Cyanoacrylate Based Products as Interpositioning Substance versus Reintervention Alone for Urethrocutaneous Fistula Repair after Hypospadias

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H M Abdallah ◽  
A M Tawfeek ◽  
A M W Mohareb
Keyword(s):  
Success Rate ◽  
Surgical Repair ◽  
Fistula Formation ◽  
P Value ◽  
Hypospadias Repair ◽  
Urethrocutaneous Fistula ◽  
Cyanoacrylate Glue ◽  
Recurrent Fistula ◽  
Significant Difference ◽  
Basis Method

Abstract Background urethrocutaneous fistula (UCF) is still the commonest complication after hypospadias repair. Although recent advances in the surgical procedures of hypospadias repair have reduced the rate of urethrocutaneous fistula formation, it remains a real complication of hypospadias and frustrating problem for surgeons. Aim of the Work evaluation of success and failure rates of using cyanoacrylate based productes as an interpositioning substance in surgical repair of fistula after hypospadias in comparison to the classic surgical repair technique. Patients and Methods this is a prospective, randomized-controled study, conducted on 40 patients from the date of the approval of the study. It is comparing two different modalities for repair of urethrocutaneous fistula that has developed after hypospadias repair. Our study was assigned on a randomized basis method according to a 1:1 ratio and patients underwent either multilayered closure using dartos facial flap or using cyanoacrylate glue as an interpositioning layer before suturing of the dartos flap for the closure of the urethrocutaneous fistula. All cases were divided into 2 equal groups, 20 cases each. The cases were distributed randomly into the two groups. Results the success rate was higher for patients using cyanoacrylate glue as a protective interpositioning layer as 16 patients (80%) were successfully repaired and 4 patients (20%) developed a recurrent fistula. However, there was no statistically significant difference between 2 groups p-value was 0.465. Conclusion there was no statistically significant difference in adding cyanoacrylate glue to multilayered closure of urethrocutaneous fistula after hypospadias repair. However, cyanoacrylates showed that they are a favourable additional protective substance and they resulted in a high success rate without adding any surgical complications.

scholarly journals Adolescent and Adult Hypospadias Repair: A Retrospective Study

2021 ◽  
Author(s):  
Krishnendu Maiti ◽  
Bikram Haldar ◽  
Dilip Kumar Pal
Keyword(s):  
Adult Population ◽  
Tertiary Care ◽  
Age Groups ◽  
P Value ◽  
Care Hospital ◽  
Hypospadias Repair ◽  
Observational Assessment ◽  
Urethrocutaneous Fistula ◽  
Exact Test ◽  
Significant Difference

Introduction: There is a general consensus that results of hypospadias repair surgery, done on children, seem to have a better outcome when compared to the adults. Hypospadias cases in adults can present as primary or with complications resulting from an attempted repair. Aim: To assess any difference in outcome of surgeries done among the adolescent and adult population and to evaluate the use of a Tunica Vaginalis (TV) second layer barrier flap in preventing complications such as urethrocutaneous fistula. Materials and Methods: This was a single centre retrospective observational assessment of the adolescent and adult hypospadias surgeries conducted at a Tertiary Care Hospital from January 2016 to July 2019. The assessment was based on the presentation, site of hypospadias meatus, previous surgery and development of any complications or recurrence. Routine surgeries as per the hospital protocol were done in these patients. Follow-up was done for the next 12 months. For data analysis tables, columns and pie charts were used. Fisher’s-exact test was used to find the association and calculate the p-value with the help of SPSS 21.0 software. Results: Total 28 patients were assessed, of which 17 patients were adolescents (mean age 14.6±1.66 years) and 11 (mean age 22.7±3.51 years) were adult. There was no significant (p-value 0.581) difference in the final outcome of hypospadias repair surgery between the adolescent and adult population. Use of TV interposition barrier flap prevented development of complications. Urethrocutaneous fistula was the most common form of complication noted in both the groups overall rate of complication was 14.2%. Conclusion: When hypospadias repair in adolescents and adults is done in a systematic and meticulous fashion, the outcome was satisfactory and there was no significant difference in outcome among the two age groups. Use of TV flap as a second layer interposition can improve the outcome in such patients.

