Urethrocutaneous Fistula Research Articles

Congenital anterior urethral valves and diverticula

Aims of StudyAnterior urethral valves (AUVs) are rare congenital anomalies causing lower urinary tract obstruction in children. The present study highlights the clinical approach in identifying the condition and its treatment options. MethodSingle centre, retrospective study of children. ResultOver a 16 year duration, 14 children were diagnosed with AUVs and diverticula with a mean age of 15 months. Clinical features included straining at micturation and a palpable penile swelling. Diagnosis was confirmed with voiding cystourethrogram and cystoscopy. An open surgical procedure was performed in 12 cases and endoscopic intervention done in one. On follow up 13 patients showed restoration of a normal voiding stream and normal renal function. One child died of chronic renal failure due to a delayed presentation, severe back-pressure changes, urinary ascites, and urosepsis. One patient developed a small urethrocutaneous fistula that healed spontaneously. ConclusionAUV, though rare, should be recognizable due to the combination of a poor urinary stream and visible swelling in the ventral aspect of penis. Open surgical excision is the method of choice, and the outcome is excellent. Level of EvidenceLevel IV.

P13 - Post-urethroplasty fistula closure with PATIO technique: An alternative for the repair of urethro-cutaneous fistulas

P13 - Post-urethroplasty fistula closure with PATIO technique: An alternative for the repair of urethro-cutaneous fistulas

Comparative study between snodgrass urethroplasty and modified snodgrass urethroplasty for distal penile hypospadias in terms of post-operative urethrocutaneous fistula formation

Background: Hypospadias is a congenital defect involving the male urethra characterized by the absence of urethral meatus at its normal position. This anomaly is usually associated with the ventrally deficient but dorsally hooded skin. In some cases, the penis is ventrally curved. Surgery is the option for this defect. So many procedures have been developed but none is free from the development of urethrocutaneous fistula. Now-a-days, the popular Snodgrass procedure is widely practiced but still fistula occurs. Many factors are thought to be responsible for it. The most important one is defective ventral penile skin which is deficient of vascular and collagen tissues. To minimize these deficient factors, a dorsal vascular preputial flap is transferred ventrally (modified) to reduce fistula formation further. A comparative study was disigned to determine the role of dorsal vascular flap.Methods: The prospective observational study was conducted in the department of pediatric surgery, Bangabandhu Sheikh Mujib medical university, Dhaka, Bangladesh since February 2017 to May 2021.Results: A total of 40 patients with distal penile hypospadias were included in this study. They were divided into Group A and group B, 20 for each. Snodgrass procedure was for Group A and the modified Snodgrass procedure was done for group B. The outcome of both the groups was determined in terms of fistula formation. Seven patients in group-A and one patient in group B developed fistula. The results were analyzed and were found statistically significant.Conclusions: Modified Snodgrass urethroplasty has a better outcome.

To Compare the Outcomes of Dartos Flap and Tunica Vaginalis Flap as Secondary Cover after Second Stage Durham Smith Repair in Reducing Post-Operative Complications

