Prevalence and causes of meatal stenosis in Circumcised Boys

Abstract Background Hypospadias is one of the most common congenital anomalies affecting males worldwide, with distal variants representing up to 70% of all cases. Several surgical techniques are adopted for distal hypospadias repair. However, there is still much controversy about the ideal technique. Objectives The aim of this study is to compare between the most popular reconstructive techniques for distal penile hypospadias repair. Highlighting their effectiveness, in term of success rate as well as the risk of postoperative complications. Methods For this systematic review, PubMed/Medline and ScinceDirect online databases were searched using the keywords ‘distal hypospadias, complications and outcome’. Inclusion criteria were primary repairs; distal hypospadias; pediatric case series and standard techniques. Abstracts of articles identified were reviewed, and then relevant articles were retrieved in full. Papers were only included if data on at least one of the main outcome measures was obtainable, which are postoperative fistula, meatal stenosis and glanular dehiscence. Data were pooled using CMA software, effect sizes were reported as event rates with 95% confidence intervals (CI) been calculated for each outcome. Results A total of 25 studies, which included 4572 patients, met the inclusion criteria. The tubularised incised plate (TIP) was the most commonly adopted procedure followed by the peri-meatal flap (Mathieu). Few studies reported data for other techniques like onlay flap, Thiersch-Duplay, meatal advancement and MAGPI procedures, in addition to urethral mobilization technique. The overall incidence of main complications was 10.5% with comparable results among different techniques. The results are in favor of urethral mobilization and TIP procedures over Mathieu regarding the incidence of both meatal stenosis and post-operative fistula. Overall, the quality of the included studies was determined to be satisfactory. Conclusion Compared with Mathieu technique, urethral mobilization and the TIP procedure for distal penile hypospadias (DPH) reconstruction were associated with a lower risk of overall complications specifically postoperative fistula and meatal stenosis.

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Single Stages Repair of Hypospadias Using The Snodgrass Technique: A Modern Choice

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v14i2.21539 ◽

2018 ◽

Vol 14 (2) ◽

pp. 50-52

Author(s):

Binod Karn ◽

N. M. Shrestha

Keyword(s):

Observational Study ◽

Plastic Surgery ◽

Teaching Hospital ◽

The Other ◽

Fistula Formation ◽

Meatal Stenosis ◽

Proximal Hypospadias ◽

Medical College ◽

Cosmetic Appearance

Background: Proximal hypospadias with chordee is the most challenging variant of hypospadias to reconstruct. During the last 10 years, the approach to severe hypospadias has been controversial.Materials & Methods: This is a hospital based observational study conducted in the plastic surgery unit of department of surgery at Nepalgunj Medical College and Teaching Hospital Kohalpur from 2012 March to 2016 September. All patients underwent single staged procedures using Snodgrass technique.Results: Thirty three patients were operated. Twenty four patients had no complications. Single fistula was present in 6(18.18%) patients. Two (6.06%) patients had 2 fistulae; one at the original site of the hypospadias and the other was sub-coronal. One (3.03%) patient had moderate meatal stenosis, which was successfully treated by repeated dilatations.Conclusion: Single Staged procedure using the principles of Snodgrass's technique; is a versatile operation that can be used for the proximal hypospadias. It decreases the rate of fistula formation; disruption; stenosis and gives a satisfactory cosmetic appearance. JNGMC, Vol. 14 No. 2 December 2016, Page: 50-52

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Re: Cultural background, non-therapeutic circumcision and the risk of meatal stenosis and other urethral stricture disease: Two nationwide register-based cohort studies in Denmark 1977–2013

The Surgeon ◽

10.1016/j.surge.2017.08.001 ◽

2018 ◽

Vol 16 (2) ◽

pp. 126-129 ◽

Cited By ~ 2

Author(s):

Brian J. Morris ◽

John N. Krieger

Keyword(s):

Cohort Studies ◽

Urethral Stricture ◽

Cultural Background ◽

Meatal Stenosis ◽

Urethral Stricture Disease

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Redo hypospadias repair by a single surgeon after failed hypospadias surgeries: Experience from a developing country

10.36811/gju.2020.110010 ◽

2020 ◽

pp. 17-23

Author(s):

Md. Abdullah Al Farooq ◽

MA Mushfiqur Rahman ◽

Tanvir Kabir Chowdhury

Keyword(s):

