Comparative study of urethroplasties to reduce urethral strictures in patients with severe hypospadias

Huang, Lingli; Wang, Jun; Ge, Zheng; Ma, Geng; Lu, Rongzhu; Deng, Yongming; Huang, Songming; Guo, Yunfei

doi:10.1177/0300060519826449

Cited by 3 publications

(4 citation statements)

References 24 publications

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“…Our previous study reported on the application of onlaytube-onlay in treating severe hypospadias with obvious chordee. Using the advantages of both Duckett and Onlay, this technique used the dorsal TPIF and the transected urethral plate to form a new urethra (9,10). According to our previous study, only 9.3% developed urethral stricture among the 32 pediatric patients who received one-stage repair for severe hypospadias, which was significantly lower than that of Duckett (11).…”

Section: Discussionmentioning

confidence: 99%

Comparative study of one-stage and the novel two-stage urethroplasty using the transected urethral plate and transverse preputial island flap (TPIF) for severe hypospadias: a single-center experience

Zhu¹,

Huang²,

Wang³

et al. 2021

Transl Pediatr

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Background: To evaluate a novel two-stage method of urethroplasty using a transected urethral plate and transverse preputial island flap (TPIF) for proximal hypospadias with severe chordee.Methods: We retrospectively analyzed 91 cases of proximal hypospadias, who had undergone either onestage or two-stage urethroplasty. Comparisons between the two groups were made based on age, glans diameter, the length of the urethral defect, and the rate of complications.Results: There was no significant difference in age at surgery, glans diameter, and the length of urethral defect between the two groups. In the one-stage group, 18 cases of urinary fistula and one case each of glans dehiscence, urethral diverticulum, and urethral diverticulum with concurrent glans dehiscence, were reported. All patients were treated using urinary fistula repair or urethroplasty. In the novel two-stage group, no cases of urinary fistula were reported after the secondary urethroplasty. However, 4 cases showed dehiscence at the glans, 2 were treated through reoperation but the 2 other 2 patients reoperation. The success rate was 62.50% and 88.57% in the one-stage and two-stage groups, respectively (P<0.05).Conclusions: Two-stage urethroplasty using a tubularized urethral plate and TPIF can significantly reduce the incidence of urethral fistula of the proximal hypospadias with severe chordee. However, it may increase the number of operations that need to be performed on children who do not need staged surgery. Although we could not prove it through this study, we believe that the necessity of two-stage urethroplasty should be determined based on the development of the glans, the severity of penile curvature, and the length of the urethra defect.

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Section: Discussionmentioning

confidence: 99%

Comparative study of one-stage and the novel two-stage urethroplasty using the transected urethral plate and transverse preputial island flap (TPIF) for severe hypospadias: a single-center experience

Zhu¹,

Huang²,

Wang³

et al. 2021

Transl Pediatr

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“…Sub coronal or distal hypospadias is associated with the opening of the meatus near the proximity of the glans, midshaft hypospadias is referred to as the opening of the meatus anywhere along the shaft of the penis, and proximal or penoscrotal hypospadias is characterized by the opening of urethral meatus at the junction of penis and scrotum [2]. Hypospadias is a congenital condition and is considered one of the most common congenital defects of males with epidemiological studies showing a prevalence of 1 in 200 births [3]. The aetiology of hypospadias is currently not well defined however recent establishment in the study shows that the aetiology of hypospadias is multifactorial with complex correlations between environmental factors, endocrine pathologies, and genetic influence [4].…”

Section: Introductionmentioning

confidence: 99%

Assessing the Effectiveness of Dorsal Flap in Surgical Repair of Hypospadias by Tubularized Incised Plate Urethroplasty

Adnan¹,

Baloch²,

Mal³

et al. 2022

PJMHS

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Background: Hypospadias is a congenital abnormality of the urethral meatus opening which is located anywhere along the length of the penis except the tip of the glans. The management of this congenital disease is surgical and comprises orthoplasty, urethroplasty, glanuloplasty and cosmetic correction. Urethroplasty is the key step of surgical correction of hypospadias. . Tubularized incision plate (TIP) urethroplasty by dorsal flap is frequently used for distal hypospadias. The reason for the preference is usually wide acceptability of low post-surgical complications and optimum cosmetic results. Other techniques include urethral plate augmentation and urethral plate replacement. Aims: The aim of this study is to assess the effectiveness of dorsal flap assisted TIP urethroplasty in patients with hypospadias of recruited population. The effectiveness will be measured against postoperative outcomes such as wound rupture, wound necrosis, meatal stenosis, and urethrocutaneous fistula formation. Methodology: This prospective study was conducted on 11 primary hypospadias cases undergoing TIPU in Dr Ziauddin Hospital, Karachi for the period of one year from November 2020 to October 2021. The inclusion criteria included infants with distal and midshaft hypospadias with sufficient width of the urethral plate. Whereas individuals with proximal hypospadias or other factors complicating the surgical procedure were excluded from the study population. Result: The total number of participants included was 11 children. The age of participants varied between 18 – and 28 months with a mean age of 24.2 ± 3.1 months. The meatus opening was seen at the distal end near the coronal sulcus in 8 participants whereas 3 participants showed preoperative meatus opening in the distal third of the shaft. An immediate follow up was done at 2 weeks intervals to assess wound health and situation. 1 out of 11 infants showed wound dehiscence which was immediately corrected. A late follow up was carried out after 2-3 years, no case presented with significant complications such as urethrocutaneous fistula or stenosis of the meatus. Conclusion: the study shows measured the post-operative complications followed by TIP urethroplasty using a dorsal flap. Immediate complications showed a single case of wound dehiscence. Whereas all long term follows up after 2-3 years showed no significant complications. After predisposing the clinical outcomes of this research against and in favour of pre-existing literature, it is concluded that dorsal flaps assisted TIP urethroplasty is a safe surgical procedure and is effective in terms of avoiding postoperative complications in individuals with hypospadias. Keywords: Dorsal flap, Hypospadias, Tubularized incised plate urethroplasty