Background: Interposition flaps are mainstay in the success of hypospadias surgery because they lead to decrease in complications of hypospadias repair significantly especially urethrocutaneous fistula by buttressing the neo urethral suture line. Many interposition flaps have been tried with varying outcome results. Most commonly used interposition flaps are Tunica vaginalis flap and dorsal dartos flap however, recently interest have also researched in Durham smith de-epithelialized dartos based overlay flap. Though there are many publications comparing outcome of dorsal dartos and tunica vaginalis flap but hardly any study that has compared all three interposition flaps. So, we aimed to compare the outcomes of dorsal dartos flap (DF), tunica vaginalis flap (TVF) and Durham smith de-epithelialized dartos based overlay flap as interposition layer in TIP urethroplasty. Aim: To compare the outcomes of dorsal dartos flap (DF), tunica vaginalis flap (TVF) and Durham smith de-epithelialized dartos based flap as secondary interposition cover after Tubularized incised plate urethroplastyin reducing post-operative complication. Materials and Methods: A retrospective study was conducted in which case records of 78 patients who had undergone repair for distal and midpenile hypospadias with minimal chordee and favorable anatomy by the Tubularized incised plate urethroplasty with interposition flap over 2 years (2017-2019) were reviewed. Patients were divided in three groups with 26 subjects in each group. Group A consisted of patients with dorsal dartos interposition flap, Group B comprised of patients with Tunica vaginalis interposition flap and Group C consisted of patients with Durham smith deepithelialized dartos based overlay cover. Outcome variables noted were the complications including wound dehiscence, Urethrocutaneous fistula, Meatal stenosis, Penile torsion, skin necrosis and preputial edema. Statistical methods were applied to compare these complications in all three groups. Results: Total number of complications in group A were 11(42.3%) and most common complications were skin necrosis (n=7, 26.9%) and urethrocutaneous fistula (n=6, 23.1%). Total number of complications in group B were 7(26.9%) while Chordee and preputial edema (n=6, 23.1% each) were among the most common complications. 9(34.6%) patients developed complications in group C and most common complications were penile torsion (n=6, 23.1%) and urethrocutaneous fistula (n=4, 15.4%). Conclusion: We have seen in our study that TV flap is a good option as second cover with lesser complications especially in terms of fistula related complications while Durham smith onlay cover found to be equally better option as it showed no skin complications and other complications were almost comparable to TV flap cover.

To Compare the Outcomes of Dorsal Dartos Flap, Tunica Vaginalis Flap and Durham Smith De-Epithelialized Dartos Based Flap as Secondary Interposition Cover after Tubularized Incised Plate Urethroplasty in Reducing Post-Operative Complications

Interposition flaps are mainstay in the success of hypospadias surgery because they lead to decrease in complications of hypospadias repair significantly especially urethrocutaneous fistula by buttressing the neo urethral suture line. Many interposition flaps have been tried with varying outcome results. Most commonly used interposition flaps are Tunica vaginalis flap and dorsal dartos flap however, recently interest have also researched in Durham smith de-epithelialized dartos based overlay flap. Though there are many publications comparing outcome of dorsal dartos and tunica vaginalis flap but hardly any study that has compared all three interposition flaps. So, we aimed to compare the outcomes of dorsal dartos flap (DF), tunica vaginalis flap (TVF) and Durham smith de-epithelialized dartos based overlay flap as interposition layer in TIP urethroplasty. Aim: To compare the outcomes of dorsal dartos flap (DF), tunica vaginalis flap (TVF) and Durham smith de-epithelialized dartos based flap as secondary interposition cover after Tubularized incised plate urethroplastyin reducing post-operative complication. Materials and Methods: A retrospective study was conducted in which case records of 78 patients who had undergone repair for distal and midpenile hypospadias with minimal chordee and favorable anatomy by the Tubularized incised plate urethroplasty with interposition flap over 2 years (2017-2019) were reviewed. Patients were divided in three groups with 26 subjects in each group. Group A consisted of patients with dorsal dartos interposition flap, Group B comprised of patients with Tunica vaginalis interposition flap and Group C consisted of patients with Durham smith deepithelialized dartos based overlay cover. Outcome variables noted were the complications including wound dehiscence, Urethrocutaneous fistula, Meatal stenosis, Penile torsion, skin necrosis and preputial edema. Statistical methods were applied to compare these complications in all three groups.

Individual treatment strategy for single urethrocutaneous fistula after hypospadias repair: a retrospective cohort study.

