Proximal hypospadias: A persistent challenge. Single institution outcome analysis of three surgical techniques over a 10-year period

Canning, Douglas A.

doi:10.1016/j.jpurol.2015.06.011

Cited by 131 publications

(42 citation statements)

References 23 publications

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“…4–7 However, recent data indicate that the complication rates of proximal repair are higher than previously reported and contrast sharply with those of distal hypospadias repair. 11–13,15,16 Of particular concern is the over extension of certain techniques, which may increase complication development. In patients with multiple complications, repair efforts focus on function, ensuring the correction of chordee and advancement of the meatus to a distal position that may not be located in the distal glans.…”

Section: Discussionmentioning

confidence: 99%

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Intermediate-Term Followup of Proximal Hypospadias Repair Reveals High Complication Rate

et al. 2017

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Purpose Results following distal hypospadias repair are favorable. Grouping proximal and distal hypospadias repair artificially increases the perceived success rate of proximal hypospadias. We identified our complication rate of proximal hypospadias repair and hypothesized a higher complication rate for 1-stage repair. Materials and Methods We retrospectively reviewed the records of consecutive boys who underwent proximal hypospadias from 2007 to 2014. Proximal hypospadias was defined as a urethral meatus location at or more proximal than the penoscrotal junction after penile degloving. We further stratified boys into those with planned 1-stage vs 2-stage repair. Univariate and Cox regression analyses were performed to assess associations with covariates and compare time to the first complication, respectively. Results A total of 167 boys met study inclusion criteria. Median followup was 31.7 months for 1-stage repair in 86 patients and staged repair in 81. The overall complication rate was 56%. Complications developed in 53 of 86 1-stage (62%) vs 40 of 81 staged (49%) repairs (p = 0.11). The number of unplanned procedures per patient was higher in the 1-stage than in the staged group (0.99 vs 0.69, p = 0.06), as was the number of patients who had at least 2 complications (29 of 86 or 33% vs 13 of 81 or 16%, p = 0.03). Cox regression showed no difference in time to the first complication for staged compared to 1-stage repair (HR 0.77, 95% CI 0.43–1.39). Conclusions Our 56% complication rate of proximal hypospadias warrants further long-term patient followup. More patients in the 1-stage group experienced at least 2 complications. However, when complications developed, they developed no differently in the 2 groups.

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Section: Discussionmentioning

confidence: 99%

“…11–13 Surgical approach included 1-stage repair 13 and planned 2-stage repair. 11–13 These high complication rates raise concern about our management of proximal hypospadias because boys are exposed to additional unplanned risk. A few of these boys are in danger of becoming a “hypospadias cripple,” from which recovery is difficult.…”

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confidence: 99%

Intermediate-Term Followup of Proximal Hypospadias Repair Reveals High Complication Rate

et al. 2017

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“…Secondary and proximal hypospadias repairs have higher rates of complication 12. Staged repair accomplished better results than tubularized incised plate repair and dorsal inlay grafts repair techniques, and glans size was an independent risk factor 13. However, these studies are mostly retrospective and limited to single-center experiences.…”

Section: Introductionmentioning

confidence: 99%

Analgesic efficacy and impact of caudal block on surgical complications of hypospadias repair: a systematic review and meta-analysis

Zhu

Rong

Tong

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesis commonly used for children undergoing hypospadias repair. However, the safety of caudal block for hypospadias repair in children is controversial in terms of surgical complications such as urethrocutaneous fistula and glans dehiscence. We sought to perform a meta-analysis to estimate the analgesic efficacy and relative complications of caudal block for hypospadias repair in children.MethodsWe identified comparative studies of caudal block versus peripheral nerve block or no caudal block; studies were published or presented through 1 January 2018, and reports of analgesic efficacy or surgical complications of hypospadias repair in children were identified. Peripheral nerve block includes dorsal nerve penile block and pudendal nerve block. Data were abstracted from studies comparing caudal block with peripheral nerve block or no caudal block; original source data were used when available. We prespecified separate assessments of randomized controlled trials (RCTs) and observational studies given the inherent differences between types of study designs. Data from 298 patients in four RCTs and from 1726 patients in seven observational studies were included. RCT and observational data were analyzed separately.ResultsIn RCTs, caudal blocks (compared with peripheral nerve blocks) showed no detectable differences in terms of need for additional analgesia within 24 hours after the surgery (OR 10.49; 95% CI 0.32 to 343.24; p=0.19), but limited data showed lower pain scores 24 hours after the surgery (standardized mean difference (SMD) 1.57; 95% CI 0.29 to 2.84; p=0.02), a significantly shorter duration of analgesia (SMD −3.33; 95% CI −4.18 to −2.48; p<0.0001) and analgesics consumption. No significant differences were observed in terms of postoperative nausea and vomiting (OR 3.08; 95% CI 0.12 to 77.80; p=0.50) or motor weakness (OR 0.01; 95% CI −0.03 to 0.05; p=0.56). Only one randomized study showed that caudal blocks (compared with peripheral nerve blocks) were associated with detectable differences in urethrocutaneous fistula rate (OR 25.27; 95% CI 1.37 to 465.01; p=0.03) and parental satisfaction rate (OR 0.07; 95% CI 0.02 to 0.21; p<0.00001). In observational studies, caudal block was not associated with surgical complications in all types of primary hypospadias repair (OR 1.83; 95% CI 0.80 to 4.16; p=0.15). To adjust for confounding factors and to eliminate potential selection bias involving caudal block indication, we performed subgroup analysis including only patients with distal hypospadias. This analysis revealed similar complication rates in children who received a caudal block and in children not receiving caudal block (OR 1.02; 95% CI, 0.39 to 2.65; p=0.96). This result further confirmed that caudal block was not a risk factor for surgical complications in hypospadias repair. The direction of outcomes in all the other subgroup analyses did not change, suggesting stability of our results.ConclusionsIn RCTs, only limited data showed peripheral nerve blocks providing better analgesic qua...

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“…I read the paper "Proximal hypospadias: A persistent challenge: single institution outcome analysis of three surgical techniques over a 10-year period" [1] and its respective comment [2] with great interest.…”

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confidence: 99%

“…"mild-to-moderate VC, defined as 30-50 degrees was corrected using a modified midline dorsal plication (DP), laterally displacing the neurovascular bundles and incising the albuginea, which was then plicated with non-absorbable sutures" [1].…”

mentioning

confidence: 99%

Response to “Re. Proximal hypospadias: A persistent challenge. Single institution outcome analysis of three surgical techniques over a 10-year period”

Jesus

2016

Journal of Pediatric Urology

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Proximal hypospadias: A persistent challenge. Single institution outcome analysis of three surgical techniques over a 10-year period

Cited by 131 publications

References 23 publications

Intermediate-Term Followup of Proximal Hypospadias Repair Reveals High Complication Rate

Intermediate-Term Followup of Proximal Hypospadias Repair Reveals High Complication Rate

Analgesic efficacy and impact of caudal block on surgical complications of hypospadias repair: a systematic review and meta-analysis

Response to “Re. Proximal hypospadias: A persistent challenge. Single institution outcome analysis of three surgical techniques over a 10-year period”

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