Split Onlay Skin Flap for the Salvage Hypospadias Repair

Patel, Rakesh P.; Shukla, Aseem R.; Leone, N.; Carr, Michael C.; Canning, Douglas A.

doi:10.1097/01.ju.0000154609.14084.5c

Cited by 20 publications

(10 citation statements)

References 13 publications

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“…However, Flap devascularization was more common in dorsal flap method (15.94%) Graft failure due to devascularization was significantly less (3.27%) with buccal mucosa. Contrary to the findings of present study Patel et al [21] reported salvage urethroplasty with split onlay skin flap with practically no flap devascularization or infection. The primary advantages with Buccal mucosa graft were more reliable and secure graft revascularisation and the ability to visually confirm the complete take and to exclude any graft contraction before considering second-stage tubularisation Major causes of obstructed voiding after hypospadias repair included meatal stenosis, urethral diverticulum and urethral stricture.…”

Section: Section: Paediatricscontrasting

confidence: 99%

See 1 more Smart Citation

Outcome Analysis of Redo Urethroplasty for Large and Multiple Urethrocutaneous Fistula

Shahid¹,

Karim²,

Ali³

et al. 2018

AIMDR

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Background: Urethrocutaneous fistula is the most common complication of hypospadias surgery. Due to the poor surrounding tissue quality, surgical treatment of these patients represents a complex problem. Objectives: Present study aimed to determine a better procedure of salvage urethroplasty for failed hypospadias, caused by persistent large (>4mm) or multiple-small (<4mm) fistulae, by a randomized comparison. Methods: This interventional study was performed in a single institute over a period of five years. Comparisons were made among three procedures of salvage urethroplasty using substitution of dorsal skin flap, Flip flap, or buccal mucosal graft in a controlled situation. Outcomes were assessed by means of objective scoring system. Results: Refistula rate, devascularization of flap and grafts and wound dehiscence rate were significantly less in Buccal mucosal graft than flip flap and dorsal transposition flap. This led to a higher success rate and better patient compliance in buccal mucosal graft. Though mean duration of hospital stay was significantly longer in buccal mucosal graft compared to other methods, it did not negatively affect patient satisfaction due to overall higher success rate. The objective scoring evaluation revealed that score gain of BM group was significantly higher than that of dorsal transposition flap and flip flap. Conclusion: Staged redo urethroplasty for large or multiple-small fistulae using substitution of buccal mucosal graft revealed as an better option for urethral reconstruction than dorsal transposition flap and flip flap procedures (group A˃ group B ˃group C).

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Section: Section: Paediatricscontrasting

confidence: 99%

“…in their study of 100 redo-surgery cases, with 18 % fistula rate. Patel et al [21] used split onlay skin flap salvage with 54.5% postoperative fistulae.…”

Section: Section: Paediatricsmentioning

confidence: 99%

Outcome Analysis of Redo Urethroplasty for Large and Multiple Urethrocutaneous Fistula

Shahid¹,

Karim²,

Ali³

et al. 2018

AIMDR

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“…Fistula occurred in 15% in onlay group; 32% in buccal mucosa group, and 19.2% in Koyanagi cases. Patel et al ( 14 ) introduced a technique called the split onlay skin flap, which had fistula in 6 patients. Subramaniam et al ( 15 ) described several surgical techniques in hypospadiasis and their complications.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Onlay Island Flap Technique in Shallow Urethral Plate Hypospadiasis

et al. 2016

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Background:Hypospadias is one of the most common congenital genital anomalies in males that necessitates to be operated early in infancy (when 6 to 9 months old). On the other hand, hypospadias is a challenging field of pediatric urology with multiple reconstruction techniques. A perfect hypospadias repair is supposed to return urethral continuity with sufficient caliber, eradicate phallus curvature, and supply an acceptable appearance with low complications.Objectives:This study aimed to evaluate the outcomes of using onlay island flap technique in the repair of hypospadias with shallow urethral plate.Patients and Methods:In this prospective study within June 2012 to December 2013, we performed onlay island flap procedure to repair hypospadias with shallow urethral plate measuring less than 6 millimeter. This technique was selected for all types of hypospadiasis except subcoronal type. Nesbit’s dorsal plication procedure was established for chordee. In cases with very small glans, urethroplasty was performed without glansplasty.Results:Twenty three patients with mean age of 30 (range 10 - 60) months underwent onlay island flap repair; all had a shallow urethral plate < 6 mm, 3 had a very small glans, and 18 had chordee. Meatus was located in distal shaft in 5 cases, mid shaft in 8, proximal in 6 and penoscrotal type in 4 patients. Chordee was corrected with Nesbit’s dorsal plication in 16 cases. Complications were: meatal stenosis in 2 cases and urethrocutaneous fistula in 2 patients, all of which were repaired surgically. Mean follow up time was 13 (3 - 20) months. All cases that had glansplasty have excellent esthetic appearance.Conclusions:This technique offers acceptable results regarding meatal stenosis, urethrocutaneous fistula and esthetic outcome.

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“…in their study of 100 redo-surgery cases, with 18 % fistula rate. Patel et al 14 In present study, an outcome without major complications like refistula, flap or graft devascularization and wound dehiscence with disruption of repair was considered as successful outcome. BM graft demonstrated significantly higher success rate in the salvage urethroplasty than the other surgical methods tested.…”

Section: Discussionmentioning

confidence: 89%

Objective Scoring Outcome Analysis of Redo Urethroplasty for Failed Hypospadias

Shahid¹,

Ali²,

Islam³

et al. 2019

TAJ: J of Teachers Assoc

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Background: Failed hypospadias refers to any hypospadias repair that leads to complicationsor causes patient dissatisfaction. One of the commonest major complications of hypospadias surgery is urethrocutaneous fistula. Objectives: Present study aimed to determine a better procedure of salvage urethroplasty for failed hypospadias, caused by persistentlarge (>4mm) or multiple -small (<4mm) fistulae, by a randomized comparison. Patients and Methods. This interventional study was performed in the department of Paediatric Surgery, Rajshahi Medical College Hospital, Rajshahi, Bangladesh, over a period of five years (from July 2011 to June, 2016). A total of 189 patients were included in present study and randomized in the three groups under study. Comparisons were made among three procedures of salvage urethroplasty of failed hypospadias caused by urethrocutaneous fistula using substitution of dorsal skin flap, Flip flap, or buccal mucosal graft in a controlled situation. Outcomes were assessed by means of objective scoring system. Results: Refistula rate, devascularization of flap and grafts and wound dehiscence rate were significantly less in Buccal mucosal graft (group A) than flip flap(group C) and dorsal transposition flap (group B ). This led to a higher success rate and better patient compliance in buccal mucosal graft. The objective scoring evaluation revealed that score gain of BM group (182) was significantly higher than that of dorsal transposition flap (112) and flip flap (89) at P value <0.05 . Conclusion: Staged redo urethroplasty for large or multiple-small fistulae using substitution of buccal mucosal graft revealed as an better option for urethral reconstruction than dorsal transposition flap and flip flap procedures (group A˃ group B ˃group C). TAJ 2018; 31(1): 38-45

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Split Onlay Skin Flap for the Salvage Hypospadias Repair

Cited by 20 publications

References 13 publications

Outcome Analysis of Redo Urethroplasty for Large and Multiple Urethrocutaneous Fistula

Outcome Analysis of Redo Urethroplasty for Large and Multiple Urethrocutaneous Fistula

Evaluation of Onlay Island Flap Technique in Shallow Urethral Plate Hypospadiasis

Objective Scoring Outcome Analysis of Redo Urethroplasty for Failed Hypospadias

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