BackgroundUrethrocutaneous fistula (UCF) remains the most common complication after hypospadias repair, and the recurrence rate of UCF is still high if the surgical techniques is not chosen properly, which called for better approaches to this problem. UCF presents different clinical characteristics due to their different locations and sizes, therefore we retrospectively analyzed the effects of different surgical techniques on single UCF after hypospadias repair in order to reduce the recurrence rates of UCF.MethodsA total of 602 patients diagnosed with UCF after hypospadias repair from January 2014 to December 2021 were enrolled. Baseline clinical characteristics such as age of patients, UCF location, size, surgical techniques were recorded. Patients were followed up in the outpatient clinic. The recurrence of UCF was defined as outcomes. Patients were divided according to the location of the UCF into a coronal UCF group and a non-coronal UCF group, which was then further classified according to the diameter of the UCF. The surgical technique and the recurrence rate of different types of UCF were analyzed and summarized.ResultsA total of 425 patients satisfied the inclusion criteria and 71 patients (16.7%) had recurrent UCF. Five surgical techniques were used to repair the UCF, namely tubularized incised plate (TIP) urethroplasty, Mathieu urethroplasty, double ligation, simple classical closure and trap-door procedure. The recurrence rate was 24.1%, 14.3%, 15.1%, 16.7%, and 22.2%, respectively. TIP or Mathieu urethroplasty is recommended for patients with coronal UCF with glans dehiscence or patients with coronal UCF diameter ≥4 mm without glans dehiscence. In patients with coronal UCF without glans dehiscence, double ligation is recommended for small UCF with diameter <2 mm, and simple classical closure is recommended for UCF with diameter 2–<4 mm. In patients with non-coronal UCF, double ligation is recommended for UCF with diameter <3 mm, and simple classical closure is recommended for UCF with diameter ≥3 mm.ConclusionsSingle UCF can be classified according to the location and size of the UCF. Different types of UCF should be treated with more appropriate individualized strategies, which can effectively reduce the recurrence rate of UCF.

Comparative Study of Sondgrass and Bracka’s Surgical Techniques for Hypospodias Repair

Objective: To compare the outcomes of Bracka’s and Snodgrass techniques in hypospadias repair among the patients admitted at Liaquat University Hospital, Jamshoro. Methods: Prospective study was conducted at the plastic surgery unit, Liaquat University Hospital, Jamshoro from January 2018 to December 2019. All male children aged between 6 months-15 years, given consent of participation, having distal hypospadias and were not previously operated for hypospadias (primary cases) with chordee, good prepuce and wide urethral plate were included. The study was ethically approved from university ethical review committee and informed consent taken from the parents / guardians. Study participant children were divided in two equal groups according to the surgical technique used. Group I (Snodgrass procedure) and Group II (Bracka’s procedure). Pre and post-surgical examination of patients were performed to determine any complications and evaluate the cosmetic results. Results: Total 100 participating pediatric patients of Hypospadias were included in the study. The mean age of study participants was 3.4±2.2 years with age range between 6 months and 15 years. Statistically significant difference (p&lt;0.05) between operative time and length of postoperative hospital stay of Group I and Group II. Urethrocutaneous fistula and meatal stenosis were observed as the most common postoperative complications in study participants. A statistically significant difference in complications between group I and group II (p&lt;0.05). Conclusion: Bracka’s technique is more beneficial compared to Snodgrass in terms of urethral fistula. While due to meatal stenosis Snodgrass technique is much advantageous because of higher scar amount results after Bracka’s method. Keywords: Congenital abnormalities, Hypospadias, Postoperative Complications

Introduction of a modified single stage reconstruction technique of male penopubic epispadias

ObjectiveTo represent the long-term outcomes of our modified single-stage technique for the reconstruction of isolated penopubic epispadias in male patients.Patients and methodsData from 113 patients were obtained from bladder-exstrophy-epispadias database of our tertiary center. A total of seven boys with isolated penopubic epispadias with no prior history of surgery and any other anomaly underwent our modified surgical approach from February 1997 to September 2019. The mean ± SD age at surgery was 6.5 ± 2.4 years. Volitional voiding status and cosmetic appearance were evaluated at each follow-up interval. Postoperative follow-up was performed at quarterly intervals in the first year and once a year in subsequent years.ResultsThe mean ± SD of follow-up was 8.5 ± 6 years. All boys who were incontinent achieved urinary control and the ability of normal transurethral micturition following the surgery. Four boys became completely dry, and the other three attained social dryness. Postoperative mean (SD) bladder capacity was significantly increased from 54.5 (11) to 124 (40.0) within 6 months, and to 194 (47.5) at 18 months after surgery. Dorsal curvature has been resolved in all cases, and no postoperative complications were noted except for surgical site infection in one patient treated with antibiotics and bilateral vesicourethral reflux resolved after injection of bulking agents. Four patients had normal erectile function and ejaculation, while the others have not reached puberty yet. Moreover, none of the patients developed urethrocutaneous fistula, stricture, or penile ischemia.ConclusionThe present findings suggest the safety and effectiveness of the combination of single-stage urethro-genitoplasty, bladder neck plication, and fat pad pedicled flap in management of boys with isolated penopubic epispadias that can lead to the achievement of urinary control, acceptable sexual function, and cosmetically satisfactory genitalia. Minimal morbidity, low complication rate, and promising outcomes are essential factors, supporting the notion of introducing this technique as a valid option for management of this entity.

