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 The outcome of limited urethral mobilization urethroplasty for anterior hypospadias.

2020 ◽  
Vol 27 (01) ◽  
pp. 210-216
Author(s):  
Shafiq-ur- Rehman ◽  
Yasir Makki ◽  
Fareena Ishtiaq ◽  
Waleeja Shami Khan ◽  
Nauman Aziz ◽  
...  
Keyword(s):  
Wound Infection ◽  
Functional Outcome ◽  
Study Design ◽  
Complication Rate ◽  
Surgical Techniques ◽  
Significant Risk ◽  
Paediatric Surgery ◽  
Urethrocutaneous Fistula ◽  
Cosmetic Appearance ◽  
Minimum Age

Objectives: Hypospadias, one of the most common genital anomalies, is characterized by an abnormal meatal opening on the ventral aspect of penis. Anterior hypospadias are the most common. Most of the surgical techniques involves the construction of neourethra with significant risk of urethrocutaneous fistula. Limited urethral mobilization technique involves the advancement of native urethra. Study Design: The objective of this study was to evaluate the outcome of Limited Urethral Mobilization Urethroplasty for Anterior Hypospadias. Setting: The study was conducted in the Department of Paediatric Surgery, DHQ teaching Hospital Sahiwal. Period: From January 2016 to December 2018. Material & Methods: A total number of 187 patients were included in this study. Limited urethral mobilization technique was used in all patients. Minimum age was 2.5 Years and maximum age was 12 years. Cosmetic appearance, functional outcome and complication rate were assessed. Results: Wound infection developed in 3.20 %( n=6) patients. Complete glanular disruption was seen in 2.13 %( n=4) patients. Partial disruption of glans with meatal retraction was observed in 1.60 %( n=3) patients. Post-operative haematoma was seen in 1.60 %( n=3) patients. Meatal stenosis in 1.06 %( n=2) patients.   Post-operative bleeding and diverticula was observed in 0.5 %( n=1) patients each. Vertical oriented, slit like meatus at the tip of glans was achieved in 95.72 %( n=179) patients. Conclusion: Limited urethral mobilization urethroplasty is a technique with proven benefits and effectiveness in the terms of cosmesis and functional outcome with a minimal number of complications because of the usage of native elastic urethra.

scholarly journals Limited Urethral Mobilization Technique in Distal Hypospadias Repair : An Overview

2017 ◽  
Vol 16 (1) ◽  
pp. 37-41 ◽  
Author(s):  
Abhi Kumar Chakraborty ◽  
Sajal Kumar Majumdar ◽  
Mirza Kamrul Zahid ◽  
Ipsita Biswas ◽  
Poritosh Palit
Keyword(s):  
Surgical Techniques ◽  
Functional Results ◽  
Postoperative Management ◽  
Fistula Formation ◽  
Hypospadias Repair ◽  
Cutaneous Fistula ◽  
College Hospital ◽  
Medical College ◽  
Distal Hypospadias ◽  
A Minor

Background: Fistula formation is the most common complication with various rates among different techniques of hypospadias repair. The urethral advancement as an one stage technique for repair of hypospadias is considered a good technique. As no new urethral tube is constructed there is no risk of fistula. We assess the outcomes of the Limited Urethral Mobilization (LUM) technique in distal hypospadias repair.Methods: Our study included 20 patients aged upto 12 years who were treated with Limited urethral mobilization technique for distal hypospadias in Shaheed Suhrawardy Medical College Hospital from December 2014 to December 2015. The urethra proximal to the meatus was mobilized for a distance sufficient to allow it to reach the glans tip without tension. Then the urethra was placed in the glanular bed and glanular reconstruction was performed.Results: Three-fold urethral mobilization was sufficient for construction of tension-free urethra-glanular anastomosis. Cosmetically normal looking circumcised penis with ventrally slit meatus achieved in all but one subcoronal case where the most distal of the glans approximation sutures disrupted leading to a minor detachment in the glans. The minor complications includes preputial edema in one patient, two patients had wound infection, one had meatal stenosis which was treated with gentle dilatations. Postoperative urethro cutaneous fistula, retraction of the urethral meatus or recurrent chordee were not observed.Conclusion: Distal hypospadias repair with the LUM technique can be effective with satisfactory cosmetic and functional results. There is no chance for development of urethro cutaneous fistula, a major postoperative complication of other surgical techniques of creating a neourethra. Postoperative management is simple and a brief hospital stay is sufficient.Chatt Maa Shi Hosp Med Coll J; Vol.16 (1); Jan 2017; Page 37-41

Reconstructive Techniques of Primary Distal Penile Hypospadias: A Meta-Analysis Study of Last 10 Years

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Omar Goda Hassan Mohammad ◽  
Khaled Ahmed Mahmoud Reyad ◽  
Ahmed Ali Hassan ◽  
Osama Fouad Mohamed Abdelgawad
Keyword(s):  
Meta Analysis ◽  
Surgical Techniques ◽  
Case Series ◽  
Hypospadias Repair ◽  
Inclusion Criteria ◽  
Meatal Stenosis ◽  
Postoperative Fistula ◽  
Distal Hypospadias ◽  
Reported Data ◽  
Reconstructive Techniques

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.

