Original Koyanagi urethroplasty versus modified Hayashi technique: Outcome in 57 patients |
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| Authors: | Massimo Catti Henri Lottmann Sergei Babloyan Stephen Lortat-Jacob Pierre Mouriquand |
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| Affiliation: | 1. Department of Paediatric Urology, Hôpital Mère Enfants – Groupe Hospitalier Est, 59, Boulevard Pinel, 69677 Bron Cedex, France;2. Department of Paediatric Urology, Hôpital Necker – Enfants Malades, Paris, France;1. Department of Pediatric Urology, Children''s Healthcare of Atlanta and Emory University of Medicine, Atlanta, GA, USA;2. Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, GA, USA;1. Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada;2. Department of Surgery, University of Toronto, Toronto, ON, Canada;3. Section of Pediatric Urology, Urology Unit, University Hospital of Padova, Padua, Italy;4. Institute of Urology, St. Luke''s Medical Center, Quezon City, NCR, Philippines;5. Health Sciences Library, McMaster University, Hamilton, ON, Canada;6. Department of Urology, McMaster Children''s Hospital and University, Hamilton, ON, Canada;7. Department of Surgery/Urology, McMaster University, Hamilton, ON, Canada;8. McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, ON, Canada;9. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada;1. Department of Plastic Surgery, University Hospitals of Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK;2. School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;3. Department of Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, UK;4. Wolfson Computer Laboratory, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, UK |
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| Abstract: | ObjectiveTo compare outcomes of the original Koyanagi technique with the Hayashi modification in severe hypospadias, i.e. hypospadias with a division of the corpus spongiosum located behind the penile midshaft associated with marked hypoplasia of the ventral aspect of the penis and a non-preservable urethral plate. Choice of technique for treating severe hypospadias is discussed.Patients and methodsTwenty-six patients (group I) were operated in Lyon using the original Koyanagi procedure and 31 (group II) underwent a modified Hayashi procedure in Paris. Most patients received preoperative androgenic stimulation. Mean follow up was 25 months (group I) and 34 months (group II).ResultsSixteen patients (61.5%) in group I and 19 (61.3%) in group II developed complications leading to 21 additional procedures in each group. Urethral dehiscence was found in 11/26 patients in group I (42.3%), and in 6/31 patients in group II (19.3%); fistulae were respectively found in 5/26 (19.2%) and 12/31 (38.7%), and stenosis in 9/26 (34.6%) and 5/31 (16.1%) patients. Urethrocele was found in 7/26 (26.9%) and 5/31 (16%) patients, respectively. Twelve (group I) and 7 (group II) patients are awaiting re-operation.ConclusionAlthough the complication rate is quite similar between the original and the modified Koyanagi procedure, the Hayashi technique seems to provide a better distal blood supply to the reconstructed urethra. |
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