scholarly journals Role of silicone stenting in endoscopic dacryocystorhinostomy

2020 ◽  
Vol 6 (2) ◽  
pp. 248
Author(s):  
Abdussalam M. Jahan ◽  
Yousef M. Eldanfur ◽  
Abdulhakim B. Ghuzi
Keyword(s):  
Success Rate ◽  
Medical Center ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
P Value ◽  
Success Rates ◽  
Duct Obstruction ◽  
Significant Difference ◽  
Silicone Stent ◽  
Endoscopic Dcr

<p class="abstract"><strong>Background:</strong> Dacryocystorhinostomy (DCR) is a surgical procedure performed to relief nasolacrimal duct obstruction, which involves the creation of ostium at the lacrimal bone to form a shunt in the nasolacrimal pathway. Closure of the rhinostomy opening was considered a major factor for surgical failure. Use of silicone stent in endoscopic DCR to improve the success rate of the operation have been tried by many surgeons. In this study we assess the success rates of endoscopic DCR with and without silicone stents.</p><p class="abstract"><strong>Methods:</strong> Prospective study includes 30 patients were operated in the Department of ENT, Misrata Medical Center, from April 2017 to March 2018. They underwent endonasal endoscopic DCR for primary acquired nasolacrimal duct obstruction.<strong> </strong>These patients were randomly divided in two groups: A and B with 15 patients in each group. The group A patients underwent endoscopic DCR with silicone stent and group B patients underwent endoscopic DCR without stent. The results were statistically analyzed by chi-square test.  </p><p class="abstract"><strong>Results:</strong> 30 patients were included in this study, their age ranged from 17 to 60 years, complaining of epiphora, 24 (80%) were females and 6 (20%) were males. The success rate was higher in patients with silicone stent (93.33%) as compared to patients without silicone stent (86.67%) but this difference in the results is not statistically significant (As p value is 0.542 which is &gt;0.05).</p><p><strong>Conclusions:</strong> Endoscopic DCR is safe, successful procedure for treatment of nasolacrimal duct obstruction and there was no significant difference in the success rates of performing endonasal DCR with silicone or without silicone stents.</p>

scholarly journals Side-to-side penoscrotal anastomosis: a reliable technique for repair of recurrent urethrocutaneous fistula in male children

2021 ◽  
Vol 8 (9) ◽  
pp. 2675
Author(s):  
Philemon E. Okoro ◽  
Ngozi O. Onyeanunam
Keyword(s):  
Comparative Study ◽  
Double Layer ◽  
Surgical Repair ◽  
P Value ◽  
Urethrocutaneous Fistula ◽  
Reliable Technique ◽  
Repair Technique ◽  
Paediatric Patients ◽  
Failed Attempt

Background: Surgical repair of urethrocutaneous fistulae (UCF) is relatively simple and results are often satisfactory. However, in some cases of UCF, recurrence results despite several attempts at repair. Reports are scanty on the management of such recalcitrant UCF. The aim of the study was to present our experience with recurrent UCF, and describes our technique of side-to-side penoscrotal anastomosis for repair of such fistulae.Methods: This was a 10 years analytical comparative study of the outcome of repair of recurrent UCF in paediatric patients using the simple double layer repair technique, and our technique of anastomosing the penis to the scrotum between 2008 and 2019 in our centre. Data obtained and analysed with SPSS 21 version included the number of previous attempts at repair, number, site and size of UCF, technique of repair, and the incidence of recurrence of UCF.Results: Nineteen patients were studied. Nine had conventional double layer repair of UCF with recurrence in 5 (55.6%). Two of the recurrent cases were added to the remaining 10 patients to make a total of 12 cases who had the staged repair by penoscrotal anastomosis (PSA) and there was no recurrence during the average follow up period of 1 year. P value was <0.05.Conclusions: Findings in this study suggest a superior outcome when the penoscrotal anastomosis is used for repair of recurrent UCF. We think it is better to apply this technique in cases of UCF which the surgeon considers potentially difficult than to wait to have a failed attempt before deploying it.

Does the Choice of Suture Material Affect the Incidence of Urethrocutaneous Fistulae After Hypospadias Repair? – A Comparison of Polyglactin 910 with Polydioxanone

2017 ◽  
Vol 9 (03) ◽  
Author(s):  
Adnan Khalid ◽  
Syed Hashim Zaidi ◽  
Marvi Baloch ◽  
Fahad Saleem
Keyword(s):  
Data Analysis ◽  
Suture Material ◽  
Fistula Formation ◽  
Military Hospital ◽  
Hypospadias Repair ◽  
Polyglactin 910 ◽  
Urethral Fistula ◽  
Significant Difference ◽  
Randomized Experimental Design

