Functional Evaluation of Mid and Distal Penile Hypospadias Surgery with Special Reference to Uroflowmetry (original) (raw)
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International Journal of Urology, 2003
Background : Uroflowmetry is a simple, accurate and non-invasive test. In the present study, we aimed to determine the role of uroflowmetry in the evaluation of the functional results of one-stage urethroplasty with parameatal foreskin flaps (OUPF) technique. Methods : Twenty-one children who had undergone OUPF repair at our clinic were selected. Selection criteria were that patients were toilet trained and had no fistula. Uroflowmetry was performed using a rotating disk sensor. The maximum flow rate (Q max ) and average flow rate (Q ave ) were plotted against body surface related flow rate nomograms. The upper 95% tolerance limits for the 5th, 10th, 15th, 20th and 25th percentiles of the normal population were used for comparison. The flow pattern was classified as bell ring, plateau or intermittent. Results : The median age at the first uroflowmetry was 4.7 years (range 2.5-8.6) and the mean postoperative follow-up period was 25 months (range 1-58). Twelve children had Q max above the 25th, six between the 5th and 25th and three less than the 5th percentiles of the normal population. A normal bell-shaped flow curve was obtained in 17 (80.6%) of the children. Of the three children with Q max below the 5th percentile, two children had a plateau flow pattern and were found to have a urethal stricture. Dilation was performed successfully, after which the Q max returned to the normal range and the symptoms disappeared. Conclusion : The OUPF technique provided satisfactory functional results for hypospadias repair. We advocate the use of uroflowmetry for routine postoperative follow-up.
Bimonthly Journal of Hormozgan University of Medical Sciences, 2014
Introduction: Hypospadias is a common congenital malformation in boys. One of the common surgical techniques for correction of hypospadias is (Tubularized Incised Plate urethraplasty=TIP). Meatal stenosis and fistula formation are known post-operative complications. The purpose of our study was to evaluate the effect of early urethral dilatation in prevention of post operative complications. Methods: A randomized clinical trial including 60 patients with distal hypospadias who underwent tabularized incised plate urethroplasty with or without dilatation was conducted in Bandar Abbas children hospital in 2011. Patients were divided in two groups. The number of the patients and mean age were not different in two groups. Urethral dilatation was started in first group at two weeks following surgery and continued for six months. The patients of second group were followed without urethral dilatation. All patients were followed for occurance of complications for one year. Chi-Square and t-t...
African Journal of Urology, 2021
Background Our prospective study aims to assess if penile parameters and GMS score can predict the postoperative outcome of patients with hypospadias repaired with the TIP technique. Methods This prospective study included patients (6 months–11 years old) with coronal, distal or mid penile hypospadias who underwent Tubularized incised plate (TIP) urethroplasty technique from 2015 to 2017. All patients were assessed preoperatively using GMS score. GMS score included a scale for each component, with the more unfavorable characteristics assigned higher scores. Penile length, urethral plate length, and penoscrotal length were measured using a ruler. Glans width was measured by using a caliper ruler. Demographics and complications were assessed within 3 months of the procedure. Results There was a statistically significant difference between complicated and non-complicated patients regarding GMS score, glans width, penoscrotal length, penile length, and urethral plate length/penile lengt...
Feasibility of repair of distal penile hypospadias as a day-case surgery
Annals of Pediatric Surgery, 2011
The aim of this study was to present the outcomes of children with distal hypospadias who were operated on outpatient basis. Methods Atotal of 47 consecutive children underwent surgical repair of distal hypospadias in our department. Urethroplasties were performed by the following techniques: stentless meatal advancement-glanuloplasty (MAGPI) or glans approximation procedure (GAP) for glanular hypospadias (14) and tubularized incised plate (TIP) urethroplasty for coronal, subcoronal and midpenil hypospadias with an indwelling urethral catheter or short stent (33). The indwelling urinary catheters were managed by the double diaper technique. Patients were discharged within 6 h after operation. Dressings and catheters were removed on the postoperative day 2 and 6, respectively. Results Voiding difficulty and urinary retention on early postoperative period were observed in 8 patients. Except meatal stenosis in 4 cases and meatal retractions in 2 cases, there were no major complications in any of our patients during the follow-up period, no postoperative fistula or urethral stricture. Conclusion In children, repair of distal penile hypospadias on outpatient basis is feasible. Catheters, urethral stents, drug therapy and dressing are not justifications for hospitalization in such cases. Ann Pediatr Surg 7:111-113
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.
IOSR Journals , 2019
Background: To report short term results of Snodgrass tubularized incised plate (TIP) urethroplasty in distal penile hypospadias (DPH) repair. The complications and outcomes of the procedure are discussed. Methods: We reviewed the results of 42 cases of Snodgrass TIP urethroplasty for distal penile hypospadias (DPH) treated between Aug 2016 and Sep 2016 in paediatric patients. Observations were recorded to note the associated anomalies, cosmesis, complications and final outcome of the procedure. Results: The age of the study participants ranged from 2 to 12 years. About half (57%) of the cases presented early below 5 years of age and barely few (12%) reported late after 10 years of age. Meatal configuration, overall cosmesis and functional results were good in 34 cases (80%). Minor fistulas occurred in 6 cases (14%) whereas major fistula occurred in 2 cases (4%). Conclusions: In our experience, Snodgrass TIP urethroplasty is technically simple, easy to learn, single stage procedure with excellent functional and cosmetic outcomes for DPH. It has simplified the algorithm for distal penile hypospadias.