Analysis in the influence factors of urethroplasty in DSD

BackgroundAt present, there is no specific research on the factors affecting the success rate of urethroplasty in patients with DSD. The purpose of this study is to explore the factors affecting the success of urethroplasty in DSD patients, and to provide some reference for the surgical treatment of DSD patients undergoing urethroplasty.MethodWe reviewed patients with DSD who underwent urethroplasty from January 2016 to December 2019 retrospectively. Patients were divided into four groups: the successful group, the urethrocutaneous fistula group, the urethral diverticulum group, and the urethral stricture group. Risk factors were determined from the following data included the DSD classification, the age of first operation, length of urethral defect, degree of hypospadias, cryptorchidism, micropenis, gonad type, hormone therapy before operation, transposition of penis and scrotum, surgical strategy, urethral covering material, and postoperative catheter removal time. We explored the difference of each factor between four groups through the comparative study of single factor and multifactor logistic regression analysis of related factors.Result122 cases were enrolled in this group (n = 122), 12 cases were lost to follow-up. Median follow-up was 28 months (12–55 months).We found the success rate of operation decreased with longer urethral defect (B = − 0.473, P = 0.005). The success rate of operation was higher in staged operation and TPIT (TPIT = Transverse Preputial Island Tube operation)-related operation than primary operation (B = 1.238, P = 0.006) and TPIT-nonrelated operation (B = 2.293, P = 0.001). Although there was a significant difference between the age of the first operation and the occurrence of urethrocutaneous fistula (P = 0.006 < 0.05), there was no significant difference in logistic regression analysis (P = 0.161 > 0.05). The incidence of urethrocutaneous fistula was lower in TPIT-related operation than in TPIT-nonrelated operation (B = − 2.507, P = 0.000). The incidence of postoperative urethral diverticulum was lower in staged operation than in primary operation (B = − 1.737, P = 0.015).ConclusionFor patients with disorder of sex development undergoing urethroplasty, the length of urethral defect is an independent risk factor affecting both the success rate of operation and the urethrocutaneous fistula. The age of the first operation has a statistically significant effect on the occurrence of postoperative urethrocutaneous fistula, but it is not an independent factor. Urethrocutaneous fistula is less found in TPIT-related operation in the study. Staged operation is an independent protective factor for postoperative urethral diverticulum compared with one-stage operation but isn’t related to urethrocutaneous fistula.

A novel triple dartous fixation in hypospadias repair

ObjectiveThis study investigates the impact of the use of dartos covering to augment the neourethra on functional and cosmetic results. To evaluate a novel technique demonstrating how to fix dartos flap to cover the neourethra as a barrier in hypospadias repair. Patients and methodsThis study comprised 204 male patients with different degree of hypospadias (DPH = 132, coronal hypospadias = 46, MPH = 26). Their ages ranged from 1 to 23 ys (mean age = 2 ys). Penile chordee was in (DPH = 45, coronal hypospadias = 33, MPH = 26). All patients had abnormal downward directed urinary stream. Hypospadias repair was performed by the classic TIP technique in addition to our novel modification of dartos covering. Patients were submitted to 5 years of follow-up including clinical examination of the functional and cosmetic parameters. ResultsSuccess rates were reported in 200 patients, 3 patients had complications with subcoronal urethrocutaneous fistula and one patient with complete repair disruption. ConclusionTriple dartos fixation is a simple technique for all hypospadiologists to minimize urethrocutaneous fistula as common complication of hypospadias repair with good functional and cosmetic results.

