A New Modification of the Koyanagi Technique for the One-stage Repair of Severe Hypospadias

Kang, Lijun; Huang, Guizhen; Zeng, Li; Huang, Yongye; Ma, Xue; Zhang, Yue; Miao, Yuan; Zhang, Jie; Huang, Lei

doi:10.1016/j.urology.2016.03.032

Cited by 12 publications

(9 citation statements)

References 22 publications

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“…There is no need for circular anastomosis, which can significantly reduce complications such as anastomotic stenosis. (5) The success rate is high. Preserving the blood supply of the distal foreskin so that the flaps will not be too long and receive a poor blood supply, especially with the scrotum or the testicular tunica on both sides of the scrotum covering the ventral side of the formed urethra to increase the level of tissue and prevent suture overlap, significantly reduces the occurrence of complications such as urinary fistula.…”

Section: Discussionmentioning

confidence: 99%

Neomodified Koyanagi technique for severe hypospadias with one‐stage sealed Y‐shaped penis foreskin vascular protection surgery

Chen

Liu

et al. 2022

Clinical Case Reports

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Proximal hypospadias defects represent the most challenging aspect of maintaining blood supply to the flap, which eventually leads to a high rate of complications. We modified a sealed Y-shaped penis foreskin vascular protection technique, which can repair the urethra in a single stage. The inner plate of the foreskin was cut along the coronal sulcus, and both sides of the urethral plate were cut as deep as Buck's fascia. The "Y"-shaped foreskin flaps on both sides of the mouth that are continuous with the urethral plate were sutured to form a new urethral skin tube. The urethral skin tube was turned to the ventral side, and the foreskin was reshaped and sutured. A total of 89 children had their urinary catheters removed 4 weeks after the operation. All children were evaluated at least once a year for 3 consecutive years. There were 11 patients with urine leakage that occurred after the operation. These children, diagnosed with urine leakage, underwent successful repair after the leakage occurred. There were no urethral strictures after the operation. The one-time success rate of this operation was 87.6% (78/89), and the incidence of urethral fistula was 12.6% (11/89). The results showed that sealed Y-shaped penis foreskin vascular protection surgery was safer and had a higher operation rate than the traditional hypospadias repair technique. Modifying Koyanagi repair by our improved Koyanagi hypospadias repair is an excellent technique with relatively low complication rates.

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Section: Discussionmentioning

confidence: 99%

Neomodified Koyanagi technique for severe hypospadias with one‐stage sealed Y‐shaped penis foreskin vascular protection surgery

Chen

Liu

et al. 2022

Clinical Case Reports

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“…They, however, used Hayashi modified koyanagi and glanuoplasty was systematic. With their modifications added to the Hayashi modified koyanagi, complications rate was at 20% comparing to 30% without the use of the tunica vaginalis flap [ 16 ]. Tunica vaginalis flap was also used by other groups, but only for treatment of urethra-cutaneous fistulas complicating mid-proximal hypospadias surgery.…”

Section: Discussionmentioning

confidence: 99%

Two simple modifications can potentially change the future of proximal hypospadias surgery. Our series and a review of the literature

Akkary

Ripepi

Akokpe

et al. 2021

International Journal of Pediatrics and Adolescent Medicine

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Background/Objective To draw a hint towards two simple modifications that could potentially decrease the complication rate. Patients and Methods It was a single center, single operator and retrospective study. All patients with severe hypospadias operated according to koyanagi with or without modifications were presented. The surgical technique was described. Complications like fistula, stenosis, dehiscence and urethral diverticulum were studied. Results and Limitations Nineteen patients were included and presented in a chronological manner. The first four patients were operated according to the original koyanagi technique. The next 15 patients were operated according to koyanagi and the urethroplasty was covered by a tunica vaginalis flap. In 10 of them, glanduloplasty was done primarily and in the last 5 patients, glanduloplasty was done as a secondary procedure. The complication rates were 100% in the original koyanagi group, and 0% in the subset were glanduoplasty was deferred. Conclusions Systematically covering the urethroplasty with a tunica vaginalis flap and deferring the glanuloplasty might ameliorate the results of the koyanagi technique.

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“…Among all degrees of hypospadias, proximal hypospadias represents the rarest but the most challenging and complex hypospadias degrees and could be managed by different techniques that vary between single or two or even more stages repair (6) . There was no one technique has gained widespread popularity.…”

Section: Discussionmentioning

confidence: 99%

“…Complications were stenosis (2%) and fistula (13%). In 2016, Kang et al (6) operated on a series of 24 patients using Koyanagi technique preserving all the dartos fascia as a blood supply. They observed 3 cases of urethral fistula and urethral dehiscence in the prior 7 cases.…”

Section: Discussionmentioning

confidence: 99%

New Modification of Koyanagi Technique Using Dartos Muscle Flap in Management of Proximal Hypospadias

Keshk

Sheikh

Rahman

et al. 2021

The Egyptian Journal of Hospital Medicine

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Background: One stage urethroplasty through parameatal foreskin flap (OUPF) available for all types of hypospadias was first described by Tomohiko Koyanagi (1983). High complication rates were reported. Objective: To evaluate the outcome of Koyanagi technique modification using dartos muscle as a 2 nd layer because it has a high vascularity, very thin, easily elevated, and leaves no complications. Patient and methods: This study was conducted in the Plastic Surgery Department at Menoufia University, during the period of April 2017 to April 2019. Thirty cases for proximal hypospadias were included during this study. After chordee release, urethra was constructed using Koyanagi technique and adding scrotal dartos muscle flap as a 2 nd layer. Results: Patient's age ranged from 1 to 4 years with mean age of 2.83 ± 1.17. All of the 30 cases were with proximal hypospadias and had severe chordee. Early complications were detected as bleeding in 2 patients (6.6%). One patient (3.3%) reported for retention due to obstruction of the inserted catheter. Another case (3.3%) showed wound infection. The reported late complications were fistula in 6 patients (20%), meatal recession in 5 patients (16.6%), meatal stenosis in 3 patients (10%), and diverticulum in one patient (3.3%). Conclusion:The modified Koyanagi one stage repair of proximal hypospadias is an innovative technique and realize many criteria for expected effective operating results. The use of dartos muscle flap as a cover for the urethroplasty improves the results and minimize complications.

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A New Modification of the Koyanagi Technique for the One-stage Repair of Severe Hypospadias

Cited by 12 publications

References 22 publications

Neomodified Koyanagi technique for severe hypospadias with one‐stage sealed Y‐shaped penis foreskin vascular protection surgery

Neomodified Koyanagi technique for severe hypospadias with one‐stage sealed Y‐shaped penis foreskin vascular protection surgery

Two simple modifications can potentially change the future of proximal hypospadias surgery. Our series and a review of the literature

New Modification of Koyanagi Technique Using Dartos Muscle Flap in Management of Proximal Hypospadias

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