Asunto(s)

Hipospadias , Masculino , Humanos , Adolescente , Adulto Joven , Lactante , Hipospadias/cirugía , Pene/cirugía , Uretra , Procedimientos Quirúrgicos Urológicos Masculinos

RESUMEN

INTRODUCTION: Neourethral covering is an essential technique for preventing complications such as fistula and glans dehiscence in hypospadias repairs. The spongioplasty has been reported for neourethral coverage about 20 years ago. However, reports of the outcome are limited. OBJECTIVE: This study aimed to retrospectively evaluate the short-term outcome of spongioplasty with Buck's fascia covering dorsal inlay graft urethroplasty (DIGU). METHODS: From December 2019 to December 2020, 50 patients with primary hypospadias (median age at surgery, 37 months; range, 10 months-12 years) were treated by a single pediatric urologist. The patients underwent spongioplasty with Buck's fascia covering dorsal inlay graft urethroplasty in single stage. The penile length, glans width, urethral plate width and length, and the location of the meatus of the patients were recorded preoperatively. The patients were followed up,complications noted, and postoperative uroflowmetries at the one-year follow-up time were evaluated. RESULTS: The average width of glans was 12.92 ± 1.86 mm. A minor penile curvature was observed in all patients (≤30°). The patients were followed up for 12-24 months, and 47 patients (94%) were free from complications. A neourethra formed with a slit-like meatus at the tip of the glans, and the urinary stream was straight. Three patients had coronal fistulae (3/50) and no glans dehiscence, and the mean ± SD Qmax of postoperative uroflowmetry was 8.13 ± 3.8 ml/s. DISCUSSION: This study estimated the short-term outcome of the DIGU covered using spongioplasty with Buck's fascia as the second layer in patients diagnosed with primary hypospadias with a relatively small glans (average width <14 mm). However, only a few reports emphasize spongioplasty with Buck's fascia as the second layer and the DIGU procedure performed on a relatively small glans. The major limitations of this study were its short follow-up time and the retrospective data collection. CONCLUSIONS: Dorsal inlay graft urethroplasty combined with spongioplasty with Buck's fascia as coverage is an effective procedure. In our study, this combination had good short-term outcomes for primary hypospadias repair.

Asunto(s)

Hipospadias , Masculino , Humanos , Niño , Lactante , Preescolar , Hipospadias/cirugía , Estudios Retrospectivos , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Uretra/cirugía , Fascia , Resultado del Tratamiento

RESUMEN

Objetivo: Hemos empleado previamente la técnica de reparación mediante tubularización e incisión de la placa uretral (TIP) con algunas modificaciones en casos de hipospadias distal debido a sus excelentes resultados cosméticos. En este estudio se evaluaron los efectos de la espongioplastia y los colgajos de dartos dorsal y de las sondas uretrales cortas en los resultados de la reparación con TIP.Materiales y método: Sólo se incluyeron casos de hipospadias distal. Los pacientes elegibles se dividieron en dos grupos: el grupo A incluyó a los pacientes con reparación mediante espongioplastia con colocación de colgajo de dartos dorsal, mientras que el grupo B incluyó a los pacientes sometidos a reparación utilizando colgajo de dartos dorsal. Adicionalmente, el grupo A se dividió en dos subgrupos según el tipo de sonda utilizada (sonda vesical o sonda uretral corta).Resultados: Un total de 473 pacientes participaron en este estudio. No se observaron diferencias estadísticamente significativas en las tasas de complicaciones entre los dos grupos. En el grupo A se utilizó una sonda vesical en 107 pacientes y una sonda uretral corta en 135 pacientes. No se observaron diferencias estadísticamente significativas al comparar los resultados de los dos grupos.Conclusiones: La espongioplastia puede combinarse con la colocación de colgajo de dartos dorsal para reducir la necesidad de plicaturas dorsales, además de reducir la tasa de fístulas. Las sondas uretrales cortas pueden utilizarse de forma segura y sin efectos durante el postoperatorio en niños con control de esfínteres Objetivo Hemos empleado previamente la técnica de reparación mediante tubularización e incisión de la placa uretral (TIP) con algunas modificaciones en casos de hipospadias distal debido a sus excelentes resultados cosméticos. En este estudio se evaluaron los efectos de la espongioplastia y los colgajos de dartos dorsal y de las sondas uretrales cortas en los resultados de la reparación con TIP

