Incidence of penile curvature in various forms of hypospadias (original) (raw)
Related papers
The Journal of medical research, 2013
Introduction: The fact that there are over 250 methods of surgical correction of hypospadias described in the literature indicates that the “hypospadiologists” are still in search of the ideal technique for repair. Objectives: To evaluate the impact of penile anatomy on the surgical management of hypospadias. Results: Fourty four patients with different types of hypospadias 88.6% presented more than one year and 11.4% less .we found that 11.4% had glandular meatus,43.2% distal and 45.4% proximal ,also 43.2% had no chordee,45.4% had superficial and 11.4% deep chordee, meatal site after chordee correction24% distal , 60 % proximal and 16% penoscrotal.
Penile Curvature Incidence in Hypospadias: Can It Be Determined?
Advances in Urology, 2011
The aim was to retrospectively determine the real incidence of congenital penile curvature in various forms of hypospadias, in order to indicate intraoperative assessment and correction of curvature. We analyzed 842 patients with hypospadias who underwent surgery from 2003 to 2010, classified into two groups. First group was intraoperatively checked for curvature as a routine procedure, while a curvature in the second group was assessed mostly in severe hypospadias. Results are analyzed using Fisher's and chi-square tests. In total, 238 cases (28.3%) of associated curvature were confirmed. Curvature was significantly more frequent in the first group, regarding hypospadias in general (P<0.01), as well as distal (P<0.05) and midshaft forms (P<0.01). Penile curvature is common figure in hypospadias, including distal types. Intraoperative testing for associated curvature should be considered as a routine procedure in hypospadias repair.
2020
Introduction: Surgical management for the severe proximal hypospadias remains controversial and it might be challenging. In this study, we evaluated the surgical outcome of patients with proximal hypospadias managed by two staged repair with dorsal prepucial flaps. Methods: Forty one boys with proximal hypospadias are enrolled between January 2006 and September 2016. The location of the urethral meatus was at the penoscrotal junction (PSH), at the scrotum (SH) or at the perineum (PRH). First stage; chordee was released and the prepucial flaps were constructed. Second stage; urethroplasty was performed according to Thiersch-Duplay principle. We assessed postoperative complication rates and utilized Hypospadias Objective Penile Evaluation (HOPE) scoring to evaluate the cosmetic outcome. Results: There are a total of 41 boys (31 PSH (%76), 3 SH (%7) and 7 PRH (%17). The mean age at first operation was 15±5.3 months. The mean interval between the stages of the surgical procedures was 10.1±4.9 months. Sixteen patients had various enzyme deficiency or dysgenesis. In two patients, diverticulum is developed after the repair. stenosis has encountered in 10 patients and fistula in 5. Two patients had dehiscence at glanular level. Relation did not demonstrated between the severity of hypospadias and development of fistula, stricture and diverticulum (p>0.05). HOPE scores; 9.4 for the position of the meatus, 5.8 for shape of the meatus, 7.2 for shape of the glans penis, 9.3 for penile torsion and 9.8 penile curvature. Discussion and Conclusion: Incorporating the dorsal prepucial skin flaps in staged procedures has both satisfactory cosmetic and functional success rates.
Management of High-Grade Penile Curvature Associated With Hypospadias in Children
Frontiers in Pediatrics, 2017
Penile curvature is a frequent feature associated with hypospadias with also a great variability of severity among each patient. While the low-grade curvature (<30°) can be relatively easily corrected by simple techniques like penile degloving and dorsal plication, severe cases often demand more complex maneuvers to manage it. A great number of surgical techniques have been developed to adequately correct curvatures greater than 30°; however, each one of them should be individualized to different patients and local conditions encountered. In this article, we will review the evaluation of the pediatric patient with penile curvature associated with hypospadias with a special attention to high-grade cases, their management, indications for surgical treatment, and several surgical options for their definitive treatment.
