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At least 19 recordsLinked to original sources
PubMed2003

Two-stage hypospadias repair: a method applicable to all types of hypospadias.

OBJECTIVE: To assess the results of two-stage repair in proximal hypospadias and cases of distal hypospadias with chordee, revision surgery and in circumcised cases. DESIGN: Prospective study. PLACE AND DURATION OF STUDY: Combined Military Hospital, Kharian and Pano Aqil, from July 1998 to June 2002. PATIENTS AND METHODS: Nineteen patients, with distal as well as proximal hypospadias, underwent two-stage hypospadias repair during the last 04 years. Splitting of glans and full thickness grafting was carried out in the first stage. Tubularization was carried out 3-6 months later and the repair was covered with waterproofing layer. The results were evaluated. RESULTS: Distal hypospadias was seen in 13 patients, 06 cases had proximal hypospadias, 08 patients had undergone repair previously by different techniques and 05 cases were circumcised. Chordee was seen in 12 cases. Common age of presentation was below 5 years. Adequate cosmetic and functional results were achieved in all these cases. Fistula occurred in 02 cases and meatal stenosis was seen in 01 case, which responded to regular dilatation. CONCLUSION: Two-stage hypospadias repair gives excellent cosmetic and functional results in all cases of proximal hypospadias and cases of distal hypospadias with chordee, revision surgery and circumcised cases.

Adolescent↗
PubMed2003

Results of single staged hypospadias surgery to repair penoscrotal hypospadias with bifid scrotum or penoscrotal transposition.

PURPOSE: During the last 10 years there has been controversy in the approach to severe hypospadias. Many pediatric urologists have elected to perform a 2-staged procedure to minimize complication rates and improve cosmesis. We continued to perform a single staged repair using the Hodgson XX or Koyanagi technique for even the most severe hypospadias. We review our results during the last 5 years in severe cases of penoscrotal hypospadias with bifid scrotum or penoscrotal transposition. MATERIALS AND METHODS: The medical records of 20 consecutive children presenting to a single surgeon from 1996 to 2000 with severe penoscrotal hypospadias were reviewed. Patients underwent a 1-stage repair using an operative microscope. Cases not requiring further surgery were grouped as successful while cases requiring subsequent procedures were considered as complications. RESULTS: After an average followup of 23 months 16 patients have not required subsequent procedures. Two patients had urethrocutaneous fistulas and 2 had a urethral diverticulum for an overall complication rate of 20%. All 4 patients were successfully treated with 1 additional procedure and have not required further intervention. Another patient with a small urethral diverticulum is being treated conservatively. All patients had satisfactory cosmetic results. CONCLUSIONS: We believe that a single staged repair can be safely and effectively performed even in patients with the most severe penoscrotal hypospadias. The Hodgson XX and Koyanagi repairs are excellent techniques with relatively low complication rates. Pediatric urologists should continue to use these techniques in their armamentarium and strive to perfect a 1-stage approach to severe hypospadias.

Follow-Up Studies↗
PubMed2004

Valproic acid is known to cause hypospadias in man but does not reduce anogenital distance or causes hypospadias in rats.

The use of valproic acid during human pregnancy increases the risk of hypospadias in the offspring. Rats exposed in utero to valproic acid did not develop hypospadias and even had a slightly increased anogenital distance in males 3-4 days after birth. A classical antiandrogenic drug, flutamide, caused hypospadias as well as a reduction of the anogenital distance in males. At the age of 3 months, rats exposed in utero with either valproic acid or flutamide showed a reduced testicular weight and hypoplasia of tubules, which seemed not to be related to the antiandrogenic activity of flutamide as it did not correlate with the presence of hypospadias. The mechanism through which valproic acid causes hypospadias in man and affects testicular development in rat is unknown. Hypospadias caused by valproic acid in man is apparently not due to anti-androgenic properties of the drug.

Androgen Antagonists↗
PubMed2005

The concept of tubularized incised plate hypospadias repair for different types of hypospadias.