Developing Country ◽

Complication Rate ◽

Hypospadias Repair ◽

Urethral Plate ◽

Meatal Stenosis ◽

Tubularized Incised Plate ◽

Tubularized Incised Plate Urethroplasty ◽

Principal Author

Background: Hypospadias surgeries are often complicated with fistulas, meatal stenosis and disruptions. We report our series of redo surgeries for failed primary repairs. Methods: We prospectively observed all the redo hypospadias repairs done by the principal author between 2013 and 2017. Thiersch-Duplayurethroplasty was done if the urethral plate was adequately wide and intact; tubularized incised plate (TIP) urethroplasty was performed if the urethral plate was intact but, narrower than 8 mm; 2 stage procedures were done with oral mucosal graft (OMG) if the urethral plate was deficient or scarred with significant chordee. Result: There was a total of 31 patients. Age ranged from 18 months to 15 years (mean 8.05 ±4.27 years). Sixteen (51.61%) patients underwent only one surgery, 10 (32.26%) patients underwent 2 surgeries, 2 patients (6.45%) underwent 3 surgeries, and 3 patients (9.68%) underwent 4 surgeries prior to presenting to us before our redo surgeries.We had performed TIP urethroplasty in 16 (51.61%) patients, meatal based flap urethroplasty in 12 (38.71%), OMG followed by urethroplasty in 2 (6.45%), and repair of urethra-cutaneous (UC) fistula in 1 (3.23%) patient. Ten (32.26%) Complications occurred in 8 (25.80%) patients. Unsuccessful repair was noted in 03 (9.67%) patients (UC fistula 1, glans dehiscence with UC fistula 1, and glans dehiscence 1). Conclusion: Thiersch-Duplay and TIP repair can be successfully performed in redo hypospadiassurgeries with acceptable complication rate. OMG graft can be reserved for cases with gross scarring of the urethral plate. Keywords: Failed hypospadias repair; Tubularized incised plate urethroplasty; Thiersch-Duplay; Outcome

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Optimal clamping time in meatotomy procedure for children with meatal stenosis: Experience with 120 cases

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2021.2.244 ◽

2021 ◽

Vol 93 (2) ◽

pp. 244-247

Author(s):

Mehdi Shirazi ◽

Umayir Chowdhury ◽

Faisal Ahmed ◽

Mohammad-Bagher Rajabalian ◽

Hossein-Ali Nikbakht ◽

...

Keyword(s):

Bladder Wall ◽

Postoperative Bleeding ◽

Urine Flow ◽

Penile Curvature ◽

Optimum Time ◽

Meatal Stenosis ◽

The Us ◽

Urinary Stream ◽

Us Findings

Objective: During meatotomy procedure for children with meatal stenosis (MS), a straight clamp used as a hemostat on the ventrum of the meatus before incised with scissors for clamping and holding bleeding from the site of operation. The aim of this study was to evaluate the optimum clamping time for meatotomy in children with MS. Materials and methods: All the patients with MS between 2014 to 2019 were enrolled in this retrospective study. Patients with uncircumcised penis, traumatic catheterization, any kind of penile abnormality such as hypospadias or penile curvature, and active urinary tract infection (UTI) were excluded. The indication of meatotomy was a pinpoint meatus that develops with dorsal or lateral deflection of the urinary stream and high-velocity urine flow. During meatotomy procedure, clamping time was examined in different groups such as 2, 3, and 4 minutes. The main symptoms of presentation and ultrasonography (US) findings were recorded and compared between groups. To assess the optimum time clamping, postoperative bleeding was noted carefully in all groups. The success rate was recorded at onemonth postoperative follow-up in the clinic. Results: Of the 120 patients with MS who underwent a meatotomy procedure, there were 40 (33.3%) participants in each group. The main symptoms were painful urination and urine stream deviation that represented in 54 (46%) patients. Bladder wall thickness was the main pre-operation finding in the US which was observed in 67 (55.8%) patients. In comparison between the groups related to clamping time, bleeding was observed and required suturing when clamping was applied for 2 minutes in 4 (3.3%) patients (p = 0.016). With a minimum follow-up of 12 months, no recurrent meatal stenosis was reported. Conclusions: Clamping time for more than 2 minutes may prevent bleeding during and after meatotomy.

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