Concomitant repair of meatal stenosis and urethral fistula does not increase the risk of fistula recurrence post-hypospadias surgery

BackgroundHypospadias surgery has been continuously evolving, although there is no single technique which can be said to be perfect and suitable for all types of hypospadias. Tubularized incised plate (TIP) urethroplasty (Snodgrass procedure) is presently the most common surgical procedure performed for distal penile hypospadias (DPH). The aim of this study was to compare the outcome of TIP urethroplasty using Dartos flap (DF) and spongioplasty as second layer in DPH.MethodsA total of 30 patients of DPH were repaired using TIP urethroplasty with DF or spongioplasty as second layer from January 2017 to June 2018. Out of 30 patients, TIP with DF was done in 15 patients (group A) and TIP with spongioplasty was done in the remaining 15 patients (group B). Preoperative mean age and weight were comparable in both groups. Postoperative complications, namely, postoperative edema, residual chordee, urethrocutaneous fistula (UCF), meatal stenosis and final cosmesis, were recorded.ResultsIn both groups, complications included postoperative edema (Gp A-1Gp B-1), residual chordee (Gp A-1, Gp B-1), UCF (Gp A-3, Gp B-4), meatal stenosis (Gp A-1, Gp B-5) and poor cosmesis (Gp A-3, Gp B-4). Wound infection was managed with appropriate antibiotics, and meatal stenosis responded to calibration in five patients.Although it seems that DF has a better outcome clinically, the difference between the two techniques was statistically not significant.ConclusionDF as an additional cover to TIP is associated with an acceptable complication and has good cosmesis compared with spongioplasty; however, the difference is not statistically significant.

Download Full-text

Outcome of Buck’s fascia repair with wingless glanuloplasty in distal penile hypospadias

African Journal of Urology ◽

10.1186/s12301-021-00174-6 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Mir Fahiem-Ul-Hassan ◽

Vinay Jadhav ◽

Narendrababu Munianjanappa ◽

Murali Saroja ◽

Ramesh Santhanakrishnan

Keyword(s):

Prospective Study ◽

Postoperative Period ◽

Simple Procedure ◽

Exclusion Criteria ◽

Testosterone Therapy ◽

Cosmetic Results ◽

Meatal Stenosis ◽

Good Cosmetic ◽

Hypospadias Surgery

Abstract Background Hypospadias surgery is technically demanding and is often encountered with complications like fistula and glanular dehiscence. To prevent these complications we have instituted Buck’s fascia repair (BFR) with wingless glanuloplasty (WLP) in the cases of distal penile hypospadias (DPH) deemed to be suitable for TIP repair. The aim of this prospective study was to assess the outcome of Buck’s fascia repair (BFR) with minimal wingless glanuloplasty (WGP). Methods This prospective study included 50 patients with coronal, subcoronal and midpenile hypospadias who received a tubularization of incised plate (TIP) repair. The exclusion criteria were glanular hypospadias, Thiersch Duplay repair, proximal penile hypospadias, previous penile surgeries, uncorrectable chordee, glans size < 14 mm, flat glanular groove and preoperative testosterone therapy. Results Over a period of 3 years, 50 patients with mean age of 3.5 ± 0.8 years were recruited for the study. Meatal position was coronal, subcoronal and midpenile in 6, 24 and 20 patients, respectively. Fistula occurred in one patient (2%) and meatal stenosis in one. Straining on micturition was noted in two patients that needed dilatation in postoperative period. None of the patients had glanular dehiscence. Surgeon acceptability of the procedure was good. Cosmetic results were also fair. Conclusion Buck’s fascia repair with Wingless glanuloplasty is a good repair for the distal penile hypospadias. It is effective and is associated with low fistula rates and glanular dehiscence. It is technically simple procedure involving minimal dissection. However, caution should be observed in midpenile hypospadias to avoid tight repair in subcoronal region.

Download Full-text

Meatal Stenosis and Urethral Strictures After Hypospadias Surgery

Hypospadias Surgery ◽

10.1007/978-3-662-07841-9_41 ◽

2004 ◽

pp. 295-300

Author(s):

Pat Malone

Keyword(s):

Meatal Stenosis ◽

Urethral Strictures ◽

Hypospadias Surgery

Download Full-text

Preoperative Topical Estrogen Treatment vs Placebo in 244 Children With Midshaft and Posterior Hypospadias

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa231 ◽

2020 ◽

Vol 105 (7) ◽

pp. 2422-2429

Author(s):

Daniela Gorduza ◽

Ingrid Plotton ◽

Laurent Remontet ◽

Claire-Lise Gay ◽

Meriem El Jani ◽

...