African Journal of Urology, 2015
Objective: This study was carried out to evaluate the correlation between the severity of penile torsion on the one hand and the degree of ventral penile curvature and the type of hypospadias on the other. We also assessed the effectiveness of correction of chordee and torsion by penile degloving and mobilization of the urethral plate and the corpus spongiosum. Patients and methods: This prospective study included 116 patients with hypospadias and penile torsion out of a total of 376 primary hypospadias cases seen between January 2006 and June 2013. The patients' age ranged from 8 months to 26 years with a mean age of 8.37 and a median age of 6.4 years. Prior to surgery the type of hypospadias as per location of the meatus, the presence or absence of chordee, the size of the dorsal hood and deviation of the median raphe on the dorsal hood were noted. The torque of the penile shaft (torsion) toward either side of the midline and ventral curvature was measured using a sterile small protractor around the penile shaft. The techniques used for the correction of penile torsion and chordee were penile degloving and mobilization of the corpus spongiosum with the urethral plate and the urethra. Results: The abnormal penile rotation ranged from 15 • to 110 • (average 51.98 •). In 70.69% of the patients the torque was on the left side, while it was on the right in 29.31%. 11.2% of the patients had a severe torque, while it was moderate in 37.94% and mild in 50.86% of the cases. The mean torque was 62.38 • ± 23.03 • in patients with distal penile (80 cases), 38.04 • ± 18.50 • in patients with mid penile (24 cases) and 18.25 • ± 3.33 • in patients with proximal penile hypospadias (12 cases) (P value = 0.001). Ventral curvature was seen in 71 cases. Mean ventral curvature was 38 • ± 18.55 • , 44.28 • ± 21.11 • and 73.58 • ± 32.96 • in patients with distal penile, mid penile and proximal hypospadias, respectively
International Surgery Journal
Background: Hypospadias is a relatively common congenital defect of the male external genitalia. It is present in approximately 1 in 250 male newborns. Hypospadias, in boys, is defined as an association of three anomalies of the penis: an abnormal ventral opening of the urethral meatus that may be located anywhere from the ventral aspect of the glans penis to the perineum, an abnormal ventral curvature of the penis (chordee), and an abnormal distribution of foreskin with a “hood” present dorsally and deficient foreskin ventrally.Methods: In this study author operated 250 cases of Hypospadias of different types in different age groups during (1992-2017) using MAGPI for glandular, TIP and Flip-flap procedure for distal penile and Ducket Onlay Flap technique for Proximal penile, penoscrotal and perineal Hypospadias. Complicated / Failed Hypospadias was repaired by Trap door technique or Byer’s double tube technique.Results: After the primary repair of Hypospadias fistula was found in 4...
Role of penile biometric characteristics on surgical outcome of hypospadias repair
Pediatric Surgery International, 2013
Purpose To assess influence of penile biometric characteristics on surgical outcome of tubularized incised plate (TIP) repair for hypospadias. Methods We prospectively studied 42 boys with distal hypospadias that underwent TIP urethroplasty. Biometric assessment prior to surgery consisted of classifying glans shape, urethral plate (UP) length and width, prepuce vascularization and penile size, using a caliper rule, according to previous definitions. Surgical outcome was assessed according to the occurrence of dehiscence, fistula or urethral stricture. Results There was no statistical difference among groups concerning postoperative complications. Glans shape: grooved (24/57 %), shallow (9/21 %) and conical (9/ 21 %). UP width: \10 mm (26/62 %) and C10 mm (16/ 38 %). UP length was evaluated in 29 patients: \10 mm in (12/41 %) and C10 mm (17/59 %). Prepuce vascularization: one predominant blood vessel (17/41 %), two predominant blood vessels (8/19 %), H-like form with communication between two well-developed blood vessels (6/14 %) and net-like form with no predominant blood vessels (11/26 %). Penile size was measured in 28 patients under 50th percentile (25/89 %). Conclusion Glans shape, UP width, UP length, prepuce vascularization and penile size do not significantly affect the complication rate of TIP repair in distal hypospadias. Most of the patients with distal hypospadias presented with penile size under mean length for age suggesting some form of mild hypogonadism.