Management of Pelvic Fracture Urethral Injury in Pediatric Patients

Purpose: Pediatric urethral surgery represents a significant surgical challenge due to smaller pelvis, decreased caliber and increased tissue fragility. This study aims to find the outcome and complications of perineal end to end anastomotic urethroplasty in the management of posterior urethral injury resulting from pelvic fracture. Methods: We performed 47 perineal bulbo-prostatic anastomotic urethroplasty for PFUIs from January, 2013 to January 2020. Mean age was 13 years with majority between 10 to 18 years (&gt;85%). All were male patients. Two patients had history of failed anastomotic urethroplasty. Patients were selected as per selection criteria and were prepared for operation after adequate counseling. After surgical intervention patients were discharged with a supra-pubic catheter (SPC) and per urethral catheter in situ. On 22nd POD urethral catheter was removed and SPC on the next day if patient can void normally. 1st and 2nd follow up done on of 3rd and 6th month respectively following surgery. If patient voided well and Qmax&gt;15ml/ sec; repair was defined as successful. Results: Success rate of anastomotic urethroplasty for PFUI was 91.47%. Total 4 procedures were failed including 1 urethro-cutaneous fistula and needed re-do anastomosis. We could not evaluate erectile dysfunction (ED) as many patients were unable to give appropriate information. Two patient developed incontinence which improved in subsequent follow-up. Conclusions: Anastomotic urethroplasty remains the gold standard in the management of PFUI. Operative series of pediatric urethral reconstruction usually involve small numbers. Experiences of anastomotic urethoplasty in large volume adult series reflects the higher outcome in pediatic patients. Bangladesh J. Urol. 2021; 24(1): 77-81

Outcome of spongioplasty alone as second layer of tubularised incised plate urethroplasty in patients with hypospadias

BackgroundSpongioplasty alone or in combination with local tissue flaps can be used as a second layer for the prevention of complications of tubularised incised plate urethroplasty (TIPU) of hypospadias repair. It can be used when wide urethral plate and well-developed robust spongiosum are present. This study aims to review the success rate and complications of TIPU performed utilising spongioplasty alone as a second layer in Type 3 well-developed robust spongiosum.MethodsThis is a retrospective observational study conducted between January 2015 and December 2019 at a tertiary care centre. A total of 21 patients aged 4–15.4 years with primary hypospadias having a Type 3 well-developed robust spongiosum, Glans score ≤ 2, Meatal score ≤ 4, and Shaft score ≤ 3 underwent TIPU using spongioplasty alone as a second layer. The hospital stay ranged from 10 to 14 days and follow-up from 12 to 36 months.ResultsHypospadias was distal in 12 (57.1%), mid in 5 (23.8%), and proximal penile in 4 (19.1%) patients. The mean Glans Meatus Shaft score was 6.1 (G = 1.25, M = 2.95, S = 1.9) with a range of 3–9. An early post-operative complication of preputial oedema and bladder spasm developed in 1 (4.7%) patient each. Meatal stenosis developed in 1 (4.7%) patient. None developed urethrocutaneous fistula. At 3 months all patients had good urinary flow (> 15 ml/s) and good cosmesis. All the patients/parents (in case of minors) were satisfied with the result.ConclusionSpongioplasty alone as the second layer after TIPU for primary penile hypospadias in patients with well-developed robust spongiosal tissue is associated with minimal, easily manageable complications.

A simple technique to repair distal and mid-shaft hypospadias using a de-epithelialized Byars' flap.