Keyword(s):

Primary Outcome ◽

Bone Growth ◽

Primary Objective ◽

First Year ◽

Double Blind ◽

Urethral Fistula ◽

Parallel Group ◽

Skin Healing ◽

Hypospadias Surgery ◽

To Receive

Abstract Purpose Urethral fistula and dehiscence are common after hypospadias surgery. Preoperative androgens have been considered to reduce these complications although this consideration is not evidence-based. Dermatologists have reported the benefits of topical estrogens on skin healing. We investigated whether the preoperative use of topical promestriene could reduce healing complications in hypospadias surgery. Our primary objective was to demonstrate a reduction of healing complications with promestriene vs placebo. Impact on reoperations and other complications, clinical tolerance, bone growth, and biological systemic effects of the treatment were also considered. Methods We conducted a prospective, randomized, placebo-controlled, double-blind, parallel group trial between 2011 and 2015 in 4 French centers. One-stage transverse preputial island flap urethroplasty (onlay urethroplasty) was selected for severe hypospadias. Promestriene or placebo was applied on the penis for 2 months prior to surgery. The primary outcome was the presence of postoperative urethral fistula or dehiscence in the first year postsurgery. For safety reasons, hormonal and anatomical screenings were performed. Results Out of 241 patients who received surgery, 122 patients were randomized to receive placebo, and 119 patients received promestriene. The primary outcome was unavailable for 11 patients. Healing complications were assessed at 16.4% (19/116) in the placebo vs 14.9% (17/114) in the promestriene arm, and the odds ratio adjusted on center was 0.93 (95% confidence interval 0.45-1.94), P = 0.86. Conclusions and relevance Although we observed an overall lower risk of complications compared to previous publications, postsurgery complications were not different between promestriene and placebo, because of a lack of power of the study or the inefficacy of promestriene.

Download Full-text

Congenital urethrocutaneous fistula: Case report with review of literature

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.105979 ◽

2012 ◽

Vol 45 (03) ◽

pp. 563-565 ◽

Cited By ~ 6

Author(s):

Ankur Bhatnagar ◽

Vijai Upadhyaya ◽

Basant Kumar

Keyword(s):

Case Report ◽

Anorectal Malformations ◽

Review Of Literature ◽

Associated Anomalies ◽

Urethrocutaneous Fistula ◽

Penile Shaft ◽

Urethral Fistula ◽

Hypospadias Surgery

ABSTRACTWe are presenting two cases of congenital urethrocutaneous fistula on ventral penile shaft. Congenital urethral fistula is an extremely rare, but easily manageable anomaly that may be confused with hypospadias. Awareness of the entity will avoid complications. This condition may be associated with other anomalies like congenital hernias and anorectal malformations. Treatment of this entity is individualized according to site of fistula, associated anomalies and condition of the distal urethra. All the principles of hypospadias surgery should be strictly followed.

Download Full-text

Fistula after hypospadias: preliminary treatment results

American Journal of BioMedicine ◽

10.18081/2333-5106/019-01/58-62 ◽

2020 ◽

Vol 8 (4) ◽

pp. 265-269

Author(s):

Kadhum Jawad Shabaa

Keyword(s):

Preliminary Treatment ◽

Fistula Repair ◽

Treatment Results ◽

Simple Closure ◽

Urethral Fistula ◽

A Prospective Study ◽

Hypospadias Surgery ◽

Fascial Layer ◽

Operating Surgeon ◽

Results Of Surgery

Fistula is the commonest complication after hypospadias surgery ranged 10-30%. The results of surgery depending on the severity of hypospadias, surgical technique, and experience of the operating surgeon. This is a prospective study analysis the operational procedures in post-hypospadias urethral fistula repair. Through July 2015 to January 2017, 21 patients with 21 fistulas where classified their treatment into: 6 fistula with simple closure, 7 fistula simple closure with fascial layer, and 7 fistula dorsal slit with fascial layer. According to my experience I have successfully treated all urethral fistulas using my method, with success rate. We concluded that the midline urethral incision with the dartos flip flap is the main point for treatment of difficult urethral fistula after hypospadias operation.

Download Full-text