PURPOSE: Using the concept of tubularized incised plate (TIP) urethroplasty technique for proximal, distal, primary, secondary and complicated cases of hypospadias. MATERIAL AND METHODS: From June 2002 to December 2003 TIP urethroplasty was performed in 15 patients between the age of 1-18-year-old with penosecrotal, mid shaft and subcoronal hypospadias. In 13 of them TIP urethroplasty used as the primary repair while in two of them as secondary repair. RESULTS: No clinically important complications were observed in those boys who underwent primary reconstruction. One of them had meatal stenosis at the early postoperative period which was corrected by dilatation of the external meatus by feeding catheter at intervals up to 2 months postoperatively. Three boys had very narrow fistula which just allow leak of few drops of urine through urination. One boy with penoscrotal hypospadias who underwent two-stage repair had fistula. CONCLUSION: The concept of TIP urethroplasty is the procedure of choice for the treatment of proximal hypospadias and, it seems to be suitable for distal, secondary and even complicated hypospadias reconstruction. The advantages of this procedure include its simplicity, low complication rates and very good appearance of the glance with normal meatus.

Adolescent↗
PubMed1997

Severe hypospadias with genital ambiguity: adult outcome after staged hypospadias repair.

OBJECTIVE: To obtain the long-term follow-up information on children born with severe perineoscrotal hypospadias associated with genital ambiguity who underwent a staged surgical correction of their hypospadias and were raised as males. PATIENTS AND METHODS: The study comprised patients who had undergone a surgical correction of hypospadias before 1978 and were traced successfully. Postal questionnaires which were completed and returned by 19 patients and 28 general practitioners (GPs) were evaluated; in addition, nine cases were clinically reviewed. RESULTS: Of the 19 patients who completed and returned the questionnaire, four were married or living with a partner and 12 had had intercourse, with debut at a median age of 17 years. Satisfactory erection and orgasm were reported by 15 men but only seven had satisfactory ejaculation. Nine men had continued difficulties with micturition and urological function. Four men considered that their psychological well-being and quality of life had been markedly impaired by their condition and two other men had evidence of mild depression. Nine patients did not complete the questionnaires but allowed their GPs to provide information about them; only one was reported to have marked psychological impairment and impaired general health. Two of the patients who did not participate in the study are known to have significant psychiatric problems. CONCLUSIONS: Staged hypospadias repair in men with severe perineoscrotal hypospadias is associated with continued difficulty with both ejaculation and micturition, but is not usually associated with major psychiatric or psychological disturbance. The findings indicate the importance of follow-up in adolescence and adult life with adequate counselling when necessary.

Adolescent↗
PubMed2002

Snodgrass hypospadias repair with vascularized dartos flap: the perfect repair for virgin cases of hypospadias?

PURPOSE: Since its introduction, the Snodgrass hypospadias repair has been applied to virtually all forms of hypospadias repair. However, fistula rates have still been reported to be as high as 5% from large center, multiple surgeon studies and 16% from smaller center studies. We report on the use of the Snodgrass repair in conjunction with routine use of a vascularized dartos flap and 2-layer closure of the neourethra from multiple institutions. MATERIALS AND METHODS: Records of patients who underwent a primary 1-stage hypospadias repair with the Snodgrass technique in conjunction with vascularized dartos flap coverage were reviewed. Nearly identical surgical technique was used by all 6 surgeons in each case, which included a 2-layer closure of the neourethra, preservation of the well vascularized periurethral tissue and routine use of vascularized dartos flap coverage. A total of 514 cases were identified, including 414 with distal and 100 with midshaft or proximal hypospadias. Stents were used in 292 of the 514 repairs. RESULTS: Of the 414 distal cases there were no fistulas and 1 case of meatal stenosis. Of the 100 proximal cases there were 3 fistulas and 1 case of meatal stenosis. The overall complication rate was less than 1% for all cases combined. CONCLUSIONS: This series represents the largest reported multi-institutional experience with the Snodgrass technique. When used in conjunction with vascularized dartos flap coverage, 2-layer closure of the neourethra and special attention to preservation of the periurethral vascular supply, this repair can be performed with a near 0 complication rate. We believe that this is the optimal repair for routine cases of hypospadias.

Humans↗
PubMed2004

Classification of prepuce in hypospadias according to morphological abnormalities and their impact on hypospadias repair.

