSI, postoperative fistulas, and reoperation rates compared to PDS II.

3M antimicrobial incise drape combined with MEBO in wound recovery of postoperative hypospadias surgery.

To evaluate the efficacy of different dressing methods in wound healing and the postoperative outcome in children who underwent hypospadias repair. Altogether 109 children with distal hypospadias who underwent urethroplasty were recruited from our hospital between January 2021 and March 2023. All patients were randomized in two groups according to the different dressing methods: Group A receiving 3M antimicrobial incise drape + MEBO (moisture-exposed burn ointment) and Group B receiving absorbent dressing + elastic bandage dressing. The age at surgery, operation time, bleeding during the dressing, postoperative changes in glans color, dressing fell off, comfort of children during the dressing, difficulty in dressing removal, and degree of pain during dressing removal were compared between the two groups. Differences in age at surgery (p = 0.337) and operation time (p = 0.055) were not significant between the two groups. The overall effectiveness of the dressing was better in Group A than that in Group B. Only five cases in Group A had blood leakage after dressing (p = 0.006), and there was no dressing dislocation (p < 0.001) or glans color abnormality (p < 0.001). Moreover, the number of complication cases was less. The overall comfort and pain degree during dressing removal in Group A was better than that in Group B (p < 0.001). Postoperative dressing using 3M antimicrobial incise drape + MEBO can achieve lower incidence rates of bleeding during dressing, postoperative glans darkening, and dressing falling off, a lower pain degree during dressing removal, and a better overall comfort level than those of the control group. This method is cost-effective and clinically safe, which contributes to the postoperative recovery of children with hypospadias and is thus worth promoting and applying.

Long term follow-up on young adults that underwent hypospadias repair through urethral advancement in childhood.

Assess the long-term outcome on cosmetic appearance, voiding, sexual function, and psychological impact of young adults operated by urethral advance (UA) technique in childhood. Patients over 14 years old, who underwent UA hypospadias repair in our centre (2000-2010) were evaluated. All patients presented mid-distal hypospadias with subcoronal or penile meatus and curvature lower than 20°. The cosmetic appearance, urinary and sexual function, body perception and overall satisfaction were assessed through 5 questionnaires. From 2000 to 2010, 143 children underwent UA hypospadias repair. 36 patients between 14 and 27 years were evaluated. The Hypospadias Objective Penile Evaluation (HOPE) showed an average of 8.75 (+/- 0.97), which indicates a good aesthetic result. Voiding dysfunction symptoms were assessed through the American Urological Association Symptom Index (AUASI) where 80.6% had none or mild symptoms and 19.4% had moderate symptoms. Only 11/36 patients were sexually active, according to the International Index of Erectile Function (IIEF-15) scale, none had erectile dysfunction, and their relationships were satisfactory. Assessment of the body perception through the Genital Perception Scale (GPS) was positive or very positive in 88.9% of the patients. However, the perception of their genitals was positive or very positive in 77.8%, there is a negative correlation between the perception of their body and genitals in 13.9% of the patients. Our results indicate that UA technique for hypospadias repair might be a valid option for the correction of mid-distal hypospadias when indicated.

Long-term impact of commonly performed operations in pediatric urology on reproductive and sexual health.

Sexual dysfunction is highly prevalent among men of reproductive age. Clinical practice guidelines have been established to assist providers in identification and education of patients who are at increased risk for infertility and sexual dysfunction with certain congenital and acquired urogenital disorders. The authors sought to review the reproductive and sexual health implications of treating common childhood urological conditions with commonly performed surgical procedures. To ensure the inclusion of influential and highly regarded research, we prioritized citations from the most-frequently cited articles on our respective review topics. Our inclusion criteria considered studies with substantial sample sizes and rigorously designed methodologies. Several topics were reviewed, including penile chordee, hypospadias, posterior urethral valves, varicoceles, undescended testicles, and testicular torsion. For chordee, surgical plication or corporal grafting may be employed. Erectile function remains unaltered post-surgery, while penile length may decrease after repair, which may be avoided using dermal grafts. Hypospadias repair hinges on severity and availability of the urethral plate. Those who underwent hypospadias repair report decreased penile length, but sexual satisfaction, libido, and semen quality are comparable to controls. Posterior urethral valves are usually treated with valve ablation. While valve ablation and bladder neck incision have not been found to affect ejaculatory function, high degree of concurrent renal dysfunction related to nephrogenic and bladder dysfunction may impact semen parameters and erectile function. Regarding varicocele, earlier management has been associated with better long-term fertility outcomes, and surgical intervention is advisable if there is observable testicular atrophy. Earlier repair of undescended testicle with orchiopexy has been found to improve fertility rates as well as decrease malignancy rates. Unilateral orchiectomy for testicular torsion without the ability for salvage has been shown to have decreased semen parameters but unaffected fertility rates. Infertility and sexual dysfunction are multivariable entities, with etiologies both congenital and acquired. At the same time, many common pediatric urology surgeries are performed to correct anatomic pathology that may lead to reproductive dysfunction in adulthood. This review highlights the need for diagnosis and management of pediatric urologic conditions as these conditions may impact long-term sexual function post-operatively.