Background: We aimed to assess the incidence of developing postoperative urethrocutaneous fistulae (UCF) while using either polyglactin 910 or polydioxanone for the repair of subcoronal hypospadias in paediatric patients. Methods: A multicenter, two-group posttest-only randomized experimental design was adopted for the study. The study was conducted at PNS Shifa Hospital Karachi, Combined Military Hospital Malir, Military Hospital Rawalpindi and Combined Military Hospital Multan from 2009 to 2016. Boys between the ages of 1 – 10 years with confirmed diagnosis of subcoronal hypospadias suitable for single stage repair with the Snodgrass technique and also completing a minimum follow up of 6 months were targeted for the study. The subjects were later randomized into PG group (those undergoing urethral repair with polyglactin 901) and PD group (those in whom polydioxanone was used). Both descriptive and inferential statistics were used for data analysis. SPSS v. 21.0 was used for data analysis with p > 0.05 taken as significant value. Results: Two hundred patients with confirmed diagnosis of subcoronal hypospadias were recruited for the study in the proposed study period. Twenty-nine patients (29%) in the PG and 26 (26%) in the PD group developed UCF. There were seven (7%) cases of wound infection in the PG group compared to four cases (4%) in the PD Group; all eleven of the said were among those who developed UCF. Meatal stenosis was observed in six patients (6%) in the PG group and in nine patients (9%) of the PD group. No significant difference in the incidence of postoperative urethral fistula formation with the use of polyglactin 910 versus polydioxanone was however reported by the study findings. Conclusion: As there was no significant difference in the incidence UCF between Polyglactin 910 and Polydioxanone, the choice of suture material should be based on economical variations and availability of the two products.

scholarly journals LIMITED URETHERAL MOBILIZATION PROCEDURE (LUMP) FOR DISTAL PENILE HYPOSPADIAS REPAIR, A SINGLE CENTRE RETROSPECTIVE ANALYSIS

2021 ◽  
Vol 9 (5) ◽  
pp. 1335-1343
Author(s):  
Muhammad Riaz-ul-Haq ◽  
◽  
Arslan Raza Wasati ◽  
Mazhar Rafi ◽  
Sohail Jamil ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Surgical Techniques ◽  
Operation Time ◽  
Postoperative Management ◽  
Fistula Formation ◽  
Paediatric Surgery ◽  
Hypospadias Repair ◽  
Urethrocutaneous Fistula ◽  
Meatal Stenosis ◽  
Cosmetic Appearance

Background: Distal penile hypospadias is one of the commonest varieties of hypospadias. Different techniques have been mentioned in literature. The success rate is usually assessed by rate of fistula formation and over all cosmetic appearance and functional outcome. Limited Uretheral Mobilization Procedure (LUMP) for distal penile hypospadias is considered a good technique with almost zero fistula rate in some series. As no new urethral tube is constructed there is no risk of fistula. Objective: To evaluate the results of the Limited Urethral Mobilization Procedure (LUMP) for distal hypospadias repair. Methods.It is retrospective analysis of 32 patients aged up to 12 years who were treated with Limited urethral mobilization procedure for distal penile hypospadias in the Department of Paediatric Surgery Jinnah Hospital Lahore from December 2018 to November 2019. All patients were operated under general anesthesia. The urethra proximal to the meatus was mobilized adequately in such a way that it should reach the tip of glans easily without any ventral bending of penis.Then the urethra was placed in the glandular wings and reconstruction of glans was carried out. Dartos flap was also placed to cover the urethra as a safety measure to avoid urethrocutaneous fistula formation. Follow up was done for a period of 3 months with respect to fistula formation, meatal stenosis, retraction , chordee and over all cosmetic appearance. Results: Age range of children was 9 months to 12 years. Operation time ranged from 60-80 minutes. Seven of 32 cases were previously operated for distal penile hypospadias but after disruption of repair meatus was lying at coronal or subcoronal level. They also underwent LUMP. Five cases had minor chordee, it was corrected at the time of uretheral mobilization by simple excision of fiberous tisse in 4 patients while modified Nesbit dorsal placation was done in one. Cosmetically normal looking circumcised penis with slit like meatus was achieved in all.Two cases got superficial wound infection, two had meatal stenosis, one meatal retraction, one ventral chordee and one urethrocutaneous fistula. Conclusion: LUMP for distal penile hypospadias is a simple and effective procedure with minimum complications.There is no chance for development of urethrocutaneous fistula, a major postoperative complication of other surgical techniques for uretheroplasty. Postoperative management is simple and hospital stay is short.

