Assessment of Outcome in Hypospadias Surgery – A Review

Springer, Alexander

doi:10.3389/fped.2014.00002

Cited by 69 publications

(50 citation statements)

References 58 publications

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“…Surgeon perceptions and reporting of complication rates may also differ,14 and there would seem conflicting information about the timeframe of occurrence of complications to determine an ideal follow-up period 15. A recent survey of surgeons reported that nearly 60% follow-up their patients for <6 months,16 yet studies suggest that nearly half of complications may only be diagnosed after the first year following surgery 17. Current information on population-based hypospadias’ prevalence, trends, rates of surgical repairs and follow-up of health outcomes appears highly important for optimal clinical decision-making treatment, management and preoperative counselling of parents.…”

Section: Introductionmentioning

confidence: 99%

Prevalence, repairs and complications of hypospadias: an Australian population-based study

et al. 2015

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Objective: To investigate hypospadias prevalence and trends, rate of surgical repairs and postrepair complications in an Australian population.Methods: Hypospadias cases were identified from all live born infants in New South Wales, Australia, 2001-2010 using routinely collected birth and hospital data. Prevalence, trends, surgical procedures or repairs, hospital admissions and complications following surgery were evaluated. Risk factors for re-operation and complications were assessed using multivariate logistic regression.Results: There were 3,186 boys with hypospadias in 2001-2010. Overall prevalence was 35.1 per 10,000 livebirths and remained constant during the study period. Proportions of anterior, middle, proximal and unspecified hypospadias were 41.3%, 26.2%, 5.8% and 26.6%, respectively. Surgical procedures were performed in 1,945 (61%) boys, with 1,718 primary repairs. The overall post-surgery complication rate involving fistulas or strictures was 13%, but higher (33%) for proximal cases. Complications occurred after one year post-repair in 52.3% of cases and up to five years. Boys with proximal or middle hypospadias were at increased risk of re-operation or complications, but age at primary repair did not affect the outcome. Conclusions:One in 285 infants were affected with hypospadias, 60% required surgical repair or correction and one in eight experienced complications. The frequency of late complications would suggest that clinical review should be maintained for more than one year post-repair.

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Section: Introductionmentioning

confidence: 99%

Prevalence, repairs and complications of hypospadias: an Australian population-based study

et al. 2015

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“…The majority of papers did not address the issue of if the boys were lost to follow-up or excluded from the study. It has to be assumed that the follow-up rate usually is 100% as is the case in our group of boys [20].…”

Section: -mentioning

confidence: 91%

Tubularized Incised Plate (TIP) Repair Improves Outcome of Hypospadias Repair

Winberg

Anderberg

Arnbjörnsson

2016

J Surg

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. There were no changes in the suture material used. The operative interventions were performed by two pediatric surgeons with 24 and 11 years' experience in hypospadias surgery respectively. All complications were handled by the same team of surgeons.The main outcome measure was any complication calling for a reoperation: a fistula, rupture and/or stricture, during the period from the operative intervention until August 2016, the endpoint of the study. The Methods of Operation Mathieu repairDuring a Mathieu procedure [1] a skin flap based towards the meatus [8] is turned 180 degrees and sutured into incision on both sides of the glanular groove and along the tip. Curvature is corrected when present. The prepuce is then partially divided and mobilized to create an outer layer. Tubularized Incised Plate repair (TIP)When a TIP repair [2] is performed a U-shaped skin incision is made along the edges of the urethral plate and the penis is degloved. The urethral plate is widened by a midline incision along its length and then tubularized over a stent. A pedicle of subcutaneous tissue is dissected from the ventral or dorsal penile skin and used to cover the neourethra. Finally, the glanular wings, mucosal collar and ventral penile skin are closed in the midline. Statistical considerationsA clinical significant relevance was set at a decrease in the complication rate with 20% units. The intention was to study independent cases and controls with 1 control(s) per case. Prior data indicate that the probability of exposure among controls is 0.3. If the true probability of exposure among cases is 0.1, we will need to study 72 case patients and 72 control patients to be able to reject the null hypothesis that the exposure rates for case and controls are equal with probability (power) 0.8. The Type I error probability associated with this test of this null hypothesis is 0.05. We will use a continuitycorrected chi-squared statistic or Fisher's exact test to evaluate this null hypothesis. Methods: Over a period of six years, the Mathieu procedure was replaced by the Tubularized Incised Plate (TIP) repair as the most favored method of grade 1-2 hypospadias repair at our clinic. All operated boys were prospectively registered during those years. Two three-year-periods were outlined with equal number of patients: 2010-2012 and 2013-2015, but with the preferred method of repair reversed. The end point was any complication calling for a reoperation. Hans Winberg*, Magnus Anderberg and Einar Arnbjörnsson Main results:In the first period 69 boys were operated whereof 50 Mathieu and 19 TIP. 35 (51%) boys required a reoperation. In the second period 73 boys were operated whereof 19 Mathieu and 54 TIP. 15 (21%) required a reoperation, P < 0.01. Research limitations:The study is prospective but the technique preferred was the choice of the surgeon. Follow up will be continued due to acknowledged accumulation of complications over time. Conclusion:Method seems to matter. Advantage TIP. We are not aware of any other prospective study follo...

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“…Given that nephron progenitors are critical in establishing final nephron endowment, these progenitors must maintain their ability to self-renew so as to prevent premature exhaustion prior to cessation of nephrogenesis (7,9,19,20). Moreover, incorrect differentiation of nephron progenitors leads to renal dysplasia (21). …”

Section: Introductionmentioning

confidence: 99%

“…Nephron patterning into the various highly specialized segments is essential for establishing the functional role of the nephron, and abnormalities of nephron pattern result in renal dysplasia (21). Progression of pretubular aggregates into polarized renal vesicles is dependent on the hierarchal expression of Fgfrl1, Fgf8, Wnt4 and Lhx1 (33-36).…”

Section: Introductionmentioning

confidence: 99%

Renal dysplasia in the neonate

Phua

Ho²

2016

Current Opinion in Pediatrics

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Purpose of review Renal dysplasia is classically described as a developmental disorder whereby the kidneys fail to undergo appropriate differentiation, resulting in the presence of malformed renal tissue elements. It is the commonest cause of chronic kidney disease and renal failure in the neonate. While several genes have been identified in association with renal dysplasia, the underlying molecular mechanisms are often complex and heterogeneous in nature and remain poorly understood. Recent findings In this review, we describe new insights into the fundamental process of normal kidney development, and how the renal cortex and medulla are patterned appropriately during gestation. We review the key genes that are indispensable for this process, and discuss how patterning of the kidney is perturbed in the absence of these signaling pathways. The recent use of whole exome sequencing has identified genetic mutations in patients with renal dysplasia, and the results of these studies have increased our understanding of the pathophysiology of renal dysplasia. Summary At present, there are no specific treatments available for patients with renal dysplasia. Understanding the molecular mechanisms of normal kidney development and the pathogenesis of renal dysplasia may allow for improved therapeutic options for these patients.

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Assessment of Outcome in Hypospadias Surgery – A Review

Cited by 69 publications

References 58 publications

Prevalence, repairs and complications of hypospadias: an Australian population-based study

Prevalence, repairs and complications of hypospadias: an Australian population-based study

Tubularized Incised Plate (TIP) Repair Improves Outcome of Hypospadias Repair

Renal dysplasia in the neonate

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