Tissue interposition in hypospadias repair: A mechanical barrier or healing promoter?

Elbakry, Adel

doi:10.1016/j.aju.2011.06.002

Cited by 11 publications

(15 citation statements)

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“…However, there are some complications for primary hypospadias repair. Urethrocutaneous fistula is the most common complication of hypospadias repair and occurs at various rates [9, 16–19]. Appignani et al [20] reported that the double-dartos flaps had significantly lower rates of fistula formation.…”

Section: Discussionmentioning

confidence: 99%

Single vs. double layer suturing method repair of the urethral plate in the rabbit model of hypospadias

Shirazi

Rahimi

Noorafshan

2016

CEJU

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IntroductionThere are different methods of urethroplasty in hypospadias. The present study aimed to compare the repair of the urethral plate by single vs. double layer suturing.Material and methodsFifteen male rabbits were assigned to the control, single layer, and double layer urethral plate suturing groups (n = 5). Experimental hypospadias was induced in the second and third groups and the urethral plates were sutured. After two weeks, the penis was dissected out and underwent histopathological processing. Stereological studies were applied to obtain quantitative histological data regarding the structure of the urethra and the related part of the corpus spongiosum.ResultsVolume density of the urethral epithelium (the fraction of unit volume of the urethra occupied by its epithelium) was higher in the single layer suturing group when compared to the double layer or control groups (p <0.01). Additionally, the volume density of the urethral lumen (the fraction of the corpus spongiosum that is occupied by the urethral lumen) in the single versus the double layer suturing groups was respectively 2.4 and 2 folds higher than that in the control group (p <0.01). Besides, the volume density of the lumen was significantly higher in the single layer suturing when compared to the double layer suturing group (p <0.01). However, no significant difference was observed among the study groups regarding the volume density of the collagen and vessels in the incised site of the penis which implied that the fraction of the urethra and surrounding corpus spongiosum was occupied by collagen and vessels.ConclusionsUrethral plate repair by the single layer suturing method could be accompanied by higher epithelialization and wider lumen in the rabbit model of hypospadias.

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Section: Discussionmentioning

confidence: 99%

Single vs. double layer suturing method repair of the urethral plate in the rabbit model of hypospadias

Shirazi

Rahimi

Noorafshan

2016

CEJU

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“…The present study indicates that covering the neourethra in a TIP hypospadias repair with a vascularised fascial flap decreases the possibility of fistula development and other healing problems. A urethrocutaneous fistula is an inherent complication of hypospadias repair, and represents the most common problem after such surgery, occurring at various rates [6,8–11] . Well-vascularised interposition tissue between the penile skin and the neourethra is essential for preventing a urethrocutaneous fistula [6,12–14] .…”

Section: Discussionmentioning

confidence: 99%

“…Also, local ischaemia was reported by Elbakry [6] as a humoral factor impairing or even suppressing the healing process of the neourethra in hypospadias surgery. Ischaemic changes can be attributed to an inadequate blood supply to hypospadiac penile skin, extensive dissection, hostile tissue manipulation, prolonged use of a tourniquet, massive postoperative oedema, haematoma with a pressure effect and finally, a tight dressing [6,7] . In an effort to reduce fistula formation and the need for repeat surgery, many strategies have been proposed, and these include the use of optical magnification, fine suture material, soft-tissue interposition, small-calibre stents, antibiotics, and new surgical approaches [3] .…”

Section: Introductionmentioning

confidence: 95%

“…Deficiencies in local growth factors in hypospadiac skin might contribute to the high rate of healing complications after hypospadias surgery [5] . Mechanical factors could be responsible for poor healing after hypospadias repair, such as epithelial interposition between the edges of the neourethra, a high intraurethral pressure secondary to meatal stenosis, or an obstructed catheter, resulting in the disruption of the suture line, urinary leakage and fistula [6] . Also, local ischaemia was reported by Elbakry [6] as a humoral factor impairing or even suppressing the healing process of the neourethra in hypospadias surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Mechanical factors could be responsible for poor healing after hypospadias repair, such as epithelial interposition between the edges of the neourethra, a high intraurethral pressure secondary to meatal stenosis, or an obstructed catheter, resulting in the disruption of the suture line, urinary leakage and fistula [6] . Also, local ischaemia was reported by Elbakry [6] as a humoral factor impairing or even suppressing the healing process of the neourethra in hypospadias surgery. Ischaemic changes can be attributed to an inadequate blood supply to hypospadiac penile skin, extensive dissection, hostile tissue manipulation, prolonged use of a tourniquet, massive postoperative oedema, haematoma with a pressure effect and finally, a tight dressing [6,7] .…”

Section: Introductionmentioning

confidence: 99%

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Single vs. double dartos layers for preventing fistula in a tubularised incised-plate repair of distal hypospadias

Maarouf

Shalaby

Khalil

et al. 2012

Arab Journal of Urology

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ObjectiveTo compare the outcome of a single vs. a double-layer dartos interposition for preventing a fistula after tubularised incised-plate (TIP) distal hypospadias repair.Patients and methodsWe retrospectively reviewed the records of patients with primary distal hypospadias who had the hypospadias repaired between February 2009 and June 2011, operated by one surgeon (S.A.K.). In all of the children a standard TIP urethroplasty was performed, which was covered by a dartos fascial flap fashioned using one of two techniques, i.e. in Group I (48 patients) double dartos preputial flaps were used, and in Group II (52 patients) a single dorsal dartos flap was used and transposed ventrally via a ‘buttonhole’. The fistula rate and other complications related to each group were recorded.ResultsThe mean (range) follow-up was 12 (6–22) months for Group I and 14 (6–24) months for Group II. The result was considered a success in 96% of Group I and 92% of Group II. In Group I there were no fistulae, while in Group II there were four fistulae (8%) detected; this difference was statistically insignificant (P = 0.1). Meatal stenosis was associated with a fistula in one patient in Group II but not in the other three. In Group I a meatal stenosis developed late after complete healing of the urethroplasty, with no associated fistula. The repair broke down in one patient in Group I (2%).ConclusionA double-dartos neourethral cover in TIP hypospadias repair seems to be more effective than a single layer for preventing a fistula, despite there being no statistically significant difference between the groups. However, the protective effect of double-dartos flaps must be appropriately evaluated in a prospective, randomised and controlled study in more patients.

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Modified Tubularized Incised Urethral Plate Urethroplasty

Bhat

2022

Hypospadiology

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Tissue interposition in hypospadias repair: A mechanical barrier or healing promoter?

Cited by 11 publications

References 11 publications

Single vs. double layer suturing method repair of the urethral plate in the rabbit model of hypospadias

Single vs. double layer suturing method repair of the urethral plate in the rabbit model of hypospadias

Single vs. double dartos layers for preventing fistula in a tubularised incised-plate repair of distal hypospadias

Modified Tubularized Incised Urethral Plate Urethroplasty

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