scholarly journals Does the early removal of urethral stent can reduce postoperative complications of Snodgrass urethroplasty for hypospadias repair? A prospective randomized trial

2017 ◽  
Vol 4 (12) ◽  
pp. 3839 ◽  
Author(s):  
Hussein Lafta Hashim ◽  
Ahmed Al Adhami ◽  
Ali Hussain Abid
Keyword(s):  
Postoperative Complications ◽  
Wound Infection ◽  
Hypospadias Repair ◽  
Urethrocutaneous Fistula ◽  
Meatal Stenosis ◽  
Early Removal ◽  
Significant Difference ◽  
Group A ◽  
Urethral Stent ◽  
Group B

Background: Hypospadias is a relatively common congenital defect of the male external genitalia. The objective of this study was to evaluate whether the early removal of urethral stent following TIP Snodgrass repair of hypospadias can reduces postoperative complications of this procedure.Methods: In Al-Yarmouk teaching hospital, the surgical procedure included 61 tabularized incised plate (TIP) repairs for penile hypospadias. The patients were prospectively observed over 36 months and randomized into 2 groups, group (A) was 30 patients where the urethral stent was removed after 24 hours of operation, and group (B) was 31 cases where the stent removed in the 6th postoperative day. Suprapubic urinary diversion was done for all patients. All of the operations were performed by the same surgeon. Complications and cosmetic appearance were documented at last follow-up.Results: The average age of the patients was 3.9 years, urethrocutaneous fistula was observed in 2 cases in group A (6.6 %), while 11 patients had fistula in group B (35.4 %) with a statistically significant difference (p < 0.05).  meatal stenosis was reported in 4 patients in (group A) (13.3%), while 12 patients had such complication in group B (38.7%) with a statistically Significant difference as (P< 0.05). 6.6 % of group A developed wound infection, while 32.2 % had wound infection postoperatively in group B with a statistically significant difference (P< 0.05). Complete surgical failure when wound dehiscence occurs, it was found that no significant difference between the 2 groups (P value=0.1).Conclusions: TIP repair is a versatile operation that can be performed in almost all cases of penile hypospadias. We believe that early stent removal after 1 day of surgery for hypospadias repair simplifies postoperative care, highly reduces risk of development of urethrocutaneous fistula, meatal stenosis and wound infection, so obviates the need for antibiotics.

scholarly journals RISK FACTORS FOR URETHROCUTANEOUS FISTULAS FORMATION AFTER ONE STAGE HYPOSPADIAS REPAIR

2011 ◽  
Vol 18 (2) ◽  
Author(s):  
Mohammad Fariz ◽  
Arry Rodjani ◽  
Irfan Wahyudi
Keyword(s):  
Hormonal Therapy ◽  
Fistula Formation ◽  
Operation Technique ◽  
Hypospadias Repair ◽  
Urethrocutaneous Fistula ◽  
One Stage ◽  
History Of ◽  
Duration Of Operation ◽  
Urogenital Anomalies ◽  
Onlay Island Flap

Objective: To evaluate risk factors that contribute to urethrocutaneous fistulas formation after one stage hypospadias repair. Material & method: A case control study was performed on hypospadias patients that underwent one stage hypospadias repair. We analyzed the correlation of urethrocutaneous fistula formation with patient age, hypospadias classification, chordee severity, other urogenital anomalies, history of hormonal therapy, suture size, duration of operation, type of dressing, type of stent, duration of stenting, and three types of operation technique, which are TIP, Duckett, and Onlay Island Flap. Results: There were 116 patients with mean age 5,7 ± 3,9 years old (4 months – 19 years old). Urethrocutaneous fistula occured in 12 patients (10,3%). From the data analysis, we didn’t find any significant correlation between urethrocutaneous fistula formation and patient’s age (p = 0,426), hypospadias classification (p = 0,695), chordee severity (p = 0,564), other urogenital anomalies (p = 0,964), history of hormonal therapy (p = 0,739), suture size (p = 0,248), duration of operation (p = 0,856), type of dressings (p = 0,580), type of stents (p = 0,600), and duration of stenting (p = 0,796). We also didn’t find any significant correlation between urethrocutaneous fistula formation and operation technique TIP vs Duckett (p = 0,314), and TIP vs Onlay Island Flap (p = 0,644). Conclusion: There were no significant correlation between urethrocutaneous fistula formation and patient age, hypospadias classification, chordee severity, other urogenital anomalies, history of hormonal therapy, suture size, duration of operation, type of dressing, type of stent, and duration of stenting. There were also no significant correlation between urethrocutaneous fistula formation and operation technique TIP vs Duckett, and TIP vs Onlay Island Flap. Keywords: Hypospadias, one stage urethroplasty, urethrocutaneous fistula.