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“…However, this classification does not provide effective guidance for selecting clinical treatments 4,5 . Severe hypospadias is, in most cases, accompanied by apparent penile curvature and severe clinical symptoms, which require more involved surgical reconstruction, whereas mild cases do not always require surgical repair 4–7 …”

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confidence: 99%

“…4,5 Severe hypospadias is, in most cases, accompanied by apparent penile curvature and severe clinical symptoms, which require more involved surgical reconstruction, whereas mild cases do not always require surgical repair. [4][5][6][7] As hypospadias is often associated with multiple syndromes and additional genitourinary abnormalities, the diagnosis of prenatal hypospadias, especially severe hypospadias, may be of high value to the clinical team and parents as it allows early counseling and directs further testing. [8][9][10] Currently, prenatal diagnosis of hypospadias relies mainly on ultrasound (US).…”

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confidence: 99%

Prenatal Diagnosis and Classification of Fetal Hypospadias: The Role and Value of Magnetic Resonance Imaging

Zhang

Yan

et al. 2021

Magnetic Resonance Imaging

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Background Prenatal diagnosis and classification of hypospadias are difficult and of value for management during perinatal and neonatal periods. The conventional approach for prenatal diagnosis of hypospadias is ultrasound; however, this technique may be inconclusive in certain cases, which prompts for further exploration with magnetic resonance imaging (MRI). Purpose To investigate the role of MRI in the prenatal diagnosis and classification of fetuses with hypospadias. Study Type Retrospective. Population Thirty‐five fetuses (median gestational age = 37, range 24–39 weeks) with possible hypospadias. Field Strength/Sequence Single‐shot fast spin echo T2‐weighted imaging, fast imaging employing steady‐state acquisition (FIESTA), and three‐dimensional FIESTA acquired at 1.5 T. Assessment Diagnosis and classification of hypospadias using MRI were performed by three experienced radiologists based on MRI features, including a short penile shaft, abnormal penile tip, penile curvature, bifid scrotum, “tulip sign,” and penoscrotal transposition. The accuracy of MRI in the diagnosis and classification of hypospadias was assessed in comparison to postnatal clinical diagnosis. The interobserver agreement between radiologists was also assessed. Statistical Tests Kendall's W test was applied to assess the interobserver agreement between radiologists. Taking postnatal clinical diagnosis as the reference standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Results Of the 35 fetuses, 24 cases were confirmed as hypospadias through postnatal clinical diagnosis. The interobserver agreement between radiologists was substantial (Kendall's W = 0.781, P < 0.001). Of the 24 confirmed cases (13 cases of severe hypospadias and 11 cases of mild hypospadias), 22 cases were correctly diagnosed by MRI. The accuracy of MRI in the diagnosis of hypospadias, severe hypospadias, and mild hypospadias was 85.71%, 82.86%, and 80.00%, respectively. Data Conclusion MRI has good performance in the diagnosis of fetal hypospadias. In addition, MRI could help evaluate the severity of fetal hypospadias. Level of Evidence 3 Technical Efficacy Stage 2

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Comparative study of urethroplasties to reduce urethral strictures in patients with severe hypospadias

Cited by 3 publications

References 24 publications

Comparative study of one-stage and the novel two-stage urethroplasty using the transected urethral plate and transverse preputial island flap (TPIF) for severe hypospadias: a single-center experience

Comparative study of one-stage and the novel two-stage urethroplasty using the transected urethral plate and transverse preputial island flap (TPIF) for severe hypospadias: a single-center experience

Assessing the Effectiveness of Dorsal Flap in Surgical Repair of Hypospadias by Tubularized Incised Plate Urethroplasty

Prenatal Diagnosis and Classification of Fetal Hypospadias: The Role and Value of Magnetic Resonance Imaging

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