Self-perception after hypospadias repair in young mens' perspective

Twenty-one males underwent an interview, clinical investigation, and measurement of urine flow and residual volume 15–25 years after surgery. All had undergone reconstruction due to hypospadias, using a staged procedure, which was essentially that of Byars. In an overall subjective evaluation, 11 men said that their hypospadias had had appreciable consequences, in 3 cases related mainly to urination, and in 8 cases mainly to appearance. Ten men felt their hypospadias was not a significant problem in daily life. Clinical examination revealed that the shape of the penis was acceptable and its length normal, as was the testicular volume. The meatus, however, was on the underside of the glans rather than on its tip in all cases, and it showed narrowing in 6 cases. Two pinhole fistulas were noted. The mean maximum flow rate was 15.9 ml/s (6.1–39.0), and the mean residual volume was 20.6 ml (0–75). Although surgical techniques have been improved during recent decades, the results of hypospadias repair made 20 years ago are nevertheless acceptable and most patients regard the outcome as satisfactory.     

Two-stage urethroplasty is a better choice for proximal hypospadias with severe chordee after urethral plate transection: a single-center experience

It is still debatable whether single- or two-stage urethroplasty is a more suitable technique for treating hypospadias with severe chordee after urethral plate transection. This retrospective study evaluated these two techniques. A total of 66 patients of proximal hypospadias with severe chordee were divided into two groups according to the techniques they underwent: 32 and 34 patients underwent single-stage (Duckett) or two-stage urethroplasty, respectively. Median ages at presentation were 7.5 years and 11.0 years in single-stage and two-stage repair groups, respectively. Median follow-ups were 28.5 months (20−60 months) and 35 months (18−60 months) in the single-stage and two-stage groups, respectively. The meatus of the neourethra was located at the top of the glans in all patients. No recurrence of chordee was found during follow-up, and all patients or parents were satisfied with the penile length and appearance. Complications were encountered in eight patients in both groups, with no statistically significant differences between the two techniques. The late complication rate of stricture was higher after the single-stage procedure (18.75% vs 0%). The complication rate after single-stage repairs was significantly lower in the prepubescent subgroup (10.52%) than in the postpubescent cohort (46.15%). These results indicate that the urethral plate transection effectively corrects severe chordee associated with proximal hypospadias during the intermediate follow-up period. Considering the higher rate of stricture after single-stage urethroplasty, two-stage urethroplasty is recommended for proximal hypospadias with severe chordee after urethral plate transection.     

Modified Koyanagi's procedure for proximal hypospadias: Our experience

Koyanagi described an elegant technique for one‐stage proximal hypospadias repair. It is particularly suited for the most severe forms of hypospadias. A modified Koyanagi technique was used to repair the hypospadias in 14 children, aged 3–9 years. One child developed breakdown of the suture line, three other children developed small urethrocutaneous fistula needing closure and one child had post‐operative meatal stenosis. Despite the high rate of complications, modified Koyanagi's procedure is a good procedure of choice for severe/proximal hypospadias.     

Analysis of factors associated with postoperative complications after primary hypospadias repair: a retrospective study

BackgroundTo determine the risk factors for postoperative complications after primary hypospadias repair. Hypospadias has a high postoperative complication rate, and the risk factors of postoperative complications have attracted extensive attention.MethodsA total of 857 children who received primary surgical repair for hypospadias in our center between 3 January 2017 and 29 January 2021 were retrospectively analyzed. The collected data included age at time of surgery, type of hypospadias, body mass index (BMI), surgeon, operation time, length of reconstructed urethra, method of anesthesia (general anesthesia or general anesthesia combined with caudal anesthesia), and postoperative constipation. The risk factors for postoperative complications were analyzed by multivariate analysis.ResultsThe follow-up time in this study was 6–54 months, with a mean follow-up time of 29 months. A total of 96 (11.2%) of the 857 pediatric patients had postoperative complications, including 44 (45.8%) cases of urethral fistula, 14 (14.6%) cases of urethral stricture, 5 (5.2%) cases of urethral diverticula, 5 (5.2%) cases of distal dehiscence, 3 (3.1%) cases of poor exposure, 2 (2.1%) cases of residual curvature, 1 (1.0%) case of penoscrotal transposition, 6 (6.3%) cases of urethral stricture and diverticulum, 6 (6.3%) cases of urethral fistula and diverticulum, 3 (3.1%) cases of urethral fistula and postoperative residual curvature, 2 (2.1%) cases of urethral fistula and distal dehiscence, and 1 (1.0%) case each of urethral fistula and transposition, urethral diverticulum and poor exposure, urethral stricture and poor exposure, distal dehiscence and transposition, and residual curvature and transposition. After univariate analysis, type of hypospadias (P=0.038), operation time (P<0.001), length of reconstructed urethra (P=0.007), and postoperative constipation (P=0.019) were included in the multivariate logistic regression analysis. The results showed that postoperative constipation was an independent risk factor for complications [P=0.027, odds ratio (OR) =1.793, confidence interval (CI): 1.067 to 3.012].ConclusionsPostoperative constipation is an important influencing factor for postoperative complications following primary hypospadias repair. Therefore, defecation management should be strengthened for hypospadias patients during the perioperative period.     

