Preservation of the Urethral Plate in Hypospadias Repair: Extended Applications and Further Experience with the Onlay Island Flap Urethroplasty

Hollowell, Jean G.; Keating, Michael A.; Snyder, Howard M.; Duckett, John W.

doi:10.1016/s0022-5347(17)39878-6

Cited by 127 publications

(50 citation statements)

References 3 publications

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“…The evolution of this concept required numerous experiences of dividing the urethral plate and performing extensive ventral corporeal dissection, only to have significant penile curvature persist with artificial erection. 11,12 Our results show that if the preoperative VC is less than 45 degrees, significant improvement should be expected after degloving and about 30% will convert to a straight penis. Even patients with proximal hypospadias and severe VC have a 40% chance of improving after degloving and a 2% chance of requiring no further treatment.…”

Section: Penile Degloving and Proximal Vc In Proximal Hypospadiasmentioning

confidence: 68%

Impact of penile degloving and proximal ventral dissection on curvature correction in children with proximal hypospadias

Weber

Braga

Patel

et al. 2014

CUAJ

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Introduction: Penile degloving is an important step in orthoplasty. Although its role in correcting mild curvature in distal and midshaft hypospadias has been previously reported, its impact on ventral curvature (VC) correction in proximal defects warrants further investigation. Therefore, we sought to document the effect of degloving and proximal urethral dissection on VC correction in children with proximal hypospadias. Methods: We retrospectively reviewed the records of 137 patients who underwent proximal hypospadias repair between 1998 and 2006. VC, defined as mild (<30%), moderate (30%-45%), and severe (>45%), was recorded before penile degloving and after erection test. Percent improvement in VC and need for further treatment (beyond degloving and proximal dissection) based on preoperative degree of curvature were assessed. ANOVA test was used to compare improvement among the 3 groups. Results: Mean age at repair was 14 months (range: 6-24). Penile degloving associated with proximal urethral dissection when necessary was responsible for the improvement in the degree of curvature in 7 of 9 (77%) patients with mild VC, 23 of 44 (52%) with moderate and 35 of 84 (40%) with severe VC. Additionally, degloving alone was sufficient for VC correction in 7 of 9 (77%) mild cases, 14 of 44 (30%) moderate and only 2 of 84 (2%) severe cases. The difference among these 3 groups was statistically significant (p < 0.001). Conclusions: Penile degloving alone can correct VC. The percentage of improvement depends on the preoperative degree of curvature, with severe VC cases showing the least improvement.

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Section: Penile Degloving and Proximal Vc In Proximal Hypospadiasmentioning

confidence: 68%

Impact of penile degloving and proximal ventral dissection on curvature correction in children with proximal hypospadias

Weber

Braga

Patel

et al. 2014

CUAJ

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“…The cosmetic results were group A -bad (0), fair (3), good (11) and excellent (19) and group B -bad (2), fair (7), good (15) and excellent (9 [ Table 1] shows the overall complications. 4 patients in group B had more than one complication together.…”

Section: Resultsmentioning

confidence: 99%

“…Decreased rate of fistula formation attributed to i. Preservation of the urethral plate Urethral plate preservation has been reported to be associated with less number of complications [11] . Every effort should be made to preserve the urethral plate during orthoplasty minimizing the need to use tubularized preputial island flaps and expanding the application of onlay procedures.…”

Section: Discussionmentioning

confidence: 99%

Onlay free preputial graft for mid and distal penile hypospadias

Gangopadhyay

Sharma

Mongha

2005

J Indian Assoc Pediatr Surg

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Onlay free preputial graft for mid and distal penile hypospadias Onlay free preputial graft for mid and distal penile hypospadias Onlay free preputial graft for mid and distal penile hypospadias Onlay free preputial graft for mid and distal penile hypospadias Onlay free preputial graft for mid and distal penile hypospadias ABSTRACT ABSTRACT ABSTRACT ABSTRACT ABSTRACTTubularized free preputial graft for hypospadias repair had been tried in the past and discarded due to high incidence of graft shrinkage causing stricture formation. We have tried to revive the technique using onlay method thus avoiding stricture formation. The technique was used in 33 subjects (Group A) and compared with 33 subjects in control group (Group B) in whom other techniques of urethroplasty were used. The study was a randomized controlled trial. The mean length of the free preputial graft was 22.06 + 4.68 mm (16-35 mm) and breadth was 9.0 + 1.32 mm (7-11 mm). Fistulae developed in 3 patients in group A out of which one healed spontaneously. In group B, 6 patients had fistula formation. Complications developed in 18% cases in group A and 50% cases in group B. There was significant difference between the cosmetic results (p < 0.05) with 58% excellent results in group A and 27% in group B. Free preputial graft onlay urethroplasty has better functional and cosmetic results. KEY WORDS: Hypospadias, Free preputial graft, Onlay urethroplastyHypospadiology is an over expanding field as none of the current methods of urethroplasty have been proved su perior over the others in terms of achieving the goal of excellent functional and cosmetic results. We have de scribed our experience with free inner preputial full thick ness onlay graft urethroplasty in mid and distal penile hypospadias and compared our results with currently used technique.

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“…However, in as many as 10% of cases, maintaining the integrity of this urethral plate is practically impossible, requiring its removal for the straightening of the penis (4,5). Once the urethral plate is removed, most authors justify that surgery should be done in two steps (two-stages).…”

Section: Introductionmentioning

confidence: 99%

The buccal mucosa fenestrated graft for Bracka first stage urethroplasty: experimental study in rabbits

et al. 2012

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Objective: To histologically evaluate, in an experimental study in rabbits, the integration process of the buccal mucosa fenestrated graft applied in the corpora cavernosa for Bracka fi rst stage urethroplasty. Materials and Methods: A urethral defect was surgically created in 16 male rabbits of the New Zealand breed through the excision of the penile urethra. The urethral defect was corrected by applying buccal mucosa fenestrated graft through two cruciform incisions in the distal portions of its longitudinal axis. The animals were sacrifi ced at 2, 4, 8 and 12 weeks post surgery and their genitals were subjected to clinical and histological assessment. Results: The buccal mucosa fenestrated graft showed complete uptake in all groups, with keratinization squamous metaplasia and mucosal proliferation of the fenestrated areas. The fenestrated graft area represented an increase in length of 25% in length in relation to the original standard graft. Conclusions: The fenestrated buccal mucosa graft presented total integration to the adjacent epithelia with re-epithelization of the incision areas of the graft (fenestrations) and no signifi cant infl ammatory or scarring reactions when compared to other mucosa transplanted areas; therefore its application is viable in cases of extensive urethral defect whenever the donating area might be insuffi cient.

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Preservation of the Urethral Plate in Hypospadias Repair: Extended Applications and Further Experience with the Onlay Island Flap Urethroplasty

Cited by 127 publications

References 3 publications

Impact of penile degloving and proximal ventral dissection on curvature correction in children with proximal hypospadias

Impact of penile degloving and proximal ventral dissection on curvature correction in children with proximal hypospadias

Onlay free preputial graft for mid and distal penile hypospadias

The buccal mucosa fenestrated graft for Bracka first stage urethroplasty: experimental study in rabbits

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