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Aim: We have previously employed the tubularized incised plate (TIP) repair technique in distal hypospadias cases with a few modifications because of its excellent cosmetic results. In this study, we aimed to evaluate the effects of spongioplasty and dorsal dartos flaps, in addition to short urethral stents on the outcomes of TIP repair.Materials and methods: Only distal hypospadias cases were involved in this study. Eligible patients were divided into two groups: group A included patients repaired with both spongioplasty and dorsal dartos flap placement, while group B included patients repaired with dorsal dartos flap placement alone. Group A was further divided into two subgroups according to the type of catheter used (bladder catheter or short urethral stent).Results: A total of 473 patients were included in this study. There was no statistically significant difference observed in the complication rates between the two groups. In Group A, a bladder catheter was used in 107 patients and a short urethral stent was used in 135 patients. When the results of the two groups were compared, there was no statistically significant difference.Conclusions: Spongioplasty could be combined with dorsal dartos flap placement to reduce the need for dorsal plication rather than to reduce the fistula rate. Short urethral stents can be used safely with no postoperative effects in children who have completed toilet training (AU)

Asunto(s)

Humanos , Masculino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Hipospadias/cirugía , Catéteres de Permanencia , Periodo Posoperatorio , Colgajos Quirúrgicos , Resultado del Tratamiento , Estudios de Seguimiento

RESUMEN

AIM: We have previously employed the tubularized incised plate (TIP) repair technique in distal hypospadias cases with a few modifications because of its excellent cosmetic results. In this study, we aimed to evaluate the effects of spongioplasty and dorsal dartos flaps, in addition to short urethral stents on the outcomes of TIP repair. MATERIALS AND METHODS: Only distal hypospadias cases were involved in this study. Eligible patients were divided into two groups: group A included patients repaired with both spongioplasty and dorsal dartos flap placement, while group B included patients repaired with dorsal dartos flap placement alone. Group A was further divided into two subgroups according to the type of catheter used (bladder catheter or short urethral stent). RESULTS: A total of 473 patients were included in this study. There was no statistically significant difference observed in the complication rates between the two groups. In Group A, a bladder catheter was used in 107 patients and a short urethral stent was used in 135 patients. When the results of the two groups were compared, there was no statistically significant difference. CONCLUSIONS: Spongioplasty could be combined with dorsal dartos flap placement to reduce the need for dorsal plication rather than to reduce the fistula rate. Short urethral stents can be used safely with no postoperative effects in children who have completed toilet training.

Asunto(s)

Hipospadias , Niño , Humanos , Hipospadias/cirugía , Masculino , Periodo Posoperatorio , Stents , Colgajos Quirúrgicos , Uretra/cirugía

RESUMEN

INTRODUCTION AND OBJECTIVE: Several popular surgical techniques have been described for the repair of distal hypospadias; however, the role of repairing the corpus spongiosum was rarely discussed. Herein we review our experience with adolescents who underwent hypospadias repair during childhood. Their main complaints were partially or totally related to spongiosum deficiency, the surgical outcomes are also discussed. METHODS: Between 2007 and 2018, 25 patients aged between 13 and 28 years of age (median 19 years) were operated upon to repair the deficiency or absence of corpus spongiosum in addition to a Thiersch-Duplay urethroplasty. Their records indicated that the primary hypospadias repairs during childhood included MAGPI (N = 10) and TIPU (N = 9), in 6 patients the repair of the distal hypospadias was unknown. The main complaints were; abnormal urinary stream which patients described as spraying and/or dripping of urine (N = 10) and distal urethral swelling during voiding and dripping of urine post voiding (N = 15). Eight patients reported that they were treated for symptomatic recurrent urinary tract infections by their primary physicians. In 5 patients, the urethral wall was thin and covered with adherent epidermis only. In 20 patients, the laterally displaced spongiosum pillars were well-defined, 4 of whom exhibited mild chordee. In 14 patients the spongiosum pillars were mobilized and approximated using interrupted absorbable sutures. Four patients had spongiosum deficiency and urethral swelling resulting in mild diverticulum formation. The urethral wall was plicated and covered with the spongiosum and/or dartos flaps. In 4 patients the spongiosum pillars were fixed and could not be mobilized to provide a tension-free closure. In these cases, a dartos flap harvested from the scrotum, and used to cover the urethral wall and was sutured on either side to the spongiosum pillars. 12/25 patients underwent glandular contouring and/or meatoplasty simultaneously to improve the penile esthetics. RESULTS: The follow-up period varied between 18 months and 7 years (mean 3.5 years). 24/25 patients reported a normal steady urinary stream, absence of urethral swelling during voiding and none (22) or minimal (2) postvoid droplets of urine which soiled the underwear. One patient developed glans dehiscence and is voiding through a coronal meatus; he declined further surgery. None developed symptomatic urinary infection. The spongioplasty corrected the mild curvature in all 4 patients. CONCLUSIONS: Failure to recognize and/or correct the deficient corpus spongiosum during the repair of distal hypospadias during childhood may become symptomatic during adolescence however, the abnormality can be corrected successfully.