尿道下裂术后尿道裂开的处理

目的　探讨尿道下裂术后尿道裂开的原因和处理方法。　方法　根据尿道外口位置和局部皮肤发育情况分别采用包皮岛状皮瓣、阴囊中隔皮瓣及膀胱粘膜行尿道重建术处理尿道下裂术后尿道裂开患儿 2 3例。　结果　 2 3例随访 1～ 9年 ,15例手术一次成功。 3例出现尿瘘经修补后愈合 ;4例出现吻合口或尿道外口狭窄 ,留置支架管 (45d～ 5个月 )后治愈 ;1例阴茎轻度下弯 ,但不影响勃起。　结论　尿道下裂术后尿道裂开尿道重建术应首选包皮或阴囊中隔皮瓣 ,膀胱粘膜仅适用于局部取材困难的病例 ;手术应由有经验的小儿泌尿外科医师操作 ,以减少术后并发症     

尿道下裂术后尿道狭窄的处理

目的 提高尿道下裂术后尿道狭窄的手术治疗水平.方法 尿道下裂术后尿道狭窄患者37例,年龄2～36岁,中位年龄5岁.其中尿道末段狭窄6例、吻合口狭窄30例,尿道末段及吻合口同时狭窄1例.单纯狭窄13例中行尿道末段切开4例、行加盖术6例、行经尿道钬激光狭窄切开术3例.复杂尿道狭窄24例,狭窄长度>0.5 cm,其中伴复杂尿道瘘8例、尿道憩室6例、阴茎弯曲4例、多次手术后尿道狭窄6例,行狭窄段切开加盖术或狭窄段切除、带蒂皮瓣尿道成形术,同时矫正阴茎弯曲、憩室切除、瘘口修补.结果 单纯狭窄组一次手术治愈12例,1例狭窄内切开术后尿道狭窄者二次手术治愈.复杂狭窄组中8例伴复杂尿道瘘一次矫治术治愈7例,二次手术治愈1例;6例伴尿道憩室者均一次手术治愈;4例伴阴茎弯曲者一次手术成功3例;二次手术治愈1例;6例多次矫治术后尿道狭窄者均一次手术治愈.37例随访12～24个月,立位排尿通畅.结论 尿道下裂术后单纯尿道末段狭窄采用狭窄切开术或加盖术,单纯吻合口狭窄采用加盖术或经尿道钬激光狭窄切开术,复杂性尿道狭窄采用狭窄切开加盖术或狭窄段切除阴茎或阴囊中隔皮管尿道成形肉膜蒂加盖术,效果良好.     

尿道下裂尿道成形术后尿瘘的治疗

目的　总结尿道下裂尿道成形术后并发尿瘘的治疗经验。方法　尿道下裂尿道成形术后尿瘘 48例 ,其中大瘘 13例 (瘘口直径 >0 .3cm) ,小瘘 3 5例 (瘘口直径 <0 .3cm ) ,小瘘采用荷包缝合修补 ,大瘘采用在Thiersch法的基础上 ,加以缝合技巧的改进 ,皮瓣整形覆盖 ,并用 6 0可吸收线缝合等。结果　手术一次成功率为 92 %。结论　手术方案的正确选择、缝合技巧的提高及缝线的选用等可提高修补成功率。     