PURPOSE: We investigated the morphology of the hypospadiac prepuce to develop a classification of different prepuce types in hypospadias. We also assessed the correlation between morphology and vascularization of the prepuce and their impact on results of hypospadias repair. MATERIALS AND METHODS: From September 1997 to December 2001, 174 patients 18 months to 24 years old (mean age 49 months) underwent hypospadias surgery. The prepuce morphology was analyzed by evaluation of the prepuce skin distribution, development and deformities. The development and course of blood vessels were analyzed using preputial illumination. According to morphology and blood supply, different types were compared. Of 174 analyzed cases 163 prepuces were used for urethroplasty. RESULTS: Based on the predominant morphology characteristics and abnormalities, we classified the analyzed prepuces into 6 groups of A-"monk's hood" or "1 humped" (43 cases, 24.7%), B-"cobra eyes" (80, 45.9%), C-"normal" (intact) (4, 2.3%), D-"flat" (24, 13.8%), E-"v"-shaped (16, 9.2%), and F-"collar-scarf" (7, 4.0%). Cobra eyes and monk's hood prepuces had the most favorable vascular pattern for the creation of flaps, the prepuces while the "flat" and "v"-shaped prepuces had the most unfavorable vascular pattern. Mean followup after hypospadias repair was 34 months (range 24 to 48). Complications (stenosis, fistula diverticulum) developed in 8.9% of the patients after "cobra eyes" and "monk's hood" prepuces were used for urethroplasty and in 25% when "v"-shaped and "flat" prepuces were used. CONCLUSIONS: Morphological characteristics correlated with vascularization of the hypospadiac prepuce. Underdeveloped prepuces and those with unfavorable vascular pattern used for urethroplasty had a higher percentage of complications. In severe hypospadias the anatomical features of the prepuce have greater influence on the proper choice of 1 or 2-stage repair.

Adolescent↗
PubMed1998

Tubularized incised plate hypospadias repair for proximal hypospadias.

PURPOSE: We report a multicenter experience using tubularized incised plate urethroplasty for proximal hypospadias. MATERIALS AND METHODS: From August 1993 to December 1996 tubularized incised plate urethroplasty was performed in 27 boys 6 months to 3 years old with mid shaft and penoscrotal hypospadias. In 7 other boys complex reconstruction combined the tubularized incised plate technique for the glanular urethra with other repairs for the proximal urethra. RESULTS: Tubularized incised plate surgery created a functional neourethra even in penoscrotal hypospadias. Complications of the primary repair developed in only 3 of 27 patients (11%). No complications were attributed to use of the technique for the glanular urethra in complex repairs. CONCLUSIONS: Tubularized incised plate urethroplasty is a versatile operation that corrects proximal hypospadias defects with few complications and superior cosmetic results.

Child, Preschool↗
PubMed1999

Distal hypospadias repair by the modified Thiersch-Duplay technique with or without hinging the urethral plate: a near ideal way to correct distal hypospadias.

PURPOSE: Various techniques have been described to correct distal hypospadias but many are best suited to patients with subtle specific nuances of meatal and/or glanular configuration. We describe a simplified approach to these defects using the modified Thiersch-Duplay technique with or without hinging the urethral plate (the Snodgrass maneuver). MATERIALS AND METHODS: Between 1990 and 1997 we performed the modified Thiersch-Duplay repair as the primary procedure for repairing hypospadias in 197 boys. We initially performed urethral plate hinging (the Snodgrass maneuver) in 1994. By 1997, 82% of our patients were undergoing repair using the hinge technique. Urethroplasty coverage was provided by a second layer of adjacent local tissue or by a pedicle of subcutaneous tissue. RESULTS: Reoperation was required in 5 boys (2.5%) with fistula and 1 (0.50%) with urinary extravasation. A fistula developed in 4 of the 63 cases (6.4%) in which adjacent local tissue was used to cover the urethroplasty and in 1 of 130 (0.80%) in which a pedicle of subcutaneous tissue was used. Overall 97% of the boys had an excellent result requiring no secondary operative procedure. CONCLUSIONS: The modified Thiersch-Duplay technique with or without urethral plate hinging is reliable for correcting distal hypospadias. The risk of fistula is almost eliminated when a vascularized pedicle of subcutaneous tissue is used to cover the repair. This technique has virtually supplanted all other methods that we used in the past to correct distal hypospadias.

Child↗
PubMed1994

One-stage repair of hypospadias: is there no simple method universally applicable to all types of hypospadias?

