Hypospadias dilemmas: A round table

Snodgrass, Warren; Macedo, António; Hoebeke, Piet; Mouriquand, Pierre

doi:10.1016/j.jpurol.2010.11.009

Cited by 159 publications

(92 citation statements)

References 14 publications

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“…The key surgical principles to achieve optimal surgical outcomes include the use of magnification, fine instruments and sutures, minimal and atraumatic tissue-handling, careful hemostasis, and good surgical assistance. 9,11 Most surgeons perform stented repairs, although distal hypospadias repairs can be done without the use of stents. 24 There is no uniform consensus regarding dressings 25 and use of prophylactic antibiotics.…”

Section: Operative Principlesmentioning

confidence: 99%

Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes

Keays

Davé

2017

CUAJ

115

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Section: Operative Principlesmentioning

confidence: 99%

Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes

Keays

Davé

2017

CUAJ

115

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“…It can be very difficult to assess the effect of these characteristics on the success of repair. 2,22 Factors related to the patient…”

Section: Risk Factors For Failed Hypospadiasmentioning

confidence: 99%

“…22 In a series of 299 patients undergoing primary hypospadias correction, complication rates improved considerably as the surgeon became more experienced. 45 A cut-off threshold of 100 cases per year has been proposed for classifying surgeons as experts in hypospadias surgery, 22 although one team has suggested that this threshold should be lowered to 50 cases per year, as risk for hospital readmission within the 12 months after primary repair was found to be lower in centres treating more than 50 cases per year compared with those performing fewer procedures. 46 Factors related to the procedure…”

Section: Surgeon Expertisementioning

confidence: 99%

Failed hypospadias in paediatric patients

et al. 2013

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| Failed hypospadias refers to any hypospadias repair that leads to complications or causes patient dissatisfaction. The complication rate after hypospadias repairs ranges from 5-70%, but the actual incidence of failed hypospadias is unknown as complications can become apparent many years after surgery and series with lifelong follow-up data do not exist. Moreover, little is known about uncomplicated repairs that fail in terms of patient satisfaction. Risk factors for complications include factors related to the hypospadias (severity of the condition and characteristics of the urethral plate), the patient (age at surgery, endocrine environment, and wound healing impairment), the surgeon (technique selection and surgeon expertise), and the procedure (technical details and postoperative management). The most important factors for preventing complications are surgeon expertise (number of cases treated per year), interposition of a barrier layer between the urethroplasty and the skin, and postoperative urinary drainage. Major complications associated with failed hypospadias include residual curvature, healing complications (preputial dehiscence, glans dehiscence, fistula formation, and urethral breakdown), urethral obstruction (meatal stenosis, urethral stricture, and functional obstruction), urethral diverticula, hairy urethra, and penile skin deficiency.

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“…However, Snodgrass's prospective databases revealed statistically increased glans dehiscence in proximal as compared to distal repairs. 13 Severity of ventral penile curvature is also associated with an increased complication rate. 15 In our study we found a total of 55 cases with varying degree of chordee, of which 3.6% of mild, 38.8% of moderate and 35.7% of severe cases had complications (p = 0.0001).…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study to Evaluate the Role of Different Variables in Results of TIPU for Hypospadias

Bhat¹,

Bhat²,

Sabharwal³

et al. 2014

UROL

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The objective of this article is to evaluate the role of different variables affecting the results of tubularised incised plate repair for hypospadias.We prospectively evaluated 125 patients of TIPU repair from April 2009 to October 2011. Study parameters were age, severity of hypospadias, degree of curvature and torsion, size of penis and glans, width of urethral plate, development of spongiosum and complication rate. Patients were classified into five groups by age; Group I-6 months to 2 years, Group II-2 to5 years, Group III-5 to10 years, Group IV-10 to 15 years and Group V-older than 15 years. Results were analyzed with reference to different variables.Age ranged from 6 months to 26 years (mean 8.8 years). Complication rate when comparing group V and youngest patients (groups I & II) was 20% Vs 3.6% (p=0.08), and when comparing older children (G-III and IV) with youngest patients (group I & II) was 15% Vs 3.6% (p=0.135). More severe hypospadias had higher complications (30% in proximal, 5.7% in distal (p = 0.001). The complication rate was 3.6%, 38.8% and 35.7% respectively in cases with mild, moderate and severe curvature (p = 0.001). Complications were higher in patients with poor spongiosum and higher age (p = 0.001) and in patients with narrow urethral plate (p = 0.0001). Follow up period was from about 10 months to 2 years (mean = 20 months).Urethral fistula and stricture were the most commonly reported complications. Important factors in outcome of TIPU repair were the degree of curvature, width of urethral plate development of spongiosum, age of child and severity of hypospadias. The development of urethral plate and spongiosum is directly proportional to the complication rate. Complications increase significantly with the increasing age of the patient.

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Hypospadias dilemmas: A round table

Cited by 159 publications

References 14 publications

Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes

Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes

Failed hypospadias in paediatric patients

A Prospective Study to Evaluate the Role of Different Variables in Results of TIPU for Hypospadias

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