Comparison of variables affecting the surgical outcomes of tubularized incised plate urethroplasty in adult and pediatric hypospadias

Bhat, Amilal; Bhat, Mahakshit; Kumar, Vinay; Kumar, Rajeev; Mittal, Ruchi; Saksena, G.

doi:10.1016/j.jpurol.2015.09.005

Cited by 42 publications

(28 citation statements)

References 29 publications

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“…Persistent chordee and unsatisfactory cosmetic appearance are two less commonly reported concerns that are gaining recognition with longer follow up 29 , 30 . Delayed repair is not a good option, as results of primary hypospadias repair in adult patients are poor, approaching 50% even for distal repairs 31 , 32 .…”

Section: Factors Contributing To a High Complication Ratementioning

confidence: 99%

Proximal hypospadias: we aren’t always keeping our promises

Long

Canning

2016

F1000Res

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Hypospadias surgery is a humbling art form. The evolution of surgical techniques has made distal hypospadias outcomes favorable, but recent publications suggest that our complication rates for proximal hypospadias are much higher than previously reported. To explain these shortcomings, we examine the literature and focus on the lack of standardized documentation, the subsequent inability to objectify the severity of the phenotype, and the underestimation of complications due to lack of long-term follow up. The variability in surgical technique and the fact that the literature abounds with small case series from single institutions also limits our ability to compare outcomes. We believe that the use of standardized and scored phenotype assessments from diagnosis through the extended postoperative period will allow for improved scientific assessment of outcomes. This will facilitate multi-institution collaboration and tabulation of outcomes, allowing rapid data accumulation and assessment for this rare disorder. As surgeons, we must follow boys through puberty into adulthood and must honestly report our results in order to advance our surgical approach to this complicated problem.

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Section: Factors Contributing To a High Complication Ratementioning

confidence: 99%

Proximal hypospadias: we aren’t always keeping our promises

Long

Canning

2016

F1000Res

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“…Due to surgical, psychological, and cosmetic reasons the consensus recommendation of pediatricians for the optimal hypospadias repair period is postpartum 6-12 months [4]. However, in developing countries hypospadias is not considered a serious disease.…”

Section: Discussionmentioning

confidence: 99%

“…Hypospadias repair has been recommended between 6 and 12 months. However, in the developing countries most births are conducted at home, with corresponding lack of recognition of congenital deformities [4]. Patient and social factors such as lack of knowledge and difficulties accessing health units lead patients to be presented late and operated on after the age of two, or maybe even after childhood as adults [5].…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Adjuvant Hyperbaric Oxygen Therapy in Adults who Underwent Hypospadias Surgery

Kara¹

2017

Ann Clin Anal Med

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Amaç: Hipospadias tedavisi amacıyla bukkal mukoza ile tüp üretroplasti yapılan erişkin hastalarda hiperbarik oksijen tedavisi (HBO2T)'nin rolünü değerlendirmek. Gereç ve Yöntem: Çalışmaya hipospadiası olan 16 erişkin hasta dahil edildi. Kısa üretra ve penil kurvaturu olan hastalar iki aşamalı tedavi edildi (ortoplasti+bukkal mukoza ile tüp üretroplasti). Tüp üretroplasti için alınan mukoza 16 Fr. nelaton kateter etrafında tübülarize edilerek üretral mea ile glans penis arasına yerleştirildi. Hastaların 13'üne ameliyat sonrası birinci günden itibaren hafta içi günlerde toplam 10 seans HBO2T uygulandi. Bulgular: Hastaların ortalama hasta yaşı 21(±1,23) ve takip süresi 10.1(±2.1) aydı. HBO2T uygulanan 13 hastanın 6(%46)'sinde iki aşamalı (ortoplasti+bukkal tüp mukoza grefti) onarım gerçekleştirildi ve ortalama greft uzunluğu 5.4(±1,23) cm idi. Bu gruptaki hastalarda hipospadias ameliyatı sonrası %54(7/13) oranında başarı sağlanırken, ikincil işlem (internal üretrotomi ve/veya fistül onarımı) sonrası başarı oranı %84.6 (11/13) olarak izlendi. HBO2T uygulanmayan 3 hastanın 1(%33)'inde iki aşamalı onarım gerçekleştirildi ve ortalama greft uzunluğu 8(±5) cm idi. Bu gruptaki hastalarda hipospadias ameliyatı sonrası başarı sağlanamazken ikincil işlem sonrası başarı oranı %33(1/3) olarak izlendi. Tartışma: Hiperbarik oksijen tedavisinin bukkal mukoza ile tüp uretroplasti cerrahisiyle kombine edilmesi başarıyı arttırmaktadır. Bu konuda daha geniş, prospektif çalışmalara ihtiyaç vardır.

