Time to Complication Detection after Primary Pediatric Hypospadias Repair: A Large, Single Center, Retrospective Cohort Analysis

Lucas, Jacob; Hightower, Tyler; Weiß, Dana; Batavia, Jason P. Van; Coelho, Simmona; Srinivasan, Arun K.; Shukla, Aseem R.; Zderic, Steven A.; Kolon, Thomas F.; Zaontz, Mark R.; Canning, Douglas A.; Long, Christopher J.

doi:10.1097/ju.0000000000000762

Cited by 41 publications

(35 citation statements)

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“…Reporting outcomes in hypospadias surgery remains a challenge, and there are some limitations to the present study. First, reporting outcomes of hypospadias surgery requires a long-term follow-up ( 2 , 9 , 10 , 33 ). Our study consisted only of short- and medium-term observations after hypospadias surgery.…”

Section: Discussionmentioning

confidence: 99%

“…A survey of 27 European countries showed that the prevalence of hypospadias was 20.9 per 10,000 births and that the trend was increasing ( 1 ). Some studies have indicated a complication rate of ~10% for distal and over 50% for proximal hypospadias repairs ( 2 ). Many techniques have been described, and although no single, best method of urethroplasty has been clearly identified ( 3 ), investigators recently reported that beneficial modifications to hypospadias surgery could improve operative results ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

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Using Buck's Fascia as an Integral Covering in Urethroplasty to Restore the Anatomical Structure of the Penis in One-Stage Hypospadias Repair: A Multicenter Chinese Study Comprising 1,386 Surgeries

et al. 2021

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Objectives: The objective of the study is to investigate the feasibility and efficacy of urethroplasty with a Buck's fascia integral-covering technique (BFIC) to wrap and restore the normal anatomical structure of the penis in one-stage hypospadias surgery.Methods: One-stage surgeries for hypospadias management were performed using BFIC from January 2016 to September 2020 at four high-volume medical centers in China. The technique integrates Buck's fascia with glans wings to mobilize and wrap the urethra and restore penile anatomical relationships. The clinical data, postoperative follow-up data, and complications were recorded, and the results were analyzed.Results: A total of 1,386 patients were included in the study: 1,260 cases of primary hypospadias and 126 cases of re-operations; distal in 382 cases (27.6%), mid-shaft in 639 (46.1%), proximal in 365 (26.3%); tubularized incised plate (TIP) in 748 cases, inlay-graft in 124, onlay-graft in 49, Mathieu in 28, free-tube graft urethroplasty in 406, and 31 of hybrid procedures. One thousand one hundred forty-two patients (82.4%) were found to have penile curvature (>10°) after artificial erection and all corrected by dorsal plication/s or transection of the urethra plate (UP) simultaneously. The median followed-up time was 27 months (6–62). A total of 143 (10.3%) complications were recorded: 114 (9.0%) in the primary operations and 29 (23%) in the re-operations, 15 (3.9%) in distal hypospadias, 61 (9.5%) in mid-shaft, and 67 (18.4%) in proximal. The complication rate in UP preservation and transection was 10.1 and 10.8%, respectively. Of all case complications, there were 73 (5.2%) of fistula, 10 (0.6%) of dehiscence, 22 (1.6%) of meatal stenosis, 21 (1.5%) of stricture, 6 (0.7%) of diverticulum, and resident curvature in 11 cases (1.2%). The overall complication rate in TIP and free-tube procedure was 9.8 and 9.9%, respectively, and fistula occurred in primary TIP of 33 cases (4.9%).Conclusions: Buck's fascia with the glans can be used as an integral covering technique in one-stage distal to proximal hypospadias and primary or re-operative hypospadias repair. It is safe, feasible, and effective for the repair of hypospadias.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Using Buck's Fascia as an Integral Covering in Urethroplasty to Restore the Anatomical Structure of the Penis in One-Stage Hypospadias Repair: A Multicenter Chinese Study Comprising 1,386 Surgeries

et al. 2021

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“…Chordee or ventral curvature (VC) was recorded visually with parents' cell camera photos while erection or micturition at the first or second visit and most reliably and quantitively after performing the erection test before making skin incisions. Chordee was defined as a penile shaft curvature and is categorized based on its degree measured by a goniometer: mild (<30), moderate (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45), and severe (>45) curvature. 10 The variables were measured and the operations were performed by a single surgeon to remove potential interobserver variations in the measurements and observations and surgical outcomes.…”

Section: Methodsmentioning

confidence: 99%

Hypospadias in toddlers: a multivariable study of prognostic factors in distal to mid-shaft hypospadias and review of literature

Roshandel

Badr

Rashed

et al. 2022

World Jnl Ped Surgery

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BackgroundTubularized incised plate urethroplasty is the most common hypospadias repair technique. However, there are unanswered questions and debates about the anatomical prognostic factors affecting the repair outcomes. This study tried to address some of the problems in the studies compromising the results of the current body of literature.MethodsA prospective cohort of 101 males aged 1–3 years undergoing primary distal to mid-shaft hypospadias repair were enrolled in the study. Complications including edema, erection, inadvertent removal of the urethral stent, surgical wound infection, bladder spasm, hematoma, and hemorrhage were evaluated. Studies in the current literature were reviewed to achieve a better perspective for future investigations.ResultsPersistent complications were found in 16 cases (15.8%) including fistula formation, the persistence of chordee, meatal stenosis, glans, and urethral dehiscence. The mean follow-up time was 6.6±3.4 months. In the single-variable analysis, the meatal location, the length and width of the urethral plate, and the reversible acute postoperative events were significantly associated with the complications. Furthermore, fistula formation was associated with acute surgical site infection (p<0.001). However, the multivariable regression study revealed the presurgical meatal location to be the only statistically significant factor (p=0.03). Notably, the glans diameter or glanular groove shape, urethral plate dimensions, or presence of mild chordee were not independently associated with the outcomes (p>0.05).ConclusionsOur study on the toddlers with hypospadias surgery revealed that the location of urethral meatal was the main predicting factor in the development of major complications. Furthermore, the fistula formation at the infected surgical site emphasizes the importance of postsurgical care.

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“…The achievement of such remarkable results remains a great challenge. A significant number of post hypospadias repair complications still exist, reaching about 10% for distal and 40% for proximal hypospadias, despite the contemporary procedures providing more favorable results [3,4]. Several anatomical features play a role during the selection process among the different surgical approaches, including glans size, UP width, meatal position, and the degree of penile curvature.…”

Section: Introductionmentioning

confidence: 99%

Urethral plate quality assessment and its impact on hypospadias repair outcomes: A systematic review and quality assessment

Abbas

Braga

Spinoit

et al. 2021

Journal of Pediatric Urology

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Time to Complication Detection after Primary Pediatric Hypospadias Repair: A Large, Single Center, Retrospective Cohort Analysis

Cited by 41 publications

References 0 publications

Using Buck's Fascia as an Integral Covering in Urethroplasty to Restore the Anatomical Structure of the Penis in One-Stage Hypospadias Repair: A Multicenter Chinese Study Comprising 1,386 Surgeries

Using Buck's Fascia as an Integral Covering in Urethroplasty to Restore the Anatomical Structure of the Penis in One-Stage Hypospadias Repair: A Multicenter Chinese Study Comprising 1,386 Surgeries

Hypospadias in toddlers: a multivariable study of prognostic factors in distal to mid-shaft hypospadias and review of literature

Urethral plate quality assessment and its impact on hypospadias repair outcomes: A systematic review and quality assessment

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