Postpubertal Examination after Hypospadias Repair Is Necessary to Evaluate the Success of the Primary Reconstruction (original) (raw)
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Outcome of Distal Hypospadias Repair in Pediatric Surgery Department at Alribat Teaching Hospital
The Journal of medical research, 2014
Background: Hypospadias is a common congenital anomaly affecting the penis in which the opening of the urethra is on the ventral surface of the penis, usually associated with ventral curvature of penis (chordae). Treating hypospadias is a challenging mission for the surgeons. Many techniques have been descried in the literature for the repair of hypospadias with variable results. Objectives: To evaluate the surgical and cosmetic outcome of distal hypospadias repair including different procedures used to repair distal hypospadias and to identify complications and suggest solutions.
Management of 220 adolescents and adults with complications of hypospadias repair during childhood
Asian Journal of Urology, 2016
The goal of hypospadias repair is to achieve normal voiding and good penile cosmesis with minimal complications. Some urethroplasties deteriorate from childhood to adolescence and late stage failures have been reported. We report our experience with adult patients who have had a previous repair during childhood and present with a late complication. Methods: We reviewed the records of 220 patients aged 15e39 years old with a history of hypospadias repair who presented to our clinic. Forty-five patients with chordee, 39 with urethral strictures, 11 urethral fistulae, five with hairy urethras, three with urethral diverticula, and 117 patients with an abnormal glans or subterminal meatus were repaired. Results: Median follow-up was 14 months. Two patients had persistent chordee. Island skin flap urethroplasty afforded one patient with a urethral fistula and another with a recurrent urethral stricture, while the buccal mucosa group had one fistula which healed spontaneously and two recurrent strictures. For the patients undergoing glanular repairs, seven had dehiscence or breakdown of the repair. All other operations were successful. Conclusion: Complications of childhood hypospadias repair may present later in life as some urethroplasties deteriorate with time. We now recommend to parents of children with repaired proximal hypospadias to come for follow-up as their child transitions to adolescence.
Journal of Chittagong Medical College Teachers' Association
Background: Hypospadias a very common condition in the children and the incidence is increasing. Here we present our experience of managing hypospadias patients over the last five years. Materials and methods: It was a retrospective study from 2014 to 2018 in the Department of Pediatric Surgery, Chattogram Medical College Hospital. Records of all hypospadias patients were analyzed and type of hypospadias, age at repair, type of repair and admission with complication of hypospadias were recorded. Results: A total of 492 boys were admitted with the diagnosis of hypospadias and 272 boys underwent hypospadias surgery. Distal penile hypospadias (148 patients, 30%) was the commonest variety followed by coronal hypospadias (144 patients, 29%). Age at surgery ranged from 6 months to 19 years with a mean age of 7±4 years. General anesthesia was given in 133 patients (64.7%) spinal anesthesia in 93 patients (31.8%) local anesthesia in 7 patients (2.4%) and caudal block in 3 patients (1%...
Outcome of pediatric hypospadias repair in adulthood
Open Access Journal of Urology, 2010
To review the evolution of the technique of hypospadias repair. Methods: A search of Pubmed, Medline and the Journal of Pediatric Urology was performed, and papers dealing with surgical techniques for hypospadias repair were critally reviewed. Special emphasis was given to papers on the effects in the long term of hypospadias repair on voiding and sexual dysfunction. Results: The techniques for hypospadias repair have evolved over the years. The most popular technique now is tubularized incised plate urethroplasty. Long-term results with the use of the new techniques of the hypospadias repair in terms of voiding and sexual problems should be addressed. Conclusion: There is a need for valid studies on the outcomes of hypospadias repair in adults that were performed in childhood in terms of cosmetic appearance, voiding and sexual performance.
Patient-reported long-term outcome after primary hypospadias repair
Journal of Plastic Surgery and Hand Surgery, 2016
Purpose: Long-term evaluation of the surgical outcome after puberty, particularly patient reported outcome is rare in the literature. The aims of this study were to investigation the patients' satisfaction with the long-term results and their views and memories of their childhood surgery and follow-up. Methods: A modified version of previously used questionnaire was sent to 134 patients ages 18 years or older previously primarily repaired due to hypospadias by one of the authors (HS) between 1989-2009. Results: Thirty-nine patients responded. Eighty-two per cent were satisfied with the appearance of their penis, 87% were satisfied with their ability to urinate and their sexual function and 92% were satisfied with the overall surgical results. Ninety per cent of patients were positive to the current duration of our post-pubertal follow-up program or would have preferred an even longer follow-up. Conclusions: The majority of patients were satisfied with the long-term surgical results and the duration of follow-up. Despite having problems patients does not always contact the health care system spontaneously, which warrants long-term follow-up.
Long-term outcomes of pediatric hypospadias and surgical intervention
Pediatric Health, Medicine and Therapeutics, 2012
Hypospadias is one of the most commonly diagnosed male congenital disorders. Many surgical techniques are described and complications often reported include fistula, wound dehiscence, and meatal stenosis. Many surgeons still believe that hypospadias should be surgically corrected before the age of 12 months. However, it is clear that the longer the follow up, the more complications are reported. Correction of a failed hypospadias repair in adult patients can be challenging. While the need for repair of proximal hypospadias during childhood is evident, distal repair during childhood is questionable. Evidence suggests that the psychosexual and functional outcomes of nonoperated distal hypospadias in the adult population are good. Therefore, the benefit of surgery and the burden of complications must be carefully evaluated. This paper highlights the difficulties inherent in decisions related to the assessment of hypospadias, the need for repair, and the paucity of good long-term data.