The Journal of Urology, 2007
Purpose: There is ongoing controversy regarding optimal treatment for severe ventral curvature. It has been suggested that ventral corporeal lengthening may be associated with recurrent curvature and erectile dysfunction. To further assess these issues we reviewed our experience with ventral penile lengthening for correcting the severe ventral curvature associated with proximal hypospadias. Materials and Methods: We reviewed the records of 38 boys with severe hypospadias and congenital ventral curvature greater than 45 degrees who were treated at our institution from 1995 to 2004 with placement of a flap or graft in the corporeal bodies to straighten the phallus. Of the patients 21 had perineal and 17 had penoscrotal hypospadias, including 22 with associated penoscrotal transposition and/or bifid scrotum and 6 with ambiguous genitalia. Testosterone stimulation before surgery was given in 11 children at surgeon discretion. Results: Median age at surgery was 15 months. The urethral plate was divided in 94.7% of patients. A tunica vaginalis flap was used alone in 23 cases and associated with dura, pericardium or small intestinal submucosa in 8, 2 and 1, respectively. The remaining 4 patients underwent ventral grafting alone, including lyophilized dura in 1, pericardium in 1 and dermis in 1. Urethral reconstruction was achieved by the transverse island flap technique or 1 of its modifications in 34 children. Four boys underwent a 2-stage procedure. Followup available on 35 of 38 patients was 1 to 11 years (median 5.3). Recurrent ventral curvature in 5 of 35 patients was mild in 1 and clinically significant, requiring re-intervention, in 4. Four of 9 patients (44.4%) who underwent corporeal grafting with lyophilized dura had recurrent ventral curvature vs 1 of 23 (4.3%) who had a tunica vaginalis flap (chi-square 5.14, p ϭ 0.02). At last followup straight erections were documented by patients and/or parents in 30 of 35 children (85.7%). Conclusions: The short-term outcome of ventral penile lengthening using tunica vaginalis flap alone for correcting severe chordee is favorable with a 95% success rate. Dural grafts were associated with a higher risk of recurrent ventral curvature compared to tunica vaginalis flaps. Although most of our patients were not yet adults, when chordee and erectile dysfunction may become apparent, we believe that tunica vaginalis flap repair is a good option for correcting severe ventral curvature.
Journal of Urology, 2008
The 2 main approaches to correct severe ventral curvature are dorsal plication of the corpora and ventral corporeal lengthening by tunica albuginea patching. Controversy persists since neither technique has been proved to be superior to the other with respect to initial or long-term outcome. However, to our knowledge a direct comparison of outcome of these 2 procedures has not been previously reported. Materials and Methods: A retrospective review of the records of 100 consecutive patients who underwent repair of penoscrotal or more proximal defects from 1996 to 2004 was performed. Children were divided into 2 groups, including group 1-32 who underwent a ventral penile lengthening procedure and group 2-68 who underwent dorsal plication. Meatal location, preoperative testosterone stimulation, severe ventral curvature (greater than 45 degrees) at the beginning of operation and after degloving, proximal ventral dissection, urethral plate transection and recurrent ventral curvature were compared between the 2 groups. Results: Mean age was 17 months (range 9 to 56) in patients with ventral penile lengthening and 17.8 months (range 10 to 58) in patients with dorsal plication. Mean followup was 65 (range 29 to 120) and 62 months (range 30 to 116), respectively. Of the 32 group 1 children 30 (93.7%) had penoscrotal or more proximal hypospadias vs 57 of the 68 (83.8%) in group 2. Three of the 32 children who underwent ventral penile lengthening had recurrent ventral curvature vs 19 of the 68 who underwent dorsal plication (9.4% vs 27.9%, p ϭ 0.03). On multivariate analysis dorsal plication remained significantly associated with recurrent ventral curvature independently of the other factors (OR 4.56, 95% CI 1.14-18.28, p ϭ 0.03). Conclusions: Dorsal plication was more often associated with recurrent ventral curvature compared to ventral penile lengthening on univariate and multivariate analysis. Future studies adjusting for proximal ventral dissection and urethral plate transection are necessary to further elucidate the role of each technique in the correction of severe ventral curvature in children with proximal hypospadias.
Annals of Pediatric Surgery
Background The assessment of a child having hypospadias with chordee/ventral curvature (VC) and meatal position that appears to be proximal/mid-penile can be challenging with regard to the choice of chordee correction and type of urethroplasty. The feasibility of preservation of native urethral plate is dependent on these choices. Classically, urethral plate resection of the corpora is performed to correct severe VC, whenever VC is presumed to be due to short urethral plate. But VC is seen to persist in many such cases, in spite of this maneuver that commits the patient to a more complex reconstruction. The aim of the study was to analyze the variation in preoperative and intraoperative assessment of proximal and mid-penile hypospadias, with respect to severity and possible surgical options, in patients treated by a standard protocol of sequential and anatomical approach to repair. The other objective was to ascertain if “extensive ventral urethral detethering” (in all cases) and “u...