Intracavernosal pressure of the erect penis in children with hypospadias.

This study objective is to examine the intracavernosal pressure (ICP) in hypospadias boys with and without previous corporotomies. Retrospectively, the ICPs that were measured routinely as part of the artificial erection test in boys who underwent hypospadias repair were collected. The measurement (mmHg) included a slow manual saline instillation and a 21-gauge needle in the corpora cavernosa, which was connected to a pressure monitor. The full and rigid erections were defined according to the Erection Hardness Score by agreement between the two surgeons operating on the patient. Included were 61 boys with a median age of 15 months (IQR 8-27). Group A included 32 boys with coronal, subcoronal, or penile hypospadias. Group B included 29 boys with penoscrotal, scrotal, and perineal hypospadias. The median pressures at full erection for Groups A and B were 71.5 (IQR 59-79) and 62.5 (IQR 48-71) (p = 0.036), respectively, and at rigid erection were 283 (IQR 219-310) and 237 (IQR 182-278) (p = 0.032), respectively. In group B, median pressures at full erection for boys with and without previous corporotomies were 53.5 (IQR 45-65) and 69 (IQR 57-82), respectively (p = 0.001), and at rigid erection were 189.5 (IQR 113-263) and 264.5 (IQR 226-298), respectively (p = 0.003). In a comparison between group A boys to 18 boys in group B who did not have corporotomies, the median pressures at full erection were 71.5 (IQR 59-79) and 69 (IQR 57-82), respectively (p = 0.9), and at rigid erection were 283 (IQR 219-310) and 264 (IQR 226-298), respectively (p = 0.86). In conclusion, ICPs of artificial erections are lower in proximal hypospadias and in boys with previous corporotomies. The durability and the implications of these pressures require further research.

Outcomes of hypospadias repair and factors associated: A study in a tertiary care hospital

ABSTRACT Background: Hypospadias is the most common congenital abnormality of the urethra affecting 1 in 300 live male births worldwide. The results of hypospadias surgery are still frequently unfavorable with a reported complication rate as high as 50% or above. Aims and Objective: The aim of our study was to determine the demographics and analyze the surgical management and factors influencing the postoperative outcomes of hypospadias repair. Materials and Methods: This hospital-based prospective study was conducted in the Department of Plastic and Reconstructive Surgery, Regional Institute of Medical Sciences, Imphal, Manipur, for 2 years from December 2019 to November 2021. The study was conducted on 28 male patients who underwent hypospadias repair. Demographics, operative techniques reviewed, and the outcome of hypospadias repair were evaluated for results and complications. Statistical Analysis: Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS version 21). Descriptive statistics such as mean, median, and percentage were used to summarize the data. The Chi-square test, Fisher’s exact test, and t-test were used to see the associations between variables of interest and prognosis of repair. P &lt; 0.05 was taken statistically significant. Results: A total of 28 male patients with a mean age of 7.46 ± 5.25 standard deviation presented for hypospadias repair. Mid-penile hypospadias was the most common type in the study population accounting for 60.71% of patients, followed by penoscrotal 35.71% of cases. 82.14% of the hypospadias were associated with some degree of chordee. Meatal stenosis, cryptorchidism, and inguinal hernia were observed in 17.8%, 3.57%, and 7.14%, respectively. 46.42% of hypospadias were repaired in two stages, while 25% were subjected to tubularized incised plate repair, and 28.57% of patients were repaired with the Asopa technique. The most common complications were edema and urethrocutaneous fistula. The complications were significantly lower in the hands of specialists than residents (P = 0.037). Two-stage repair has higher complications than single-stage repair (P = 0.0001). Conclusion: Hypospadias surgery has a long learning curve because it requires a great deal of temperament, surgical skill, and acquaintance with magnifications along with knowledge of surgical anatomy. Regular periodic audits should also be performed to improve the outcome of the hypospadias repair.