The Complication Rate after Hypospadias Repair and Correlated Preoperative Symptoms*
Open Journal of Urology, 2014
Aim: To assess the rate of complications following hypospadias repair in a consecutive series of boys and the correlations of those complications with their preoperative symptoms, degree of hypospadias and method of operation. This study was conducted to address the question of whether all boys with all degrees of hypospadias should undergo reconstruction. Methods: This was a prospective cohort study. We included every boy who underwent an operation for the primary repair of hypospadias between January 2011 and April 2014. The median follow-up time was 24 months. The study ended in October 2014. The main outcome measurements were the frequency of postoperative complications and their correlations with the degree of hypospadias, the preoperative symptoms and the operative intervention performed. Results: Among the 76 boys who underwent operations, 23 had degree 1, 47 had degree 2, and 6 had degree 3 hypospadias. Preoperatively, 43 of the boys had symptoms that motivated the operation, including stenosis (38), a curvature (10) or both (5). Forty-three boys underwent operations with the MAVIS technique, 28 underwent TIP repair, 1 underwent a Duckett procedure, and 4 underwent Byar two-stage procedures. There were complications requiring reoperations including fistulas or ruptures in 26 (34%) boys. There were no significant differences in the rates of complications with surgery, fistulas (P = 0.4775), ruptures (P = 0.2417) or other complications (P = 0.5165) between the groups with or without preoperative symptoms, those with different degrees of hypospadias or those who un-* Part of the information in this manuscript has been presented as an abstract with the following number A-587-0025-00540 and an oral presentation with the title "Should all boys with hypospadias undergo reconstruction?" in the 4th World Congress of Pediatric Surgery H. Winberg et al. 156 derwent different operative methods for repair. Conclusions: The complication rate in this series was high. The study was prospective, and no boy was lost during follow-up. Because the complication rate did not correlate with the degree of hypospadias nor the preoperative symptoms, there may be a group of boys with hypospadias without symptoms for whose operations are questionable. The preoperative symptoms should be reported in future reports of the results of hypospadias surgery.
Distal hypospadias repair: comparison of two different techniques
International urology and nephrology, 2002
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.
Is there an ideal age for hypospadias repair? A pilot study
Journal of Pediatric Urology, 2009
Objective: To assess whether repairing hypospadias before or after 18 months affects psychological adjustment, health-related quality of life (HRQoL) and surgical outcome. Patients and methods: Seventy-seven boys aged 6e17 years were assigned to one of two groups, according to whether they had a hypospadias repair before or after the age of 18 months. The surgical outcome was assessed using the pediatric penile perception score by non-involved urologists. A psychologist interviewed the patients to assess HRQoL and gender-role behavior. The child's psychological adjustment was assessed with a questionnaire for parents. Results: The surgical outcome and complication rate were not significantly different between groups. A covariance analysis of HRQoL, gender-role behavior and psychological adjustment as a function of age at the last operation with current age as covariant was performed, but differences did not reach significance. Conclusion: This study does not provide evidence to support recommendations concerning the ideal age for hypospadias repair. In the absence of evidence of a benefit of early surgery, anesthesia-related risk factors must be considered when operating in very early infancy. Large, prospective studies, measuring surgical and psychological outcome with similar instruments to those presented may reveal whether there is a true ideal age for hypospadias surgery.
Repair of hypospadias in Mosul Paediatric Surgery Centre (analysis of 125 cases)
Annals of the College of Medicine, Mosul, 2008
Aim: A retrospective study of 125 cases with different types of hypospadias. Evaluation of the surgical procedure for each type to choose the suitable techniques for each problem. Patients & methods: 125 cases of hypospadias were admitted and treated at Al-Khansa'a Paediatric Surgery centre in Mosul during the Period from Jan. 2005 to Feb. 2007. Their age ranged between 6 months to 12 years. All types of Hypospadias were managed using different techniques. Majority of them were distal type. The surgical repair varies according to the type of hypospadias. Catheters were used for different periods according to the procedure used. Hospitalization period also varied according to the severity and techniques used. Results: The types of hypospadias varied from glanular to penoscrotal. Glanular were 14 patients, coronal and sub coronal were 48 patients, distal penile were 37, mid shafts were 18 patients, proximal and peno-scrotal type were 8 patients. The types of repair used were, MAGPI in 41patients (33,6%), TIP technique in 75 patients (60%), Mathiew technique in 4 patients (3,2%), and Onlay tube flab in 5 patients (4%). Associated problems found with hypospadias repair were; Circumcision in ten patients (six coronal, three subcoronal and distal hypospadias, and only one case with proximal hypospadias). Chordee found in eight patients. Torsion of the shaft of penis in 5 patients (four with mild degree and only one with severe degree). Major complications such as stenosis in 18 patients, fistula in 16 patients and flap or skin necrosis in 3 patients. Conclusions: There is no single procedure which could be used for all types of hypospadias, but the TIP techniques can be used for a wide range of hypospadias from coronal up to penoscrotal type and this techniques is simple, quick, single stage procedure, and it offers good functional and cosmetic results. The presence of circumcision prior to the repair is not a problem in repairing distal hypospadias but it could be a problem in the proximal type.