尿道下裂术后尿道狭窄的治疗

目的 :探讨尿道下裂尿道成形术后尿道狭窄的治疗。方法 :对尿道下裂尿道成形术后发生尿道狭窄 2 9例患者临床资料进行分析。结果 :尿道外口狭窄 2 1例 ,其中 11例经扩张治愈 ,另 10例分别行狭窄的外口切开及狭窄段切除阴茎包皮转移皮瓣尿道外口整形术。吻合口狭窄 8例 ,对其中 2例行吻合口狭窄直接扩张 ,另 6例行狭窄部切除端端吻合术 ,均获成功。结论 :尿道下裂尿道成形术后尿道狭窄发生的主要原因是成形尿道皮瓣的设计不合理、血供差、感染、原尿道外口狭窄或发育不良处未切除以及缝合材料选用不当。对尿道外口狭窄主要行扩张治疗 ,对吻合口狭窄应以手术治疗为主。     

Hallucinations after hypospadias repair

The authors report a case of a 4-year-old child who developed hallucinations after hypospadias repair. He was brought to the emergency department the morning after outpatient surgery where the diagnosis of central anticholinergic syndrome was made. We review oxybutynin overdose and the importance of providing clear instruction to parents and caregivers about the administration of medications.     

尿道下裂修复术后尿道皮肤瘘的治疗

目的:探讨尿道下裂修复术后尿道皮肤瘘尿瘘的治疗方法.方法:收集1995～2004年间42例尿瘘的临床资料.根据瘘口的大小和位置分别采用简单缝合术,Y-V皮瓣成形术、皮瓣推进术进行修补.结果:42例尿瘘修补后39例成功,3例失败,一次修补成功率93%(39/42).结论:遵循尿瘘的修复原则,采用皮瓣技术和多层缝合技术,可提高尿瘘修补的成功率.     

A modified tubularised incised plate urethroplasty technique and a revised hypospadias algorithm

To simplify and standardize surgical management of hypospadias, a modified tubularised incised plate (TIP) urethroplasty (Snodgrass) technique has been described and a revised hypospadias management algorithm has been formulated. The study aims to evaluate the viability of the described procedure in different types of hypospadias and tests the validity of the algorithm. The modification described is recruitment of penile and glandular skin lateral to the urethral plate to facilitate tubularisation. The algorithm starts with penile degloving with preservation of urethral plate. Snodgrass repair was done in cases with no chordee and where skin chordee resolved by skin take down. Modified Snodgrass repair was done in cases where urethral plate was narrow. Another modification proposed by us is single layer penile skin closure instead of an added dartos flap, which was done in both classical and modified Snodgrass repair. Cases of severe chordee not resolved by skin take down were repaired by transverse preputial island flap (TPIF) and Bracka''s technique. Dorsal plication was not used as an orthoplasty modality. It was possible to repair 68.89% of the cases by Snodgrass repair. These patients either had no chordee or had superficial skin tethering (skin chordee) which resolved on degolving. All these cases were coronal, distal and mid penile hypospadias. Remaining cases were mid, proximal and penoscrotal with true fibrous chordee and were repaired by TPIF or Bracka''s technique. The Snodgrass technique had a fistula rate of 9.67%. Acceptably, low fistula rate and simple execution make the proposed modification of classical Snodgrass repair a viable option. The proposed algorithm proves to be a useful tool for standardised and logical preoperative decision making. It also defines indications of the three techniques vis-à-vis the type of hypospadias.     

尿道下裂术后尿道憩室的处理与预防

目的 总结尿道下裂术后尿道憩室发生的原因,提出合理的治疗与预防措施.方法 回顾分析2000年1月至2007年6月首诊治疗尿道下裂术后发生尿道憩室患儿的临床资料,包括Ⅰ期尿道成形术的方法 、憩室发生的时间、临床表现、部位、憩室裁剪术中所见等.结果 首诊治疗尿道下裂266例,Duckett术式187例(含Duckett + Duplay术式32例),Onlay术式48例,Snodgrass术式22例.尿道口前移、阴茎头成形术式9例.术后并发尿道憩室20例,均发生于Duckett术式(含Duckett + Duplay术式)术后.憩室裁剪尿道修复术后随诊6个月以上,2例术后发生尿道瘘,2例术后再次发生憩室样扩张,1例术后尿道狭窄,余一次治愈.结论 憩室裁剪尿道修复术是治疗尿道憩室样扩张的手术方法 .Ⅰ期尿道成形术时避免尿道狭窄和裁剪新尿道宽度适中可防止尿道下裂术后尿道憩室的发生.     

