Experience with single stage hypospadias reconstruction

Our experience with single stage primary hypospadias repair in 96 patients over a 12-month period is reviewed. The ages ranged from 7 months to 14 years with an average of 3.5 years. Seventeen patients were 18 months or younger at the time of operation. Meatal advancement and glanuloplasty (MAGPI) was performed in 46 patients mainly with coronal and glanular hypospadias. There was a fistula rate of 4%. The modified Mathieu and Mustarde operations were used for subcoronal and distal hypospadias. The transverse preputial island flap technique was found to be very versatile and was employed in 33 patients. The fistula rate was 18% and proximal urethral stricture rate 9%. These complication rates are considered quite acceptable in busy centers where surgeons in training are involved in these operations. It is concluded that by mastering a relatively limited number of techniques, single stage hypospadias reconstruction can be undertaken in almost all cases at the optimal time.     

带蒂皮管正位尿道口一期尿道下裂修复术

自１９８４年４月利用包皮或阴囊正中带蒂皮管一期修复尿道下裂２９例，采用梭形切除阴茎腹侧增厚的白膜外层３～５处的方法纠正切除纤维索条后仍存在的阴茎下弯。用隧道法或阴茎头成形术使尿道口达正常位并纠正阴茎头下垂等畸形。阴茎下弯和阴茎头下垂矫正满意。仅４例合并小尿瘘，经修补治愈。随访２～５年，阴茎直立，排尿通畅，无尿道回缩。     

膀胱粘膜一期尿道成形术的改进

应用膀胱粘膜一期尿道成形术治疗尿道下裂９１例，其中阴茎型１８例，阴茎阴囊型３９例，阴囊型２１例，会阴型１３例，成功率９６．７％。介绍了对解剖畸形的认识，手术中各步骤操作方法的要点和术后处理的每个环节。     

Distal hypospadias repair: Comparison of two different techniques

The cosmetic results and the morbidity of Mathieu and Barcat techniques are presented and compared in a series of 52 children aged between five months to 19 years during January 1991 to May 2001. All patients treated with the Mathieu procedure had negligible glandular hypospadias at some level. The neomeatus was slit-like or elliptic in majority of the cases. The horizontal bucket handle deformity was eliminated which remains as a meatal problem of the original Mathieu procedure. Four patients had fistula, which was closed by surgery whereas another three had mild stricture formation. Cosmetic and functional results were excellent with the Barcat balanic groove technique. There was no fistula formation, only two had meatal stricture which responded to dilatations.The Barcat technique allows anatomically superior glans reconstruction resulting in a vertical and slit like neomeatus in distal hypospadias repair with a low complication rate.     

不同术式一期正位开口修复先天性尿道下裂：附114例报告

总结１１４例不同手术方式一期修复各种类型尿道下裂的经验。本组中阴茎型３０例，阴茎阴囊型６３例，会阴型２１例。阴茎型尿道下裂宜采用包皮内板转移皮瓣尿道成形术。阴囊型根据缺损尿道长短采用阴囊纵带蒂皮瓣术或包皮内板阴囊纵隔联合皮瓣尿道成形术。会阴型采用包皮内板阴囊纵隔联合皮瓣术或膀胱粘膜尿道造成形术本组一期手术的成功率为８４．８％。     

Experience with modified two stage inner preputial flap for repair of proximal hypospadias with chordee: A single institution study with intermediate follow up

Purpose:We present our modified technique of using the inner preputial flap to cover the penile shaft, while removing the subcutaneous tissue of the distal part of the flap to act similar to graft. Herein, we present our experience with modified two stage inner preputial flap for repair of proximal hypospadias with chordee.Patients and MethodsThe current study was a single-institution retrospective study between January 2016 and December 2020. Thirty-one patients with proximal hypospadias with chordee were included and underwent our modified technique. We excluded re-operative hypospadias and incomplete follow-up cases (<6 month of follow up). Patient demographics, outcomes and complications in the form of fistula formation, diverticulum, metal stenosis, stricture formation and glans dehiscence were reviewed.ResultsA total of 31 patients were included in the study and underwent our modified technique. The median age was 18 months (9–60) & IQR 15–25). The median follow up was 40 months. Overall, success was achieved in 24 cases (77.4%). Complications occurred in seven cases (22.6%) and included urethrocutanous fistula in three patients (9.7%), diverticulum in two patients (6.5.%), metal stenosis in one patient (3.2%) and glans dehiscence in one patient (3.2%).ConclusionOur technique provides a favourable outcome with a low complication rate for repair of proximal severe hypospadias.Level of EvidenceCase Series Study (Level IV).     

One-stage hypospadias repair

A surgical technique for correction of hypospadias with chordee in one stage is described. This technique which brings the ectopic meatus up to the tip of the glans was successfully applied in 3 cases of penoscrotal and in 8 cases of penile hypospadias.     

Glandular hypospadias repair

Glandular hypospadias represents approximately 15% of the hypospadias variants seen. This article will examine common surgical approaches applicable to the child with glandular hypospadias. Hypospadias repairs discussed in this article will include urethromeatoplasty, MAGPI, the GAP procedure, MIV glans plasty, urethral advancement procedure, and parameatal based flap variants, including the Mathieu and Barcat procedures. Because these anomalies are cosmetically less aberrant than more proximal variants, only those surgical techniques which assure a normal-appearing penis should be undertaken.     

Experience with the MAGPI hypospadias repair

Over a 9-month period, 25 consecutive patients with subcoronal hypospadias underwent hypospadias repair using the MAGPI technique. Only those patients with subcoronal lesions, and without chordee were included in this series. The mean age at the time of repair was 3 years with a range of 1.2 to 9 years. The average length of hospitalization was eight hours and the overall complication rate was 4%. The technical simplicity and reliability of this procedure as well as the excellent cosmetic and functional results which can be obtained make it an essential adjunct to our surgical armamentarium.     

Lateral-based flap: a single stage urethral reconstruction for proximal hypospadias

Purpose

The aim of this study is to describe and report the outcome of a single stage repair—the lateral-based (LB) flap—for proximal hypospadias with chordee.

Materials and Methods

Between January 1995 and January 2007, 107 boys with proximal hypospadias underwent repair using the LB flap technique. The boys' age ranged from 1 to 5 years. The technique employs the use of lateral penile skin and extends into the outer preputial skin. The LB flap enjoys double blood supply from the base of the meatus as well as the preputial vessels. The Y-shaped incision in the glans gives a terminal slit-like meatus, and the technique allows for correction of the chordee. Follow-up period ranged from 1 year to 13 years (mean, 72 months).

Results and Complications

Satisfactory results were obtained in 98 (91%) patients. Three patients developed fistulae. Two patients had proximal stenosis that required temporary urethrotomy for 3 months. Four patients developed urethral diverticulum.

Conclusions

The LB flap is a robust flap with a reliable dual blood supply, which produces good results (91%) and is suitable for proximal forms of hypospadias with chordee.     

Current hypospadias techniques

Hypospadias repairs must encompass straightening of the penis and construction of the neourethra at the tip of the penis. In addition to an outline of preoperative and postoperative management, five techniques of single-stage surgical repair are discussed. All hypospadias defects can be repaired using one of these five basic procedures.