Asunto(s)

Hipospadias , Adolescente , Adulto , Humanos , Hipospadias/cirugía , Lactante , Masculino , Pene , Colgajos Quirúrgicos , Uretra/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos , Adulto Joven

RESUMEN

INTRODUCTION AND OBJECTIVE: The objective of the study was to evaluate the functional and cosmetic outcome of single-stage modified partial penile disassembly repair in isolated male epispadias. MATERIALS AND METHODS: A retrospective analysis of 15 cases of primary epispadias repair, from June 2015 to December 2018, was performed. Patients were classified by the type of epispadias, urinary incontinence, chordee, and rotation. SURGICAL TECHNIQUE: Penile degloving with the mobilization of the urethral plate from the ventral to the dorsal aspect with the preservation of blood supply at both ends, distally up to the level of mid-glans and proximally up to the pubic symphysis is done. Tubularization of urethral plate followed by spongioplasty, corporoplasty with medial rotation of corporeal bodies, and glanuloplasty with meatoplasty was done to bring the meatus ventrally. The skin cover is done by the rotation of the ventral flaps and the z-plasty whenever required. RESULTS: Age of the patients varied from 4 months to 21 years with a mean of 11 years. Thirteen patients had excellent cosmetic outcome while two patients had minimal residual chordee but did not require any surgery in a follow-up. Five patients with partial incontinence in the study group achieved continence after surgery. None of the patients developed complications such as fistula or stricture. All five male patients in the post-pubertal group reported normal erections and successful ejaculations after the surgery. Follow-up ranged from 3 months to 18 months. CONCLUSIONS: Modified partial penile disassembly incorporates all the benefits of Cantwell Ransley repair and needs less extensive dissection than total penile disassembly. Both functional and cosmetic results are good with a low complication rate.

Asunto(s)

Epispadias/cirugía , Pene/cirugía , Procedimientos de Cirugía Plástica/métodos , Adolescente , Niño , Preescolar , Eyaculación , Epispadias/complicaciones , Epispadias/fisiopatología , Humanos , Lactante , Masculino , Erección Peniana , Pene/anomalías , Pene/fisiopatología , Periodo Posoperatorio , Estudios Retrospectivos , Incontinencia Urinaria/etiología , Adulto Joven

RESUMEN

BACKGROUND: Outcomes of hypospadias surgery continually lagged behind anticipations among practitioners, prompting continuing refinement of approaches. Refinements typically involved modified surgical techniques. OBJECTIVE: Herein, the author aimed for reporting the comparative anatomical topography of distal hypospadias anomaly vs normal controls, to boost its reparative approach. PATIENTS AND METHODS: This is a prospective clinical study of distal hypospadias cases presented to the author's facility between June 2018 and June 2020. Anatomical topography of the hypospadias penis was studied concerning the corresponding marks in another control cohort with normal penile development. Meatal marks, glans wings alignment, frenulum, and corpus spongiosum were the anatomical landmarks looked into. Operative correction of the anomaly was carried out considering these landmarks, aiming for pinpoint reassembly. The control group served to identify the normal topography. RESULTS: The author studied 49 cases of distal hypospadias and 10 uncircumcised boys with an otherwise normal penile anatomy. In distal hypospadias, the corpus spongiosum splayed out - at about mid-penile level - ending at a consequently splayed glans penis, rather than involving a primary glans defect. After the corpus spongiosum had been closed/zippered up, no further glans wings' surgical dissection was deemed necessary to attain the anatomical topography identified by the control group. By the end of a median follow-up period of 14 months, no urethrocutaneous fistulae or meatal stenoses were reported, with a typical apical re-assembled meatus, glans ventrum, and frenulum. CONCLUSION: Topographic mapping against control subjects revealed that the glans penis is fully developed in boys with distal hypospadias. After the spongiosal plate has been adequately zippered up, no glans wings' surgical dissection was deemed necessary to attain the typical glanular topography identified by the control group.