ObjectiveTo describe standard and modified de-epithelialized Byars’ flap techniques in tubularized incised plate urethroplasty and evaluate postoperative outcomes.MethodsWe retrospectively evaluated data for 404 primary hypospadias repair patients who underwent standard (Group A) or modified (Group B) urethroplasty between January 2016 and 2021. Group B’s data were analyzed to evaluate whether our modified technique was effective for all hypospadias types.ResultsThere was no difference in the ratio of different hypospadias types between Groups A (n = 145) and B (n = 259). Median follow-up duration was 35 months. Fistula occurred in 19 patients in Group A and 12 in Group B (statistically significant difference). The total complication rate was statistically significantly different between the groups. In Group B, 3/142 patients with distal hypospadias developed urethrocutaneous fistula vs 4/95 with mid-shaft hypospadias and 5/22 with proximal hypospadias. No difference was noted between the distal and mid-shaft groups. Significant differences were observed when comparing distal and mid-shaft groups with the proximal group; total complication rates were similar. Glans dehiscence and meatal stenosis rates were similar between Groups A and B, and among the hypospadias phenotypes.ConclusionOur modified procedure is simple to perform and yields excellent results in distal and mid-shaft hypospadias repair.

Effects of Caudal and Penile Blocks on the Complication Rates of Hypospadias Repair

Background:The major influencing factors for complications during hypospadias repair are the original location of the meatus, previous urethral surgery, surgical technique, and surgeon’s experience. While the effect of the technique of regional analgesia on complication rates has been considered in some studies, this issue remains controversial.hile the effect of the technique of regional analgesia on complication rates has been considered in some studies, this issue remains controversial.Aims:To determine the effect of caudal block and penile block on complication rates of hypospadias repair in patients with subcoronal hypospadias.Study Design:Retrospective cross-sectional study.Methods:Data of children who underwent hypospadias repair between 2011 and 2019 in our clinic (n = 770) were reviewed retrospectively. Only patients with subcoronal hypospadias and who underwent tubularized incised plate urethroplasty, performed by the same two experienced surgeons (n = 279), were included in the study. The exclusion criteria were incomplete data and follow-up time shorter than 12 months. Data of 279 patients were analyzed. Patients were divided into two groups according to the analgesia type: caudal block (n = 95) and penile block (n = 184), and complication rates were compared between these groups.Results:The median age was 36 months in the caudal block group and 30 months in the penile block group (P = 0.390). The median follow-up times were 54 and 42.7 months in the caudal and penile block groups, respectively. Total complication rates did not differ significantly between the groups and were determined as 10.5% and 12.5% in the caudal and penile groups, respectively. Urethrocutaneous fistula rates were observed as 2.1% and 4.3% (p=0.50). None of the patients had penile chordee and no penile plication was performed in the whole group.Conclusion:This study shows that there is no increase in post-repair complications in patients with subcoronal hypospadias who underwent caudal block.

Urethral Plate Characteristics in Cases of Non-proximal Hypospadias May Not Be Associated With a Higher Risk of Complications When a Two-Stage Repair Is Applied.

PurposeTo investigate whether a two-stage repair of distal- and mid-shaft hypospadias (non-proximal hypospadias) could eliminate the risk factors resulting from adverse urethral plate characteristics and eventually reduce complication rates.MethodsWe retrospectively reviewed all cases of primary surgical repair of non-proximal hypospadias performed in our center between 2009 and 2018. In all cases where adverse urethral plate characteristics were found, such as meatal stenosis, a shallow urethral groove, a thick web of tissue between the native meatus and the urethral groove or in the presence of a very “thin,” skin-like distal urethra, a two-stage repair was routinely undertaken. In cases of native meatal stenosis, a meatotomy, and meatoplasty were performed. In cases of a very “thin” distal urethra we incised the skin proximally up to the point of a normal urethral fold and a meatoplasty was performed at that point. Hypospadias repair was then performed in a second operation, 3–6 months following the first procedure. Urethroplasty, both in cases of a single-stage repair and in cases of a two-stage repair, was always performed using the Thiersch-Duplay technique. Patients with a follow-up of less than 12 months were excluded from this study.ResultsOver a period of 10 years, 208 boys underwent primary surgical repair of non-proximal hypospadias. Eighty-nine of the 208 patients (42.8%) underwent single-stage hypospadias repair. Two-stage repair of the hypospadias was required in 119 (57.2%) of the patients. The overall complication rate was 3.4% in the group operated in a single stage and 7.6% in the group that required a two-stage repair (p = 0.09). The most frequent complication reported was urethrocutaneous fistula (p = 0.31), followed by meatal stenosis (p = 0.37), urethral stricture (p = 0.08) and wound dehiscence (p = 0.16). There was no significant difference between the complication rates of the two groups.ConclusionPatients with distal hypospadias and poor urethral plate characteristics repaired in a two-stage approach have comparable low-complications to those with favorable urethral plate characteristics repaired in a single-stage.

