Proximal Hypospadias

Kraft, Kate H.; Shukla, Aseem R.; Canning, Douglas A.

doi:10.1100/tsw.2011.76

Cited by 27 publications

(19 citation statements)

References 38 publications

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“…It is difficult to correct the malformation, and there are still many postoperative complications after surgery. After many years of development, both the operative skills for treating proximal hypospadias and the cure rate have greatly improved [ 9 ], but there is no perfect surgical method to avoid postoperative complications [ 2 ]. Controversy still exists with regard to the choice of single-stage or two-stage surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Hypospadias is one of the most common congenital urinary malformations in children [ 1 ]. Proximal hypospadias refers to a urinary meatus that is located at the shaft of the penis near the scrotum, the junction of the penis and scrotum, or the perineal area [ 2 ]. Hypospadias is a serious condition, and surgery is the only treatment for proximal hypospadias, although it is associated with a difficult technique and high postoperative complication rate.…”

Section: Introductionmentioning

confidence: 99%

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Clinical efficacy of transverse preputial island flap urethroplasty for single-stage correction of proximal hypospadias: a single-centre experience in Chinese patients

Cui

Huang

et al. 2020

BMC Urol

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Background This study was designed to summarize the clinical outcomes of transverse preputial island flap urethroplasty for single-stage correction of proximal hypospadias in our hospital. Method This study retrospectively analysed the clinical data, including the preoperative general information, intraoperative and postoperative data, and follow-up data, of 155 children with proximal hypospadias who were admitted to our hospital from January 2009 to January 2019. Results During follow-up, a total of 92 postoperative complications occurred, and 41 patients underwent reoperation. There were 49 patients with urinary fistula, 26 patients with urethral stricture, 9 patients with urethral diverticulum and 8 patients with urinary tract infection. Regarding the family members’ satisfaction with the cosmetic appearance of the penis, the satisfaction rate with the urinary meatus was 85.2%, the satisfaction rate with the glans appearance was 87.7%, the satisfaction rate with the the appearance of the foreskin of the penis was 92.3%, and the satisfaction rate with the overall penis shape was 89.0%. Conclusion Proximal hypospadias is a serious condition that is often combined with severe chordee, and transverse preputial island flap urethroplasty for single-stage correction is an effective surgical procedure for treating this condition.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical efficacy of transverse preputial island flap urethroplasty for single-stage correction of proximal hypospadias: a single-centre experience in Chinese patients

Cui

Huang

et al. 2020

BMC Urol

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“…Urethrocutaneous fistula, glans dehiscence, and meatal stenosis are the most common complications encountered in hypospadias surgery, each occurring in 5–18% of patients 17 – 19 . Surgical reconstruction for proximal hypospadias is more extensive than for distal variants and, although many approaches exist, they can be broadly characterized by the single- and multi-stage approach 20 .…”

Section: Identification Of the Problemmentioning

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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“…The technique used for construction of the flap is unique in our technique and differs significantly from the typical technique reported to create onlay preputial flaps. Classically, the onlay has been constructed with the inner layer of the prepuce ( 24 ) leaving the outer layer, which may be needed to cover the penile shaft (usually as rotational Byars flaps ( 25 )) with poor blood supply ( 26 ). In contrast, the use of the TPF ( 16 ) ensures that both the skin used for the onlay and the skin use for ventral coverage preserve excellent blood supply.…”

Section: Discussionmentioning

confidence: 99%

Results of Onlay Preputial Flap Urethroplasty for the Single-Stage Repair of Mid- and Proximal Hypospadias

2018

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AimsTo report current results of preputial flap onlay urethroplasty using the principle of the total preputial flap (TPF) for the one-stage repair of mid- and proximal hypospadias.MethodsThis study was a retrospective chart review of patients in a prospectively kept database of all hypospadias operations performed at two institutions from January 1 2011 to August 2017. Inclusion criteria: all patients who underwent hypospadias repair using a preputial only flap urethroplasty based on the principle of the TPF. Demographic data, duration of follow-up, complications, and reoperations were recorded. A successful result was considered to be a straight penis, a glanular meatus, and absence of voiding symptoms. Whenever possible an uroflow was obtained during the follow-up visits.ResultsForty-nine children met the inclusion criteria. All patients had marked penile curvature. Three patients had chromosomal abnormalities. The mean age at the time of surgery was 22 months (11–110) and the mean duration of follow-up 23.4 months (1–79). In 48 cases, the urethral plate could be preserved without dividing it. The penile curvature was corrected with chordectomy alone in 10 patients, 38 required a dorsal plication of the tunica albuginea, and 1 required an additional ventral dermal graft. In 38 patients (77.5%), the initial operation was successful, and no further operations were needed. There were eight urethrocutaneous fistulas, three dehiscences of the glans approximation. One patient suffered a wound infection and partial loss of the flap.ConclusionOne-stage repair of mid- and proximal hypospadias preserving the urethral plate and using a TPF for the urethroplasty and coverage of the ventral penis is successful in 77.5% of cases. Complications in the remaining patients were easily managed or did not require treatment. Compared to a planned two-stage approach, the technique described in this report resulted in significantly fewer procedures till complete resolution of the problem.

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Proximal Hypospadias

Cited by 27 publications

References 38 publications

Clinical efficacy of transverse preputial island flap urethroplasty for single-stage correction of proximal hypospadias: a single-centre experience in Chinese patients

Clinical efficacy of transverse preputial island flap urethroplasty for single-stage correction of proximal hypospadias: a single-centre experience in Chinese patients

Proximal hypospadias: we aren’t always keeping our promises

Results of Onlay Preputial Flap Urethroplasty for the Single-Stage Repair of Mid- and Proximal Hypospadias

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