RESUMEN

INTRODUCTION: Additional cover after neourethra formation to decrease the fistula rate, has been described using the dartos, tunica, denuded skin and corpus spongiosum. The use of corpus spongiosum alone to cover the neourethra is infrequent. The objective of this study was to evaluate the efficacy of spongioplasty alone as an intervening layer in the prevention of urethral fistula following tubularized incised plate urethroplasty (TIPU). MATERIALS AND METHODS: A prospective study was performed including 113 primary hypospadias cases undergoing TIPU with spongioplasty from June 2010 to March 2012. Correction of chordee was carried out by penile degloving alone in 5, mobilization of urethral plate with spongiosum in 22 and combination of both in 45 cases. Intra-operatively, spongiosum was taken to be poorly developed if it was thin and fibrous, moderate if good spongiosal tissue with good vascularization and well-developed if healthy robust spongiosum, which became bulkier than native spongiosum after tubularisation. Spongioplasty was done in a single layer after mobilization of spongiosum, starting just proximal to the native meatus and into the glans distally. RESULTS: The mean age of the patients was 11.53 years. The type of hypospadias was distal, mid and proximal in 81, 12 and 20 cases respectively. Spongiosum was poorly developed in 13, moderate in 53 and well-developed in 47 cases. The mean hospital stay was 8-10 days and follow-up ranged from 6 months to 2 years. Urethral fistula was seen in six patients (11.3%) with moderate spongiosum (distal 1, mid 1 and proximal 4), and three (23.03%) with poorly developed spongiosum (one each in distal, mid and proximal) with an overall 7.96% fistula rate. None of the patients with well-developed spongiosum developed a fistula. Poorer spongiosum correlated with a greater number of complications (P = 0.011). Five out of thirteen cases with poor spongiosum (38.46%) had proximal hypospadias, i.e. more proximal was the hypospadias, poorer was the development of the spongiosum (P = 0.05). Meatal stenosis was seen in two patients (1.76%) with proximal hypospadias, one with moderate and the other with poorly developed spongiosum. More proximal was the hypospadias, greater were the number of complications (P = 0.0019). CONCLUSION: TIPU with spongioplasty reconstructs a near normal urethra with low complications. Better developed and thicker spongiosum results in lower incidence of fistula and meatal stenosis. More proximal hypospadias is associated with poorer spongiosum. We recommend spongioplasty to be incorporated as an essential step in all patients undergoing tubularized incised-plate repair for hypospadias.

RESUMEN

AIM: To share our experience of doing tubularized incised plate urethroplasty with modifications. MATERIALS AND METHODS: This is a single surgeon personal series from 2004 to 2009. One hundred patients of distal hypospadias were subjected for Snodgrass urethroplasty with preputioplasty. The age range was 1 to 5 year with mean age of 2.7 years. Selection criteria were good urethral plate, without chordee and torsion needing complete degloving. Main technical modification from original Snodgrass procedure was spongioplasty, preputioplasty, and dorsal slit when inability to retract prepuce during surgery. RESULTS: Average follow-up period is 23 months. Seven (7%) patients developed fistula and one patient had complete preputial dehiscence. Phimosis developed in three (3%) patients and required circumcision. Dorsal slit was required in seven patients. One patient developed meatal stenosis in postoperative period. All other patients are passing single urinary stream and have cosmesis that is acceptable. CONCLUSIONS: Modified tubularized incised plate urethroplasty with preputioplasty effectively gives cosmetically normal looking penis with low complications.