The contemporary role of 1 vs. 2-stage repair for proximal hypospadias

This review discusses the most commonly employed techniques in the repair of proximal hypospadias, highlighting the advantages and disadvantages of single versus staged surgical techniques. Hypospadias can have a spectrum of severity with a urethral meatus ranging from the perineum to the glans. Associated abnormalities are commonly found with proximal hypospadias and encompass a large spectrum, including ventral curvature (VC) up to 50 degrees or more, ventral skin deficiency, a flattened glans, penile torsion and penoscrotal transposition. Our contemporary understanding of hypospadiology is comprised of a foundation built by experts who have described a number of techniques and their outcomes, combined with survey data detailing practice patterns. The two largest components of hypospadias repair include repair of VC and urethroplasty. VC greater than 20 degrees is considered clinically relevant to warrant surgical correction. To repair VC, the penis is first degloved—a procedure that may reduce or remove curvature by itself in some cases. Residual curvature is then repaired with dorsal plication techniques, transection of the urethral plate, and/or ventral lengthening techniques. Urethroplasty takes the form of 1- or 2-stage repairs. One-stage options include the tubularized incised urethroplasty (TIP) or various graft or flap-based techniques. Two-stage options also include grafts or flaps, including oral mucosal and preputial skin grafting. One stage repairs are an attractive option in that they may reduce cost, hospital stay, anesthetic risks, and time to the final result. The downside is that these repairs require mastery of multiple techniques may be more complex, and—depending on technique—have higher complication rates. Two-stage repairs are preferred by the majority of surveyed hypospadiologists. The 2-stage repair is versatile and has satisfactory outcomes, but necessitates a second procedure. Given the lack of clear high-quality evidence supporting the superiority of one approach over the others, hypospadiologists should develop their own algorithm, which gives them the best outcomes.     

尿道下裂术后尿道瘘的处理

为了探讨尿道下裂成形术后尿道瘘的处理，对我院1975～1995年收治的251例尿道下裂患者术后发生尿道瘘的情况进行分析，结果术后发生尿道瘘60例，发生率为23．9％，其中28例行尿道瘘修补术，直接修补术15例，成功6例，带蒂皮瓣转移术4例，成功2例，瘘孔周围皮瓣横形Y－V成形术7例，均获成功，另2例重新施行尿道成形术亦获成功。认为只有提高尿道成形术的成功率，才能从根本上减少尿道瘘的发生；如发生尿道瘘，则应以瘘孔周围皮瓣横形Y－V成形术为主。     

Impact of caudal block on postoperative complications in children undergoing tubularised incised plate urethroplasty for hypospadias repair: a retrospective cohort study

This study aimed to assess the association between caudal block and postoperative complications after tubularised incised plate urethroplasty. The medical records of 388 paediatric patients who underwent urethroplasty at a tertiary medical centre were analysed retrospectively. Among the 342 patients included, 216 patients received a caudal block and 72 (21.1%) patients suffered surgical complications. The number of patients having surgical complications was significantly greater among patients who received a caudal block than among patients who did not receive a caudal block (53 (24.5%) versus 19 (15.1%), respectively, p = 0.04). Based on multivariate logistic regression analysis, duration of surgery, caudal block and hypospadias types were independent risk factors for the surgical complications. Patients with caudal block had an odds ratio of 2.1 (95% CI, 1.14‐3.81, p = 0.018) for the development of postoperative complications compared with patients without caudal block. This analysis demonstrates that caudal block is associated with surgical complications after tubularised incised plate urethroplasty.     