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

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

OUTCOME OF TUNICA VAGINALIS FLAP FOR REPAIR OF URETHROCUTANEOUS FISTULA AFTER HYPOSPADIAS REPAIR

2021 ◽  
pp. 27-28
Author(s):  
Aniket Patil ◽  
Ajay Naik
Keyword(s):  
Suture Material ◽  
Surgical Techniques ◽  
Absorbable Suture ◽  
Hypospadias Repair ◽  
Urethrocutaneous Fistula ◽  
Tunica Vaginalis ◽  
Basic Principles ◽  
Urethral Closure ◽  
Distal Obstruction ◽  
Hypospadias Surgery

The commonest complication following hypospadias repair is occurrence of urethro-cutaneous stula(UCF) with a reported incidence of 4-25% 1. The expected stula rate is between 10% to 15% for onestage hypospadias surgery. UCF after hypospadias repair remains a signicant challenge for paediatric surgeons despite the advances in surgical techniques. Our aim is to assess the outcome of tunica vaginalis ap repair in cases of urethro-cutaneous stula. Our study included 23 patients who underwent UCF repair using TVF. Successful repair of these UCF depends on several basic principles, which are the avoidance of procedures on inamed tissue, correction of distal obstruction, a tension-free urethral closure with absorbable suture material, and covering of the urethral repair with well-vascularized tissue. From our study we feel that many complications mainly recurrent stula can be avoided using the above principles.

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 Dorsal vertical island flap urethroplasty in children with hypospadias: a single center’s experience 75 patients

2019 ◽  
Vol 2 (1) ◽  
pp. e000021
Author(s):  
Gontumukkala Chalapathi ◽  
Kadiri Sitha Ramaiah ◽  
Javvadi Veeraswamy
Keyword(s):  
Good Alternative ◽  
Urethral Diverticulum ◽  
Vertical Tube ◽  
Island Flap ◽  
Urethrocutaneous Fistula ◽  
Urethral Plate ◽  
Meatal Stenosis ◽  
Cosmetic Appearance ◽  
Good Cosmetic ◽  
The Mean

ObjectiveTo assess the results and complications of dorsal vertical island flap (DVIF) urethroplasty.MethodsA total of 175 children were operated on for hypospadias. Out of these, 41 with proximal hypospadias with severe chordee required two-stage urethroplasty. In 18 babies with glanular hypospadias, a meatal advancement and glanuloplasty procedure was done. In 25 babies with mid-penile and distal penile hypospadias, tubularized incised urethral plate (TIP) urethroplasty was the option. 16 babies with unhealthy urethral plate and chordee were chosen for dorsal vertical tube urethroplasty after excision of the urethral plate. The rest of the 75 babies with proximal, mid-penile or distal penile hypospadias with no or minimal chordee after degloving and poor urethral plate were chosen for DVIF urethroplasty. These 75 babies with DVIF were followed up from 3 months to 5 years to assess complications such as urethrocutaneous fistula, meatal stenosis, glans dehiscence, megalourethra or urethral diverticulum, stricture, and penile torsion/rotation.ResultsA total of 75 patients with proximal, mid-penile, or distal penile hypospadias in whom DVIF was used during the study period were included. The mean age was 3.7 years, ranging from 8 months to 14 years. Fourteen patients developed complications (18.6%). The most common complication was urethrocutaneous fistula, which was seen in seven (9.3%) patients. Glans dehiscence was seen in five patients (6.6%), and one had meatal stenosis with diverticulum formation. Skin necrosis was observed in one patient. In 61 patients, stream was good, with no torsion, and good cosmetic appearance was observed.ConclusionsDVIF is a good alternative to TIP in mid-penile and distal penile hypospadias. Our early experience with DVIF urethroplasty showed an acceptable rate of complications and good cosmetic results.

scholarly journals Spongioplasty with Dartos Flap Coverage in the Snodgrass Technique of Hypospadias Repair

2020 ◽  
Vol 38 (2) ◽  
pp. 64-67
Author(s):  
Sahadeb Kumar Das ◽  
Kaniz Hasina ◽  
Md Ashraf Ul Huq ◽  
Syed Abdul Adil ◽  
Md Mahbubul Alam ◽  
...  
Keyword(s):  
Prospective Study ◽  
Fistula Formation ◽  
Hypospadias Repair ◽  
Urethrocutaneous Fistula ◽  
Urethral Plate ◽  
Flap Coverage ◽  
Dartos Flap ◽  
Distal Hypospadias ◽  
A Prospective Study

Objective: The aim of the study is to evaluate the role of spongiosal tissue with dartos flap coverage for preventing Urethrocutaneous Fistula (UCF) formation in the Snodgrass technique. Materials and Methods: It is a prospective study, performed on 35 patients of mid penile and distal hypospadias aged 15 months to 144 months who underwent urethroplasty in the Snodgrass technique using spongiosal tissue and dartos flap for neourethral coverage. Results: Among 35 patients, Age ranged from 15 months to 144 months (mean 85.94 months). Chordee was corrected by penile degloving alone in 11 patients, partial mobilization of urethral plate with spongiosum in 20 patients and 4 patients required dorsal plication. Glans groove was deep in 19 patients, shallow in 13 patients and no groove noticed in 3 patients. Sixteen patients had narrow urethral plate (<8mm) and 19 patients had adequate urethral plate (>8mm). Urethrocutaneous Fistula (UCF) was encountered in five patients (14.28%), meatal stenosis in two patients (5.71%), and partial glanular dehiscence in one patient. Conclusions: Approximation of spongiosal tissue along with dartos flap as the intermediate layer for neourethral coverage reduces fistula formation. J Bangladesh Coll Phys Surg 2020; 38(2): 64-67

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