Comparative study between the closure of small-sized and medium-sized urethral cutaneous fistula after hypospadias repair with and without autologous platelet-rich plasma graft

Background and aim Many complications have been recorded after hypospadias repair surgeries. The most common one is the urethrocutaneous fistula (UCF). In this study, we aimed to compare the closure outcome of the small-sized and medium-sized UCF after hypospadias repair with and without autologs platelet-rich plasma (PRP) graft. Patients and methods This is a prospective comparative study for managing UCF in the pediatric age group of over 1 year. They were randomly divided into two groups: group A included 20 patients who underwent repair without PRP and group B included 20 patients who underwent repair with PRP. Complication rates were compared between the two groups. Results There was a significant difference in the occurrence of complications between the two groups. Recurrence of the fistula was observed in five cases, three (15%) in group A and two (10%) in group B. In group A, the three cases with fistula failed to be treated conservatively and needed another operation 6 months after the primary repair, while in group B, two cases were treated conservatively, and spontaneous closure of the fistula occurred while only one case required another operation for closure of the fistula. Postoperative infection was reported in two (10%) cases in group A and three (15%) cases in group B; they were treated using topical and systemic antibiotics. An extensive scar was reported in one case in group A. Conclusion Autologs PRP graft could be used in hypospadias surgeries and the repair of post-hypospadias repair UCF as it is safe, easily applicable, and proven its role in decreasing complications.

Ultrasound-guided dorsal penile nerve block is a safe block in hypospadias surgery: A retrospective clinical study.

Caudal and dorsal penile nerve blocks are commonly used regional anesthesia methods in hypospadias surgery. Some studies have reported that regional anesthesia methods are risk factor for the development of postoperative complications following hypospadias surgery. The aim of the current study is to evaluate the relationship between postoperative complications and regional anesthesia methods used in distal hypospadias surgery.Forty-nine distal hypospadias patients were included. Patients had either received caudal or ultrasound (US)-guided dorsal penile nerve block. The age, type of hypospadias, regional anesthesia method, operation time, and postoperative complications were recorded. Fisher exact test and Mann–Whitney U tests were used to compare the data.Caudal epidural block was used in 25 (51%) patients and US-guided dorsal penile nerve block in 24 (49%) patients. There was no statistically significant difference between the groups regarding the types of hypospadias, operation time, and age. Fistula developed in 4 (16%) patients in the caudal block group and in none of the patients in the dorsal penile nerve block group. Fistula rates were statistically significantly different between the groups (P = .030).Conflicting data are found in the literature on the long-term postoperative complications of the regional anesthesia techniques used in hypospadias surgery. In our study, all patients with urethrocutaneous fistula were in the caudal block group. We believe that our study will contribute to the literature as it is the only study comparing caudal block with US-guided dorsal penile nerve block using in-plane technique in terms of postoperative complications in hypospadias surgery.

Role of tunica vaginalis flap and dartos flap in tubularized incisional plate for primary hypospadias repair: A retrospective monocentric study.