The Efficacy of Caudal Anesthesia in Pediatric Surgery

Background: Despite a long history of safety, spinal anesthesia (SA) is still seldom used outside of specialist pediatric institutions and is sometimes debated as a primary anesthetic approach for children. To lessen the risk of postoperative apnea, it is often used on previously preterm newborns who have not yet reached viability (60 weeks post- conception) (GA). There is, however, a wealth of evidence indicating its safety and effectiveness for appropriate operations in adolescents. Objective: The primary purpose of this investigation is to assess the efficacy of Caudal anesthesia pediatric surgery. Method: Tertiary care hospital was the setting for this prospective investigation. 200 children, ages 4 to 10, were included in the research because they were all given different types of anesthesia for infraumbilical or lower extremities surgery during the study's 1-year time frame. The research participants had a thorough preoperative assessment. During the study 50 patients of each were given different anesthesia including Endotracheal intubation, LMA, Caudal block and local anesthesia. Results: Majority was belonged to 4-6 years age group, 70% and 60% were male. Plus, majority of the patients were undergone circumcision, 35% and Herniorrhaphy, 28%. Followed by 20% undergone appendectomy and 5% undergone hypospadias repair. Besides, anesthesia induction and recovery on the operating room table, was lowest in the local anesthesia group (P = 0.015), whereas the results were comparable in the other groups. However, patients with caudal and local anesthesia spent significantly less time in the postoperative recovery unit (P &lt; 0.001). In fact, patients who got Caudal block had less complication where only 1% had Convulsions, Bloody puncture and vomiting. Conclusion: Caudal anesthesia as a sole method for pediatric subumbilical surgery is a relatively safe method. Patients having operation under caudal anesthesia have faster discharge times from postoperative recovery units, compared with general anesthesia. This probably reduces recovery unit expenditures.

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.

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

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.

MP18-10 DOUBLE VS SINGLE DIAPER TECHNIQUE AFTER HYPOSPADIAS REPAIR, DOES IT REALLY MATTER?

You have accessJournal of UrologyCME1 Apr 2023MP18-10 DOUBLE VS SINGLE DIAPER TECHNIQUE AFTER HYPOSPADIAS REPAIR, DOES IT REALLY MATTER? Khaled Aldabek, Samuel Luketich, Amr A. Elbakry, Ahmed Abdelhalim, and Osama Al-Omar Khaled AldabekKhaled Aldabek More articles by this author , Samuel LuketichSamuel Luketich More articles by this author , Amr A. ElbakryAmr A. Elbakry More articles by this author , Ahmed AbdelhalimAhmed Abdelhalim More articles by this author , and Osama Al-OmarOsama Al-Omar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003238.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Double-diaper technique is a common practice after hypospadias repair, which is believed to have fewer complications and better surgical outcomes. This practice is not evidence-based, and some families get stressed about this particular step of postoperative care. This study hypothesizes that the single-diaper technique offers similar surgical outcomes compared to the double-diaper technique. METHODS: 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 free inside the single diaper. Short-term complications including: surgical site infection (SSI), urinary tract infection (UTI) and wound dehiscence were the primary outcome; whereas long-term urethroplasty complications were secondary outcomes. Outcomes were analyzed according to the type of diaper care. RESULTS: 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 the age at surgery, follow-up duration, type of hypospadias, associated chordee and surgical technique. Looking at the primary outcomes, there was no statistically significant difference in SSI, UTI or wound dehiscence rates between the study groups. Only one dehiscence was reported in the single-diaper group for a patient with myelomeningocele who required self-catheterization. For the secondary outcomes, the incidence of meatal stenosis (8.3 vs. 1.4%, p=0.044), and fistula formation (5.4 vs. 15.3%, p=0.037) was significantly higher in the double-diaper than the single diaper group, respectively. Patient demographics and surgical outcomes are summarized in table 1. CONCLUSIONS: Single-diaper technique for hypospadias repair is simple, easy, and is not associated with increased risk of complications compared to double-diaper technique. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e226 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Khaled Aldabek More articles by this author Samuel Luketich More articles by this author Amr A. Elbakry More articles by this author Ahmed Abdelhalim More articles by this author Osama Al-Omar More articles by this author Expand All Advertisement PDF downloadLoading ...

