Failed hypospadias repair: An algorithm for secondary reconstruction using remaining local tissue

Ekmark, Ann Nozohoor; Svensson, Henry; Arnbjörnsson, Einar; Hansson, Emma

doi:10.1016/j.bjps.2015.06.024

Cited by 13 publications

(4 citation statements)

References 30 publications

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“…Urethroplasty is the key procedure for treating hypospadias and different types of procedures have appeared over the years. Many patients have to face multiple surgeries due to failed procedures, and these patients typically develop problematic conditions, such as stricture, fistula, and ventral curvature [ 11 , 12 ]. It is very challenging to perform the reconstructions for complex conditions.…”

Section: Discussionmentioning

confidence: 99%

Comparison of lingual mucosa and buccal mucosa grafts used in inlay urethroplasty in failed hypospadias of pre-pubertal boys in a Chinese group

Hongyong¹,

Shuzhu²,

Wu³

et al. 2017

PLoS ONE

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ObjectiveThe purpose of this study was to compare the outcomes of the buccal mucosa and lingual mucosa used in children who received multiple failed hypospadias surgeries.MethodWe conducted a retrospective study of 62 children who received buccal or lingual mucosa graft urethroplasty in our hospital between 2012 and 2015. The ages ranged from 3.5–11 y. All cases included multiple failed hypospadias procedures, and the subjects received previous operations 2–3 times. All patients underwent one-stage operations. Thirty-three cases were treated with lingual mucosa grafts. The patient ages ranged from 3.5 to 11 y (median 7.5 y), and they had previous operations 2–3 times (mean 2.8±0.7). Grafts ranged from lengths of 2–6 cm (mean 5.1±0.46 cm) and widths of 0.5–1.5 cm (mean 1.2± 0.16 cm). Our follow-up was 5 to 12 m (mean 8.3±1.2 m). Twenty-nine cases were treated with buccal mucosa grafts. The patient ages ranged from 4 to 9.2 y (median 7.0 y), and they had previous operations 2–3 times (mean 2.5±0.2). Grafts ranged from lengths of 2–5.3 cm (mean 4.9± 0.28 cm) and widths of 0.5–1.5 cm (mean 1.0±0.11 cm). Our follow-up was 5 to 12 m (mean 7.9±0.5 m). The results were tested with SPSS 18.0. The rates of complications were compared by a chi-square test, and pre-operative conditions were compared by t test.ResultsFor the outcomes of the two groups, there was no significant difference between the groups in terms of age, preoperative surgery time, and the length and width of the grafts (p>0.05). For the lingual mucosa graft group, fistula: 2/33 (6.0%), stricture: 1/33(3.0%), ventral curvature: 2/33(6.0%), complications: 5/33(15.0%), success rate: 28/33(84.8%), Hose score: 14.34±0.95, peak flow: 6.5 ml/s-12.0 ml/s, and mean peak flow: 9.3±0.4 ml/s. For the buccal mucosa graft group, fistula: 2/29(6.8%), stricture: 2/29(6.8%), ventral curvature: 1/29 (3.4%), complication rate: 5/29(17.0%), success rate: 24/29 (83.0%), Hose score: 14.28±1.03, peak flow: 6.5 ml/s-12.0 ml/s, and mean peak flow: 9.2±0.2 ml/s. There were no differences between the two groups for overall success, complication rates, peak flow, and the Hose scores(P>0.05).ConclusionThe lingual mucosal graft and the buccal mucosa graft both achieved good outcomes, and the lingual mucosa graft made up for the shortcomings of the buccal mucosa graft, which provided a reliable way to treat the multiple failed hypospadias surgeries in pre-pubertal boys.

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Section: Discussionmentioning

confidence: 99%

Comparison of lingual mucosa and buccal mucosa grafts used in inlay urethroplasty in failed hypospadias of pre-pubertal boys in a Chinese group

Hongyong¹,

Shuzhu²,

Wu³

et al. 2017

PLoS ONE

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“…There is still no consensus on the optimal algorithms for reoperation. Nozohoor [7] proposed an algorithm for failed hypospadias utilizing the remaining local skin tissue but did not propose a solution if local skin tissue was insufficient. Craig [14] proposed an algorithm for failed hypospadias in adults that detailed the treatment for urethral stricture but did not include urethral tissue transection for severe RVC correction.…”

Section: Discussionmentioning

confidence: 99%

Identification of risk factors associated with numerous reoperations following primary hypospadias repair

Tang

et al. 2021

Journal of Pediatric Urology

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“…Significant tissue scarring and the paucity of local genital skin make it challenging to do the repair surgery [2]. Several salvage urethroplasty have been reported for patients with repeated failed surgeries, including the free grafts, onlay island flap, tubularized incised plate urethroplasty and so on [4]. Generally when a suitable urethral plate is available, possible strategies for redo include onlay graft, tubularized incised plate and dorsal inlay urethroplasty.…”

Section: Discussionmentioning

confidence: 99%

Scrotal-Septal Fasciocutaneous Flap Used as a Multifunctional Coverage for Prior Failed Hypospadias Repair

Zhang¹,

Zhou²,

Li³

et al. 2016

Urol Int

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Objectives: The study aims to report the method and outcome of using scrotal-septal fasciocutaneous flap as a multifunctional coverage for prior failed hypospadias repair. Methods: From January 2014 to June 2015, 18 hypospadias patients who have undergone repeated failed surgeries were enrolled. Their penile skin, urethral plate and dartos fascia are not enough to reconstruct the urethra, but have well-developed scrota. We performed urethroplasty by buccal mucosa free grafting and tubularized anastomosis 6 months after the urethroplasty. Then, scrotal-septal fasciocutaneous flap was used to be a multifunctional coverage on the surface of anastomotic urethra, which was a waterproof layer and cutaneous coverage. Results: The skin flaps survived and the incisions healed in 18 patients. No fistula and stricture occurred. The scar of donor site seemed like a new scrotal raphe. The flap can slip slightly along with the preputial movement and retain the original sense of touch. All patients were followed up at 1 and 6 months by telephone or in person and gained good recoveries. Conclusion: Scrotal-septal fasciocutaneous flap, including sufficient fascia tissue, reliable blood supply and skin coverage, is a good choice for the coverage of anastomotic urethra as both the waterproof layer and skin coverage, especially for hypospadias patients who have undergone several failed operations.

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Failed hypospadias repair: An algorithm for secondary reconstruction using remaining local tissue

Cited by 13 publications

References 30 publications

Comparison of lingual mucosa and buccal mucosa grafts used in inlay urethroplasty in failed hypospadias of pre-pubertal boys in a Chinese group

Comparison of lingual mucosa and buccal mucosa grafts used in inlay urethroplasty in failed hypospadias of pre-pubertal boys in a Chinese group

Identification of risk factors associated with numerous reoperations following primary hypospadias repair

Scrotal-Septal Fasciocutaneous Flap Used as a Multifunctional Coverage for Prior Failed Hypospadias Repair

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