A simple method of hypospadias repair is described. The operative technique consists of 7 steps, including 1) outlining the skin incision and dartos mobilization; 2) artificial erection, harvesting parameatal foreskin flap and release of chordee as needed; 3) glans splitting and creation of glanular wings; 4) 1-stage urethroplasty with parameatal foreskin flap; 5) meatal glanuloplasty; 6) creation of Byars' flaps of the skin, and 7) skin closure. Central to the technique is the feasibility of the choice of 1-stage urethroplasty with meatal based manta-wing flap or with parameatal based and fully extended circumferential foreskin flap even after the skin incision is made, which enables its application to all types of hypospadias. Of 120 patients the 1-stage urethroplasty was performed with meatal based manta-wing flap in 50, and with parameatal based and fully extended circumferential foreskin flap in 70. Primary success was obtained in 82% of the cases with meatal based manta-wing flap, and in 53% with parameatal based and fully extended circumferential foreskin flap. Complications requiring secondary repair occurred in 42 cases (9 with meatal based manta-wing flap, and 33 with parameatal based and fully extended circumferential foreskin flap) but repair was successful in 32. Thus, the overall success rate was 91% (96% with meatal based manta-wing flap, and 87% with parameatal based and fully extended circumferential foreskin flap). Additional repair (10 secondary, 2 tertiary and 1 quaternary) is planned in 13 cases. The technique of 1-stage urethroplasty with parameatal foreskin flap is recommended as a simple and reliable treatment for hypospadias with a reasonable success rate.

Child↗
PubMed2003

Pseudo-iatrogenic hypospadias: the megameatus intact-prepuce hypospadias variant.

This article presents the authors' experience with 21 patients with the megameatus variant of hypospadias who were treated during an 8-year period. In nine of the cases, the parents were convinced that the defect was a complication of circumcision, and the patients were examined in consultations in preparation for litigation. Seven of those nine patients had been previously examined by either a plastic surgeon or a urologist, who failed to recognize this variant. The typical appearance of the defect and how to differentiate this congenital deformity from true iatrogenic hypospadias are described. The features of the megameatus intact-prepuce variant of hypospadias include a wide spatulated glans, a deep groove, a large wide patulous meatus at the subglanular groove, an intact prepuce before circumcision, no evidence of glanular scarring, and no history of bleeding at the time of circumcision.

Adolescent↗
PubMed1993

Transverse mucosal preputial flap for repair of severe hypospadias and isolated chordee without hypospadias: a 350-case experience.

Three hundred patients with hypospadias and 50 patients with isolated chordee without hypospadias were operated on and followed by the same surgeon. A very low postoperative urethrocutaneous fistula rate (4.8%) was related to complete cutaneous coverage of the neourethra. The incidence of stenosis, noted in 8% of the cases, has progressively decreased with improvement of technical details and with growing experience. A total of 75% of the patients were corrected with a single operative procedure. Good disponibility of penile skin rendered a second intervention always easy.

Adolescent↗
PubMed1994

The management of proximal hypospadias using a 1-stage hypospadias repair with a preputial free graft for neourethral construction and a preputial pedicle flap for ventral skin coverage.

A total of 77 patients with proximal hypospadias underwent a 1-stage hypospadias repair using a preputial free graft for neourethral construction and a preputial pedicle flap for ventral skin coverage. Of the patients 84% achieved excellent functional and cosmetic results with 1 procedure.

Follow-Up Studies↗
PubMed1996

When is hypospadias not hypospadias?

Hypospadias is a deformity of urethral and penile development in the male. Some cases are secondary to more serious disorders of sexual differentiation. Simple clinical rules can sort the common morphological defect of hypospadias from the rarer but more dangerous diagnosis of intersex.

Disorders of Sex Development↗
PubMed1980

Reverse tumble flap with tubed island-flap urethroplasty for hypospadias or chordee without hypospadias.

From July 1971 to April 1979, 47 children who required detachment of the meatus from more distal tissues for adequate chordee release or who needed division of the urethra underwent a 1-stage tubed island-flap procedure. In this procedure the dorsal surface of the hooded prepuce is used to form a urethral tube and the ventral surface is used for shaft skin coverage. In followup to 5 years our long-term functional and cosmetic results appear acceptable for situations requiring creation of only a moderate length of urethra. For more proximal hypospadias a high complication rate has discourged our continued use of this 1-stage procedure.

Adolescent↗
PubMedDate not supplied

[Surgical treatment of hypospadias. Apropos of 700 hypospadias surgically treated (1966-1988). Indications and results. Current trends of the surgical treatment].

The surgical treatment of hypospadias is very complex. The objective is to obtain a satisfactory urinary and genital function with an equal morphological, anatomical and aesthetic result. Our contribution covers 22 years of surgical multicentre experience (700 cases). We evaluate the surgical indication, results, complications, associated malformations and study protocols. The anterior forms 590 (82%) were treated using the Duckett Magpi, Mathieu, Duplay and Leveuf techniques. Posterior forms 110 (18%) with a wide variety of techniques. Results have been encouraging in both. We have objectively evaluated the evolution of the indications, as well as the application of different techniques depending on the extent of urethral malformation.

Child↗