Single- vs. multi-stage repair of proximal hypospadias: The dilemma continues

Badawy, Haytham; Fahmy, Ahmed

doi:10.1016/j.aju.2013.03.009

Cited by 20 publications

(8 citation statements)

References 49 publications

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“…However, it is believed that infection predisposes to UCF as mentioned in a paper done to study the acute post-operative complications of hypospadias. [ 21 ] Post-operative oedema did not affect the occurrence of UCF, as only one (5.3%) of the patients who suffered oedema developed UCF ( P = 0.37). We could not find studies specifically addressing the link between UCF and post-operative oedema, but in a study done by Kundra et al .…”

Section: Discussionmentioning

confidence: 97%

A Comparative Study of Polydioxanone (PDS) and Polyglactin (Vicryl) in Hypospadias Repair

Alaraby¹,

Abdeljaleel²,

Hamza³

et al. 2021

African Journal of Paediatric Surgery

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Background: Hypospadias is a fairly common problem, and it is the most common genital congenital anomaly. Objective: This study was carried out to compare polyglactin and polydioxanone in hypospadias repair by assessing the rate of complications, especially urethrocutaneous fistula (UCF) formation. Patients and Methods: This is a prospective observational cross-sectional hospital-based study carried out at the Department of Paediatric Surgery, Ribat University Hospital, from June 2015 to November 2016. In Group A, there were 55 patients who underwent repair using polyglactin, and in Group B, there were 50 patients who underwent repair using polydioxanone. All patients were operated by the same surgeon. Results: The mean age of Group A was 5.7 ± 4.3 years and 5.1 ± 3.9 years in Group B. Meatal advancement and glanuloplasty incorporated operation was done in 47.6%, Tubularized incised plate urethroplasty in (31.4%), Theirsch-Duplay in 20% and Mathieu's repair in 1%. The complication rate was 34% in Group A and 10.9% in Group B. The most frequent complication was UCF, as 19 patients (18.1%) of the study candidates developed UCF; most of them were in Group A (14 patients) and 5 patients in Group B. Another significant complication was meatal stenosis, which occurred in 11 patients (10.5%): 9 in Group A and 2 in Group B. Conclusion: Polydioxanone (PDS) is satisfactory in hypospadias repair as it is associated with better outcome, especially UCF, which is most common and most difficult to treat complication.

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Section: Discussionmentioning

confidence: 97%

A Comparative Study of Polydioxanone (PDS) and Polyglactin (Vicryl) in Hypospadias Repair

Alaraby¹,

Abdeljaleel²,

Hamza³

et al. 2021

African Journal of Paediatric Surgery

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“…Both materials were able to show evidence of inducing tissue regeneration within 16 weeks of treatment. The replacement tissue consisted of fibrous tissue with epithelial cells lining the surface and a neoangiogenesis in submucosal and serosal layers (Grossklaus et al 2001;Badawy and Fahmy 2013). Although the marginal areas of the replacement tissue demonstrated evidence of muscle layer hypertrophy, no muscle layer regeneration was noted within the replacement tissue by 16 weeks.…”

Section: Discussionmentioning

confidence: 99%

Partial resection of the urinary bladder in swine and sheep and replacement of the resected segment by biologically inert patches

et al. 2018

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This study was performed to examine the adequacy of biological inert patches as a substitute material for the construction of urinary bladder replacement tissue. An animal model experiment was conducted in six sheep and six swine. In all animals partial resection of the urinary bladder was performed; round or oval-shaped, 5–6 cm in diameter. Patches of the same shape, 4–5 cm in diameter were used. Two types of patches, polytetrafluorethylene and small intestinal submucosa were tested in the experiment, sewn with an absorbable 4-0 polydioxanone suture. Following 16 weeks the animals were euthanized followed by autopsy and histologic analysis. All animals showed evidence of bladder regeneration at the replaced segment. The patches were found to be contracted to 12–20 mm in length and 8–10 mm in width, attached to the bladder mucosa with their smaller base and protruding into the bladder lumen. In some animals, no shrunk patches were found, suggesting they had been passed out by urine. Histologically, fibrous tissue completely replacing the substitute tissue was identified with endothelial-lined luminal surface and submucosal and serosal ingrowth of new blood vessels. The replacement tissue showed no evidence of muscle layer ingrowth. Bladder capacity was also measured and no significant decrease was recorded. Our experiment demonstrated the formation of replacement tissue at the site of graft implantation, which allows the resection of a larger portion of bladder without decreasing its capacity and thus constitutes a very good method for surgical treatment of urinary bladder tumours and other defects.

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“…Thus, it is more judicious for a hypospadiologist to master a few of these procedures to achieve the best results, regardless of the technique used. 9 Risk factors as severe chordee, middle and posterior localized hypospadias, and use of a pedicle island flap may increase the postoperative complication rate. There is no gold-standard technique for hypospadias repair; the procedure of choice should depend on the individual anatomy of the penis.…”

Section: Discussionmentioning

confidence: 99%

Case series: long term experience with different types of hypospadias and its correction by single stage procedure

2018

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Background: Hypospadias is a relatively common congenital defect of the male external genitalia. It is present in approximately 1 in 250 male newborns. Hypospadias, in boys, is defined as an association of three anomalies of the penis: an abnormal ventral opening of the urethral meatus that may be located anywhere from the ventral aspect of the glans penis to the perineum, an abnormal ventral curvature of the penis (chordee), and an abnormal distribution of foreskin with a “hood” present dorsally and deficient foreskin ventrally.Methods: In this study author operated 250 cases of Hypospadias of different types in different age groups during (1992-2017) using MAGPI for glandular, TIP and Flip-flap procedure for distal penile and Ducket Onlay Flap technique for Proximal penile, penoscrotal and perineal Hypospadias. Complicated / Failed Hypospadias was repaired by Trap door technique or Byer’s double tube technique.Results: After the primary repair of Hypospadias fistula was found in 4.5% of patients. Post-operative haemorrhage was seen in 3.2% of patients. Flap Necrosis was found in 8% of patients after Mathieu’s Flip- Flap technique. The success rate of Complicated Hypospadias was quite satisfactory and Meatal Stenosis was seen in 10% of the cases. Over All study has shown superior cosmetic results and one stage repair is cost effective, satisfactory and less psychologically affecting the parents and the patients.Conclusions: MAGPI and its different modifications in the repair for Glandular and Flip-flap or TIP for distal penile in cases of mild or no chordee. Proximal Penile has sufficient Chordee and can be corrected by dorsal plication and urethroplasty by Ducket’s Onlay flap technique. The cost-effectiveness due to single stage repair and its cosmetic results and there least complications prove the efficacy of this protocol. Single stage repair is also beneficial for developing countries like India where the follow-up compliance in the rural patients is extremely poor.

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Single- vs. multi-stage repair of proximal hypospadias: The dilemma continues

Cited by 20 publications

References 49 publications

A Comparative Study of Polydioxanone (PDS) and Polyglactin (Vicryl) in Hypospadias Repair

A Comparative Study of Polydioxanone (PDS) and Polyglactin (Vicryl) in Hypospadias Repair

Partial resection of the urinary bladder in swine and sheep and replacement of the resected segment by biologically inert patches

Case series: long term experience with different types of hypospadias and its correction by single stage procedure

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