尿道下裂手术后并发症(附110例报告)

目的 探讨尿道下裂手术后并发症发生因素和预防处理的办法。方法 对７年１１０例尿道下裂不同手术方法（Ｄｕｐｌａｙ法４０例，随囊纵隔瓣法３０例，Ｄｕｃｋｅｔｔ包皮瓣法４０例）的并发症进行分析。结果 并发症包括尿瘘３１例（２８．２％），尿道憩室或狭窄６例，尿道僵直４例，非正常尿道开口２８例（２５．６％），阴茎扭转９例。结论 降低尿瘘的发生率是尿道下裂手术成功的关键，Ｄｕｃｋ－ｅｔｔ包皮瓣法可作为尿道下裂     

Longitudinal dorsal dartos flap for prevention of fistula after a Snodgrass hypospadias procedure

OBJECTIVES: The Snodgrass technique presents the procedure of choice for distal hypospadias. Fistula formation is the most common complication with various rates. We evaluated the importance of a urethral covering using vascularized dorsal subcutaneous tissue for fistula prevention. METHODS: Our study included 126 patients, aged 10 months to 16 years, who underwent hypospadias repair from April 1998 through June 2005. Of the patients, 89 had distal, 30 had midshaft and 7 had penoscrotal hypospadias. All patients underwent standard tubularized incised plate urethroplasty, which was followed by reconstruction of new surrounding urethral tissue. A longitudinal dorsal dartos flap was harvested and transposed to the ventral side by the buttonhole manoeuvre. The flap was sutured to the glans and the corpora cavernosa to completely cover the neourethra with well-vascularized subcutaneous tissue. RESULTS: Mean follow-up was 32 (6-87) months. A successful result without fistula was achieved in all 126 patients. In six patients, temporary stenosis of the glandular urethra occurred and was solved by dilation. CONCLUSIONS: A urethral covering should be performed as part of the Snodgrass procedure. A dorsal well-vascularized dartos flap that is buttonholed ventrally represents a good choice for fistula prevention. Redundancy of the flap and its excellent vascularization depend on the harvesting technique.     

尿道下裂术后尿道狭窄的预防及再手术术式选择

目的：探讨尿道下裂术后尿道狭窄的预防及再手术术式选择。方法：对53例尿道下裂术后尿道狭窄病例的临床资料进行回顾性分析。结果：53例中获访45例，其中尿道外口狭窄或闭锁行尿道外口成形12例，8例治愈；26例单纯吻合口狭窄行狭窄段剖开、切除吻合或一期尿道重建，17例治愈；新尿道全部瘢痕狭窄行广泛切除一期尿道重建4例，2例治愈；尿道造瘘二期尿道重建3例，2例治愈。结论：尿道狭窄是尿道下裂术后严重的并发症，关键在于预防，应根据不同的情况选择合理的治疗方法。     

A method of hypospadias repair

Summary The treatment of hypospadias requires the release of chordee and the reconstruction of a new urethra to provide for a satisfactory sexual function and normal micturition. A technique is described in two stages. In the first stage a large dorsal apron flap of prepuce skin is developed by a pericoronal incision. The chordee is released well beyond the urethral opening. A button-hole incision allows the prepuce flap to be reflected to the ventral surface. The distal part of this flap is formed into a skinlined tube with raw surface outward and pulled through a transglandular tunnel incision to the tip of the glans while rotating it 180 degrees. The ventral surface is closed. After three to six months, the penis presenting with a subglandular opening of the tube and the proximal hypospadiac urethra, the final reconstruction is undertaken. The excess ventrally shifted skin from the first stage between both orifices is incised by means of two parallel incisions and tubed to form one continuous urethral skin tube. A multi-layer closure burying the tube completes the procedure. The technique has given very encouraging results.     

Analysis of complications after repair of hypospadias.

We have reviewed 184 patients after repair of primary hypospadias. They were operated on and followed-up according to a standard protocol, and the senior author (HS) participated in all operations. The patients were reconstructed using a Byars two-stage procedure (n=102) or a Scuderi (n=29) or Mathieu (n=41) single-stage procedure. The rest (n=12) just had a removal of the chordee with realignment of the skin. Complications recorded were haematomas, postoperative infections, malfunction of catheter, urinary retention, fistulas, and strictures. Thirty-eight complications developed in 26 patients and the overall incidence of fistula was 22 in 18 patients (10%). Our findings suggest that the most decisive risk factor for complications is the severity of the primary malformation, because a severe malformation per se is difficult to treat as it requires a long reconstruction; in addition the curvature, shortage of tissue, and extensive surgery generally require a staged reconstruction in these cases. Other factors seem to be of much lesser importance.