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“…Aside from the postulated psychological benefits of early repair [19, 27], it has been argued that hypospadias surgery performed during adulthood does not indicate greater risk for urethroplasty complications [28]. This is not supported by other reports [29–31]. Based on bioethical principles, it has also been argued that hypospadias repair should only occur when the patient becomes able to participate in the decision-making process [32].…”

Section: Discussionmentioning

confidence: 99%

Age of the Mother as a Risk Factor and Timing of Hypospadias Repair According to Severity

Jorge¹,

Perez-Brayfield

Torres

et al. 2016

JURNOA

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Background & Objectives Hypospadias is characterized by a displacement of the urethral opening in males that can change from the typical position within the glans penis to a subcoronal position (Type I), to anywhere along the ventral shaft (Type II), to penoscrotal, scrotal, or perineal positions (Type III). We and others have previously reported that age of the mother (≥ 40 years old) is a risk factor for having a child with hypospadias, but there is a scarcity of reports on whether such risk is higher for having a child with the mild (Type I) or the more severe forms (Types II and III). In addition, we aimed to assess the timing of hypospadias repair according to severity. Methods Parents of children with hypospadias were interviewed by using a series of questionnaires (n = 128 cases). Severity was confirmed in the clinic and age of the mother was self-reported. Number of surgeries, age of child by the first and the last intervention was also assessed. Ordered logistic regression and the Brant test were employed to calculate risk between mild (Type I) and severe cases (Types II and III), and the assumption of proportional odds, respectively. The Mann-Whitney U Test was used to compare number of surgeries and age by the last repair between mild and severe cases. One-way ANOVA was employed to compare age of the child at the time of first surgery across severities (Types I - III). Results Women ≥ 40 years of age are 3.89 times [95% CI: 1.20-12.64] at a higher risk for having a child with the more severe forms of the condition than younger women. Repair of Type I was accomplished with 1 intervention whereas more severe cases required 1 – 4 (2 ± 0.5) surgical interventions. The timing for hypospadias repair of Type I cases occurred at an average age of 16.2 ± 4.88 months, of Type II cases occurred at an average age of 20.3 ± 8.15 months whereas the average age of the first hypospadias repair among Type III cases was 12.68 ± 2.52 months. Number of surgeries according to severity (p ≤ 0.0018, z-ratio = 2.91) and age difference for the timing of last repair (p ≤ 0.045, z-ratio = 1.69) were statistically different, but not the age difference for the first repair. Conclusions Increased maternal age is associated with the most severe forms of hypospadias. There is room for improvement for the timing of hypospadias repair according to severity.

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Comparison of variables affecting the surgical outcomes of tubularized incised plate urethroplasty in adult and pediatric hypospadias

Cited by 42 publications

References 29 publications

Proximal hypospadias: we aren’t always keeping our promises

Proximal hypospadias: we aren’t always keeping our promises

The Effectiveness of Adjuvant Hyperbaric Oxygen Therapy in Adults who Underwent Hypospadias Surgery

Age of the Mother as a Risk Factor and Timing of Hypospadias Repair According to Severity

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