Management of complications after hypospadias repair

Snyder, Charles L.; Evangelidis, Apostolos; Hansen, Gregory; Peter, Shawn D. St.; Ostlie, Daniel J.; Gatti, John M.; Gittes, George K.; Sharp, Ronald J.; Murphy, John P.

doi:10.1016/j.urology.2004.11.037

Cited by 45 publications

(37 citation statements)

References 17 publications

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“…Urethral strictures after hypospadias repair occur with a published frequency of 6e12% [1,4]. In spite of this, there are few studies evaluating the optimal management of these patients [3,4].…”

Section: Discussionmentioning

confidence: 99%

“…Hypospadias is one of the most commonly treated congenital genitourinary anomalies in boys with an estimated incidence of 3e5 per 1000 live births [1]. While the operative techniques to treat this condition have evolved significantly in the last few decades, few studies have focused on determining the optimal management for the more common complications ensuing from hypospadias repair.…”

Section: Introductionmentioning

confidence: 99%

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Management of recurrent urethral strictures after hypospadias repair: Is there a role for repeat dilation or endoscopic incision?

Gargollo

Cai

Borer

et al. 2011

Journal of Pediatric Urology

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of recurrent urethral strictures after hypospadias repair: Is there a role for repeat dilation or endoscopic incision?

Gargollo

Cai

Borer

et al. 2011

Journal of Pediatric Urology

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“…There is a significant difference in outcome of hypospadias surgery done by pediatric urologists vs. other surgical specialists. [23]…”

mentioning

confidence: 99%

General considerations in hypospadias surgery

Bhat

2008

Indian J Urol

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Nonsystemic review of the literature was done for timing of surgery, preoperative evaluation and plan, anesthesia, suture materials, magnification, tissue handling, stent and diversion problems, intra and postoperative care, dressing, and follow-up protocol. The best time for hypospadias repair is between 6 and 18 months. Preoperative evaluation in proximal hypospadias includes hormonal and radiological examination for intersex disorders, as well as for upper tract anomalies along with routine evaluation. General anesthesia is a rule but local blocks help in reducing the postoperative pain. Magnification, gentle tissue handling, use of microsurgical instruments, and appropriate-sized stent for adequate period help in improving the results. Hormonal stimulation is useful to improve growth and vascularity of urethral plate and decrease the severity of chordee in poorly developed urethral plate with severe curvature. Urethral plate preservation urethroplasty with spongioplasty is the procedure of choice in both proximal and distal hypospadias. Algorithms are proposed for management of hypospadias both with curvature and without curvature. Two-stage urethroplasty has its own indications. A good surgical outcome may be achieved following basic surgical principles of microsurgery, fine suture materials, choosing one or two-stage repair as appropriate, proper age of surgery, and with good postoperative care. Future of hypospadiology is bright with up coming newer modalities like laser shouldering, robotics, and tissue engineering.

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“…UCF and FD formation are the most common complications and continue to be undesirable. Despite advances in surgical techniques, these complications are present in 10-73% of cases [1,[12][13][14][15][16] . Some authors have described that the incidence of complications of proximal HS repair is far larger than with distal HS, and surgical management of proximal HS requires exceptional surgical skills [17] , which might explain the variation in reported UCF and FD outcomes.…”

Section: Discussionmentioning

confidence: 99%

Use of Fibrin Sealant in Hypospadias Surgical Repair Reduces the Frequency of Postoperative Complications

et al. 2007

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Introduction: Urethrocutaneous fistulas (UCF) and flap dehiscence (FD) are the most common postoperative complications after hypospadias (HS) surgical repair. The aim of this study was to evaluate whether the application of fibrin sealant over the site of surgery and suture lines reduces these complications. Materials and Methods: A prospective cohort of consecutive patients was treated over a 3-year period. 30 patients were submitted to HS surgical repair plus application of fibrin glue over the suture line and surgical site; for comparison, another 56 subjects made up the control group which was submitted to surgical repair only. Variables assessed included: age, type of HS, fibrin sealant used, complications and number of surgical procedures required to treat recurrences. Results: In general, the frequency of complications was 10 vs. 41% for UCF (p = 0.002), 13 vs. 50% for FD (p = 0.001), and for flap necrosis (FN) 6.7 vs. 28.6% (p = 0.01) for the treatment and control groups respectively. The number of surgical reinterventions to treat recurrences was higher in the control group than in the study group (p = 0.04). Conclusion: The incidence of UCF after HS surgical repair can be reduced by applying fibrin sealant over the site of surgery and the suture lines.

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Management of complications after hypospadias repair

Cited by 45 publications

References 17 publications

Management of recurrent urethral strictures after hypospadias repair: Is there a role for repeat dilation or endoscopic incision?

Management of recurrent urethral strictures after hypospadias repair: Is there a role for repeat dilation or endoscopic incision?

General considerations in hypospadias surgery

Use of Fibrin Sealant in Hypospadias Surgical Repair Reduces the Frequency of Postoperative Complications

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