Minimizing the postoperative complications of severe hypospadias using a simple technique (original) (raw)
Related papers
Outcome of hypospadias repair - stentless versus stented repair
International Surgery Journal, 2016
Background: This study was undertaken to evaluate the outcome of hypospadias repair with or without stents. Methods: Total 30 patients below 14 years underwent primary and re-operative hypospadias surgery in NSCB medical college, Jabalpur between September 2006 to September 2007. Out of these 30 patients, 18 were proximal and 12 were distal hypospadias. All patients were operated for hypospadias repair using standard operative techniques. In alternate patient stent was not placed, while urethral stents were kept in place for a week in the remaining half. Results: In 14 cases early stent removal was done or no stent was placed and in 16 cases late removal of stent was done. In distal hypospadias cases 2 patients developed fistula and both were from the group in which stents were placed .In proximal hypospadias 6 patients developed fistula post operatively, of these 4 were from the early removal group while 2 were from the late stent removal group. The duration of hospital stay was not significantly affected by the duration of stent placement. But doing a MAGPI procedure significantly reduced hospital stays as compared to Snodgrass repair in distal hypospadias. No such difference in hospital stay was associated with different procedures used in proximal hypospadias. Conclusions: Stent placement can be avoided specially in cases of distal hypospadias to reduce morbidity and postoperative stay in these patients. Repair with stents or without stents did not affect the outcome of hypospadias repair in terms of fistula formation or postoperative stay.
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.
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.
Perioperative Techniques and Long-term Outcomes in Hypospadias: A Systematic Review
Malaysian Journal of Medicine and Health Sciences, 2023
Introduction: Hypospadias is a condition when the urethra distal opens on the bottom of the penis and has a ventral penile curvature. Hypospadias is the second most frequent genital birth abnormality in boys after cryptorchidism. Surgery is the standard treatment of choice and has a significant risk problem. There are many surgical procedure complications, especially in appearance and function. This article discusses the appropriate operative management and the best long-term outcome. Methods: The data was culled and selected from the ten years of full-text English publication (2012-2022) utilizing the PubMed and Google Scholar databases. Meta-analyses (PRISMA) paradigm and PICO investigation of management techniques and long-term outcomes in clinical and randomized clinical trials. Result: From 149 search articles, 7 met the inclusion criteria. The gland penis size and the meatal location did not affect the outcome of the surgical technique. However, 58/432 patients required reoperation, and 61(13%) had urethroplasty complications (UC), although not statistically significant (OR 0.8, 95% CI: 0.7-0.9). Testosterone is advised for small penises, narrow glands, thin urethral plates, and proximal hypospadias (67 vs. 87%). Preoperative antibiotics reduce the incidence of infection (17/150 repairs), tubularized incised plate (TIP), and the stent is recommended. Conclusion: The recommended strategies are good perioperative treatment, including antibiotics, testosterone treatment, surgery ages (6-18 months), tubularized incised plate (TIP) technique, and stent postoperative.
Complications of hypospadias surgery: Experience in a tertiary hospital of a developing country
African journal of paediatric surgery : AJPS
Over 300 different operations have been described for the management of hypospadias. In recent times, the numbers of operations used in various centres have gradually reduced as the principles necessary to ensure adequate cosmetic and functional results with minimum complications are better understood. The aim of this article was to review the different types of operations used for managing hypospadias in a tertiary hospital in a developing country, to analyse the complications of surgery and discuss the factors that contribute to complications. Patient folders, theatre, and ward records were used to obtain the required information. The age at surgery, types of hypospadias at presentation, types of operations done and complications were analysed. With three main types of operations, tubularised incised plate urethroplasty and meatal advancement and glanuloplasty incorporated for anterior hypospadias (glanular, coronal, subcoronal, distal, midpenile), and lateral based flap urethropl...
Management of complications after hypospadias repair
Urology, 2005
Objectives. To review our experience with hypospadias complications (seen after 10%-15% of repairs) and to identify factors influencing outcome. Methods. We reviewed the available medical records of 113 patients who underwent repeat operation for hypospadias complications. Of the 113 patients, 40% had undergone the initial repair at our institution (internal referral); 60% had undergone the initial repair elsewhere before referral (external referral). The variables potentially affecting outcome were reviewed, including the severity of the defect, concomitant disease, age at the initial operation and revisions, type of complications and treatment, and the number of revisions. Outcomes were compared on the basis of specialty and experience. Results. Isolated hypospadias was present in 81% and other genitourinary abnormalities in 10%. External referral patients were older at the first revision (7.3 versus 4.2 years, P ϭ 0.027). Complications included fistula (73%), stricture (12%), breakdown of repair (10%), and diverticulum formation (11%). Successful revision was independent of the initial defect. The first, second, and third revision was successful in 77%, 64%, and 67% of patients, respectively. The cumulative success rate was 77%, 92%, and 97% after each respective repair attempt. The success of the repair was independent of the patient's age at the initial operation/revision and of the interval from the initial repair to reoperation. Internal referral and external referral patients had similar results. Specific experience with the repair of hypospadias complications correlated with a successful outcome (P Ͻ0.001). Conclusions. Complications after hypospadias repairs are common, with fistula accounting for approximately 75%. The outcome in our series was independent of hypospadias severity, patient age at repair, number of revisions, stent use, and referral status. Repairs performed by an experienced pediatric urologist were associated with improved outcomes (P Ͻ0.001). UROLOGY 65: 782-785, 2005.
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%...
Factors influencing the results of Surgery for Hypospadias: Experience at NICH
To evaluate the factors that may influence the results of surgery after hypospadias repair at National Institute of Child Health, Karachi. Methods: It was a retrospective observational study. Files of all patients who had Hypospadias repair were retrieved and analysed with a view to identify the factors which may influence the results of surgery for Hypospadias. Patients with complete record available were included in the study, whereas those with incomplete data were excluded. For most patients who had penile or distal hypospadias TIP (Tubularised Incised Plate) urethroplasty was performed. Patients with severe chordee had Duckett Island flap urethroplasty as a two stage procedure. Patients having moderate chordee were subjected to the Mustardee Procedure. Some underwent MAGPI and Mathieu's repairs. Results: One hundred four patients were operated. Files of only 46 patients with a mean age of 4 years could be retrieved and these were included in the study. Twenty five patients had TIP urethroplasty, 5 had island flap urethroplasty, 2 had Mustardee repair, 6 had MAGPI, 5 had Mathew's repair and 3 had Byers Staged Urethroplasty. Over all incidence of fistula formation was 26%. The frequency of fistula formation was less with TIP urethroplasty (16%) compared to those who received no dartos pedicle flap. Mathieu's repair gave good results with 20% incidence of fistula formation. Highest numbers of complications (60%) were seen in patients who had Island flap urethroplasty for proximal hypospadias with chordee. Conclusion: TIP urethroplasty is a safe and reliable method of hypospadias repair. The results of surgery can however be improved by using dartos pedicle flap to protect the repair, meticulous surgical techniques, use of monofilamentous absorbable suture material and soft waterproof dressing (JPMA54:577;2004).