scholarly journals A comparative prospective randomised controlled study for mesh fixation by cyanoacrylate glue versus prolene sutures in patients undergoing Lichtenstein hernioplasty

2019 ◽  
Vol 7 (1) ◽  
pp. 83
Author(s):  
Dheer S. Kalwaniya ◽  
Satya V. Arya ◽  
Sumedha Gupta ◽  
Manigandan Kuppuswamy ◽  
Jaspreet S. Bajwa ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Mesh Fixation ◽  
Operating Time ◽  
Control Group ◽  
P Value ◽  
Study Group ◽  
Cyanoacrylate Glue ◽  
Post Operative Pain ◽  
Significant Difference

Background: Inguinal hernia repair is one of the most commonly performed procedures by general surgeons. Cyanoacrylate is the generic name for a family of fast acting adhesives. The aim of the present study done in Department of General Surgery, Safdarjung Hospital, New Delhi was to compare the newer emerging technique of mesh fixation.Methods: A total of sixty patients were included in the present study and were allotted in case and control group randomly by sealed envelope technique. In case (study) group, all the patients underwent mesh fixation by cyanoacrylate glue and in control group, by prolene 3-0 sutures.Results: Most frequency in age group 31-40 yrs, males:females ratio >1 and right sided inguinal hernia was more common. Bi-lateral hernia was common in elderly. Indirect: direct ratio 4.5:1. Operating time period for the patients of the case (study) group is less than control group. P value of post-operative pain in immediate post-operative period (day 1 and 2) and POD 30, 60 and 90 was not of clinical significance whereas the p-value on 6,120,150 and 180 post op day was of clinical significance. In our study, there was a case of incidental observation: a) reaction due to use of cyanoacrylate glue, b) rejection of mesh for which mesh had to be removed.Conclusions: There is no statistically significant difference between mesh fixation with cyanoacrylate glue and mesh fixation by prolene suture techniques in immediate post-operative pain. Statistically significant difference favoring mesh fixation by cyanoacrylate glue technique was seen with respect to operating time and post-operative groin pain with increasing post-operative duration.

scholarly journals Isoamyl 2-cyanoacrylate interposition in the urethro-cutaneous fistula repair: A randomized controlled trial

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
A. M. Tawfeek ◽  
Andrew Makeen Mohareb ◽  
Ahmed Higazy ◽  
Ahmed Farouk ◽  
Karim Omar Elsaeed ◽  
...  
Keyword(s):  
Surgical Repair ◽  
Controlled Trial ◽  
Demographic Data ◽  
Trial Registration ◽  
Cyanoacrylate Glue ◽  
Cutaneous Fistula ◽  
Group I ◽  
Significant Difference ◽  
Registration Number ◽  
Group Ii

Abstract Background We aim to evaluate isoamyl 2-cyanoacrylate as an intervening layer in the surgical repair of the urethra-cutaneous fistula (UCF) after hypospadias in comparison with the classic surgical repair technique. Methods Between January 2017 and July 2018, 40 patients with UCF were randomized into two equal groups. Group I represented a multilayered closure with dartos fascia flap while using cyanoacrylate glue as an interposition layer, while group II represented the same procedure without applying the glue. We followed up our patients for 6 months following the procedure to evaluate a successful closure. Results Forty patients were available for evaluation at the end of our study. There was no statistically significant difference between the two groups regarding their demographic data. The mean fistula size was 3.25 ± 0.64 and 3.15 ± 0.75 mm in group I and II, respectively, with a statistically significant difference. Successful UCF closure was achieved in 80% of cases in group I (16/20) and 70% of group II (14/20) with no statistically significant difference. There was no statistically significant difference between both groups as regards the occurrence of mild complications in the postoperative period, which was 10% in both groups. Conclusion The application of cyanoacrylate during UCF repair was feasible and safe. The successful repair of UCF was found to be higher with cyanoacrylate. However, we could not demonstrate a statistically significant difference between the two groups. Trial registration number The trial is registered at clinicaltrial.gov with trial registration number: NCT04876976 (retrospective registration)

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