Indian Journal of Urology, 2005
Tubularized incised plate (TIP) technique of urethroplasty, adopted by Snodgrass, has proven feasibility and success in the repair of distal hypospadias. However, its versatility in the management of proximal hypospadias needs to be evaluated. Patients and methods From May 2011 to June 2014, 42 patients with proximal hypospadias in the pediatric age group were managed surgically. A total of 32 patients underwent TIP urethroplasty and 10 were candidates for a two-stage repair due to severe ventral curvature or deficient urethral plate, for all of whom the urethral plate was sacrificed. Among those undergoing TIP, 16 patients showed no chordee after the artificial erection test, eight cases presented chordee less than 301, which was corrected through dorsal plication, and eight cases presented with chordee more than 301, which was corrected by the elevation of urethral plate from corpora cavernosa and dorsal plication while maintaining the urethral plate. Results The 10 cases with sacrificed urethral late were excluded from the analysis. Mean follow-up for the TIP cases (n = 32) was 12 months (2-38 months). Complication rate was 34.3% in the form of fistulae in three (9.375%) cases, meatal stenosis in two (6.25%), glanular dehiscence in one (3.75%), urethral diverticulum in one (3.75%), neourethral stricture in two (6.25%), and meatal recession in two (6.25%) cases. Conclusion Snodgrass (TIP), a definitive technique for the correction of distal hypospadias, has evolved and proven feasible for proximal hypospadias as well. Dorsal plication and dissecting the urethral plate has aided in the preservation of the urethral plate. In some cases it is inevitable to transect the urethral plate either for being deficient or due to severe chordee and ventral curvature.
Urethral advancement procedure in the treatment of primary distal hypospadias
Annals of Pediatric Surgery, 2017
Introduction Distal hypospadias is the most common genital anomaly, occurring in almost 65% of all hypospadias cases. Although there are several surgical techniques for the treatment of distal hypospadias, it is clear that none can be used to correct all forms of hypospadias. The aim of the study was to evaluate urethral advancement in the repair of primary distal penile hypospadias with regard to feasibility, complication rates and the final cosmetic outcome. Patients and methods Between October 2014 and June 2015, the urethral mobilization technique was used in 20 patients who presented at the Pediatric Surgery Unit, Tanta University Hospital, with primary distal hypospadias. A submeatal crescent-like incision was performed a few millimeters proximal to the meatus with two vertical incisions from the lateral ends of the submeatal incisions. The urethra within the corpus spongiosum was dissected from the skin of the ventral surface and from the glans and corpora cavernosa for a distance of B4 : 1. The urethra was advanced till the urethral meatus reached its normal position without any tension. Spongioplsty can be performed, and covering Buck's or Dartos' layers can be used. The follow-up was conducted on a weekly basis in the outpatient clinic in the first month, and then every month for 6 months. Results The age of the patient at the time of operation ranged from 6 to 24 months, with a mean age of 10.5 months. The operative time ranged from 60 to 90 min, with a mean time of 73.5 min. Intraoperative urethral injury occurred only in one patient. In all patients, the catheter was removed immediately postoperatively except for one patient who had operative urethral injury. Deep wound infection was noticed in only one patient, followed by partial glanular disruption. Only one patient had urethrocutaneous fistula and two patients had meatal retraction. Conclusion Urethral advancement can be used safely in the mobilization of the distal urethra with wide glanular dissection and wide lateral mobilization of glanular wings. However, it should be stressed that in the presence of hypoplastic distal urethra and/or persistent ventral curvature, another technique should be adopted. The majority of our patients had very good cosmetic results and minimal complication. However, the technique requires further studies with a larger number of patients and longer follow-up periods to draw more precise and final conclusions.
Snodgrass' urethroplasty in hypospadias surgery in Clinical Hospital Mostar--preliminary report
Collegium antropologicum, 2007
Amongst the various methods of reconstructing the hypospadic urethra such as the MAGPI, Mathieu's and Preputial island flap urethroplasty method and the Snodgrass method, the latter is being used more frequently nowadays in patients with the urethral meatus located in the proximity of the penis. In the Pediatric ward at Mostar Clinical Hospital, we have recently adopted the Snodgrass method when reconstructing the hypospadic urethra. We herewith present our research regarding the successful results in adopting the aforementioned method. Success was evaluated according to the frequency of post-operative complications, as well as the patients' satisfaction with the functional and the cosmetic result of the urethra reconstruction. The conclusions relating to our research result in an addition basis from which to evaluate whether the Snodgrass method should receive privileged preference in future operative treatment of the hypospadias over others methods, as can be seen from our...
Bangladesh Journal of Urology
Introduction: The optimal treatment of hypospadias remains controversial. Severaltechniques have been described, but the best approach remains unsettled. Objective:To compare the outcomes of two popular methods, Tubularized incised plateurethroplasty (TIPU) and Transverse preputialonlay island flap (TPOIF) for the correctionof distal penile hypospadias. Materials and method: This prospective interventional study was conducted in theDepartment of Urology, Dhaka Medical College Hospital, during the period of September2015 to March 2017. 40 patients with distal hypospadias with minimum or no chordeeand no previous history of circumcision or hypospadias surgery were allocated into twogroups by simple random sampling with equal number of distribution. In Group-A, patientswere subjected to correct the defect by TIPU procedure while in Group-B, they wereoperated by TPOIF urethroplasty technique. In this study, the outcomes of theaforementioned procedures were compared in terms of operative...