Opioids and pediatric urology: A prospective study evaluating prescribing habits and patient postoperative pain and narcotic utilization

Few pediatric urologists believe patients require a majority of the doses of opioids prescribed to them postoperatively. Seeking a better understanding of postoperative pain and analgesia in pediatric urology patients may help reduce opioid over prescription while still adequately managing postoperative pain. We sought to better understand: 1) the postoperative pain levels experienced by pediatric urology patients, 2) the factors that correlate with postoperative pain and number of opioids consumed following pediatric urologic procedures, and 3) the patients who do not require opioids after surgery. Pediatric patients undergoing circumcision, inguinal hernia repair, orchidopexy, or hypospadias repair were eligible to participate. Patients were enrolled in the prospective cohort on the day of the procedure. For each of the first 7 postoperative days, patients' parents completed a text message-based questionnaire, quantifying their child's pain level and the doses of pain medication the child consumed. 165 participants were enrolled. 57 patients underwent circumcision, 54 underwent orchiopexy, 32 underwent hypospadias repair, and 22 underwent inguinal hernia repair. For all procedure types, pain scores (p<0.01) and doses of oxycodone consumed were highest on postoperative day one and steadily declined thereafter. Overall, average 7-day pain score (2.02; 0.86-5.14) and doses of narcotics consumed (3.50; 0-5) were low. Patients in each surgical subgroup were prescribed narcotics in excess of what was consumed. There was an average excess of 10.9 doses (0-39.0) for hypospadias repair, 8.6 (1.0-30.0) for circumcision, 9.0 (3.0-21.0) for inguinal hernia repair, and 6.1 (0-22.0) for orchiopexy. Overall, reported pain scores and number of narcotics consumed were low regardless of surgery type. Opioids were overprescribed regardless of surgery type. Our findings indicate that level of pain and opioid use varies by procedure type, but that number of narcotics prescribed greatly exceeds number needed.

Glans augmentation by pedicled inner preputial flap in distal penile hypospadias: A prospective interventional study

Abstract Aims and Objective: The aim of the study was to describe a modification in the tubularized incised plate (TIP) procedure that incorporates glans augmentation with the inner preputial flap in cases of distal penile hypospadias with small glans and shallow groove. Materials and Methods: This was a prospective interventional study conducted over a period of 1 year from July 1, 2021, to June 31, 2022, at the Department of Pediatric Surgery, SMS Medical College and attached SPINCH, Jaipur. All distal penile hypospadias patients with small glans and shallow groove were included in the study. Patients with failed repairs and having associated congenital conditions were excluded. All the included patients underwent hypospadias repair by the standard TIP technique, and a modification was added to augment the glans by inner preputial flap. The incidence of glans dehiscence and fistula formation along with cosmetic appearance was recorded. Results: A total of 25 patients were included, which comprised subcoronal (n = 14; 56%), distal penile (n = 7; 28%), and coronal (n = 4; 16%) hypospadias. There were no immediate or late postoperative complications. Follow-up periods were ranging from 4 months to 12 months. There was no meatal stenosis or urethra cutaneous fistula formation after 6 months of follow-up period. The cosmetic appearance and color of the glans were satisfactory after 6–12 months of follow-up. Conclusions: With this modification of the TIP procedure in patients with distal penile hypospadias having small glans and shallow groove, a good glans width with normally placed meatus without stenosis and fistula can be achieved.

Do preoperative leukocyte and neutrophil levels have a predictive value on the complications of hypospadias repair in children?

Surgeons observed that the outcomes after the same repair technique in the same type of hypospadias performed by the same surgeon may be different. There may be some indeterminate factors that influence the results such as subclinical inflammation. Our study evaluated the predictor values of inflammatory hematologic parameters on the complications after hypospadias repair. We retrospectively reviewed the data of patients who underwent hypospadias repair between January 2016 and January 2019 in our clinic. Age at surgery, hypospadias type, repair technique, complications were recorded. Patients who underwent Snodgrass repair by a single surgeon were included in the study while patients who underwent different techniques or procedures that were performed by other surgeons were excluded. The levels of white blood cell, neutrophil, lymphocyte, platelet and monocyte, the mean platelet volumes were recorded from blood test that were performed one day before surgery. Neutrophil-lymphocyte ratio (NLR), plateletlymphocyte ratio (PLR), and other parameters were analyzed to determine their relationship with complications after hypospadias surgery. WBC and neutrophil levels were statistically higher in patients with complications (p = 0.006 and 0.017 respectively). Other hematological parameters were not different between patients with or without complications. To predict the complications, the WBC cutoff was 9500/mm3, the neutrophil cutoff was 3000/mm3. WBC and neutrophil values were statistically significant in predicting the complications after Snodgrass repair in patients with hypospadias. Our result determined no relation between complications and NLR, PLR.