In the tubularized incised plate (TIP) procedure, flap interposition between the skin and neourethra is highly recommended to decrease the postoperative fistula rate. However, there is no consensus regarding the ideal flap for this procedure. This study aimed to report our experiences in the one-stage TIP hypospadias surgery utilizing dartos flap (DF) (penile skin subcutaneous tissue) and tunica vaginalis flap (TVF) (parietal layer of the testis) as a tissue coverage of neourethra. In a retrospective study from Sep 2018 to May 2021, 16 cases of hypospadias with different types, ranging from midpenile to penoscrotal types, were managed with TIP urethroplasty using DF or TVF as a tissue coverage of neourethra were enrolled. The demographic characteristics of the participants, type of hypospadias, outcome, and complications were analyzed and compared. We used TVF and DF as soft tissue coverage in 11 (68.8%) and 5 (31.3%) patients, respectively. The mean age was 56.38 ± 47.83 months. Mid-penile, proximal, and penoscrotal hypospadias were presented in 3 (18.8%), 8 (50.0%), and 5(31.2%) patients, respectively. The total success rate was 14 (87.5%), while 2 (12.5%) patients developed a urethrocutaneous fistula, which required delayed closure later. In comparison between TVF and DF groups: the TVF was applied in all patients with moderate and severe chordee and all patients with penoscrotal hypospadias, and six patients with proximal hypospadias, while only three patients with mild chordee and two patients with proximal hypospadias used the DF and showed statistical significance between groups (p < 0.001 and 0.012) respectively. The success rate was 90.9% vs. 80.0% in TVF and DF groups, respectively, with no statistical significance between groups (p = 1.000). In the primary TIP repair, the TVF is a practical option as a DF for the interposition cover of a neourethra, especially in penoscrotal and proximal hypospadias with severe chordee.

Dorsal Versus Ventral Dartos Flap to Prevent Fistula Formation in Tubularized Incised Plate Urethroplasty for Hypospadias.

The purpose of this study is to evaluate the results of two different flap procedures for prevention of urethrocutaneous fistula in hypospadias patients undergoing tubularized incised plate urethroplasty . We retrospectively reviewed 89 patients who underwent hypospadias repair. The standard technique of tubularized incised plate urethroplasty was used. There were 45 patients in Group 1 and 44 patients in Group 2, in which ventral and dorsal dartos flaps were used to cover the neourethra respectively. Surgical complications were assessed as the main outcomes. The results were analyzed with Chi-square and Mann-whitney u tests. There was no significiant difference between the groups in terms of age and meatus location. We observed postoperative surgical complications in 15 (33.3 %) patients in Group 1 and in 4 (9.1 %) patients in Group 2. The complications noted in the Group 1 were urethrocutaneous fistula in 10 patients ( 22.2 %) and meatal stenosis in 5 patients ( 11.1 %). In Group 2, fistula was observed in 2 patients (4.6 %) and stenosis in again 2 patients (4.6 %). Urethrocutaneous fistulas occurred statistically more frequently when ventral based dartos flaps were used (P < .05). Several flap procedures and their modifications have been suggested to avoid fistula formation. Within these procedures, dartos flaps are reported to be very useful for primary distal or proximal hypospadias repair and reoperations. In this study, we concluded that ; vascularized dorsal preputial dartos flap procedure is safe and more effective than ventral based flap in prevention of fistula formation.

Comparative Study of Early Neonatal Versus Late Circumcision in Terms of Post Operative Complications

Objective: The objective of this study was to compare early neonatal versus late circumcision by plastibell in terms of postoperative complications. Methodology: It was a comparative study conducted at Department of Pediatric Surgery at Shifa International Hospital Islamabad from January 2018 to November 2019. The present study is a prospective analytical review of 482 uncircumcised patients who presented to the Shifa International Hospital, Islamabad. The variables that were observed in this study were age, mode of presentation, and complications. Patients divided into 2 groups. In Group A circumcision was done within the first 3 days of life and in Group B circumcision was done from in conventional manner after one week of life till 3 months of age. Results: Total 482 patients were presented during this study period, out of which 70 belong to Group A and 412 belong to Group B. In Group A, bell retraction was seen in 4 patients (5.71%), infection of glans in the form of flakes of pus was seen in 1 patient (1.42%), delayed fall was seen in 2 patients (2.85%) and meatal ulcer was seen in 1 patient (1.42%). In Group B, bell retraction was seen in 8 patients (1.94%), infection in 4 patients (0.97%) and delayed fall in 4 patients (0.97%). Complications like bleeding, over/under circumcision, smegmal cyst, meatal stenosis and urethrocutaneous fistula were not seen in any group. Conclusion: We conclude that neonatal circumcision done within first 3 days of life or even soon after birth is safe and has no significant difference of complications as compared to patients in whom circumcision is done at a later stage.