Scrotal Hypospadias with Severe Chordee, Micropenis, and Bifid Scrotum in A Child Treated with Multi Stage Repair and Hormonal Therapy

Proximal hypospadias, include proximal penile, penoscrotal, scrotal and perineal types, are a less common occurrence and correspond to 20% of total hypospadias. Surgical reconstruction is the only possible therapeutic option for hypospadias. The primary objectives of the reconstruction are to create a vertically slit orthotopic meatus, straighten the penis and establish good cosmetic results that include a conically shaped glans. Other important aspects for the reconstruction are to avoid shortening the penis and optimal skin coverage. A 9 years old male presented with abnormal spraying during urination. The parents said that the opening of his urethra is located under the penis. Everytime he urinates, the urine flowing along the thighs. In physical examination, the opening of urethra is in the scrotum. The penis was uncircumcised while the scrotum was bifid in the normal position, and bilateral testes were fully descended in the well-developed scrotum. Repair of proximal hypospadias involves correction of several components of the hypospadias complex with the intent of optimizing long-term functional and cosmetic outcomes. These components include ventral penile curvature, proximal location of the urethral meatus, ventral skin deficiency, glans morphology abnormality, abnormal division of the corpus spongiosum, penile torsion and penoscrotal transposition. Surgical correction of several components divide into five sequential steps. Severe forms of hypospadia are typically accompanied by an abnormal ventral curvature of the penis (chordee). Surgical correction of both chordee and hypospadias is recommended. When properly corrected, it does not cause long-term problems, and a natural appearance of the penis is usually restored.

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Staged buccal mucosa graft Bracka urethroplasty in children with proximal hypospadias

Urology and andrology ◽

10.20953/2307-6631-2020-1-15-20 ◽

2020 ◽

Vol 8 (1) ◽

pp. 15-20

Author(s):

G.V. Kozyrev ◽

◽

D.Т. Manasherova ◽

G.А. Аbdulkarimov ◽

F.K. Аbdullaev ◽

...

Keyword(s):

Buccal Mucosa ◽

Penile Curvature ◽

Urinary Flow ◽

Proximal Hypospadias ◽

Buccal Mucosa Graft ◽

Primary Surgery ◽

History Of ◽

Key Words Hypospadias ◽

Cosmetic Outcomes

For management of proximal hypospadias in children both one-stage (Hodgson, Ducket), and two-stage (Bracka) technieuqa are used. The staged Bracka repair is preferable because of fewer complications. The objective of the study was to assess and improve the outcomes of treating children with proximal hypospadias by improving the staged buccal mucosa graft Bracka repair. Patients and methods. In the department of uroandrology of the National Children’s Clinical Hospital in the period from 2013 to 2019 126 boys with proximal hypospadias received operative treatment according to the methos of buccal mucosa graft Bracka repair. Depending on whether it was primary surgery or an operation after failed repair, all patients were divided into 2 groups. Results. Both functional and cosmetic outcomes of treatment were assessed in the near and long-term post-operative periods. The assessment of the functional outcomes was based on the following criteria: recovery of free passage of urine with a wide stream (average urinary flow rate) and absence of penile curvature. Cosmetic outcomes were analysed by the HOPE score. Conclusion. Staged buccal mucosa graft urethroplasty permits to obtain positive functional and cosmetic outcomes of treatment in 60% (51% good and 9% satisfactory) of patients in the near and long-term periods. The percentage of complications is 41% and they are mainly presented by urethral fistulae. In patients with a history of failed surgery the risk for developing complications is practically the same as in primary patients. Key words: hypospadias, curvature correction

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Faculty Opinions recommendation of Proximal hypospadias treated with a transverse preputial island tube: long-term functional, sexual, and cosmetic outcomes.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732995200.793552517 ◽

2018 ◽

Author(s):

Hsi-Yang Wu

Keyword(s):

Proximal Hypospadias ◽

Cosmetic Outcomes

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Urinary and sexual functions after surgical treatment of penile fracture concomitant with complete urethral disruption

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2014.1.15 ◽

2014 ◽

Vol 86 (1) ◽

pp. 15 ◽

Cited By ~ 5

Author(s):

Ali Abdel Raheem ◽

Hassan El-Tatawy ◽

Ahmed Eissa ◽

Abdel Hamid Elbahnasy ◽

Mohamed Elbendary

Keyword(s):

Case Series ◽

Surgical Reconstruction ◽

Urethral Injury ◽

Penile Curvature ◽

Retrospective Case ◽

Penile Fracture ◽

Case Series Study ◽

Long Term Follow Up

Objectives: Penile fracture with concomitant complete urethral disruption is an uncommon urologic disorder. Data about the treatment and outcome measurements of this condition are scarce in the literature. The aim of the present study is to evaluate the long term urinary and sexual functions of patients with penile fracture associated with complete urethral injury after immediate surgical reconstruction. Patients and methods: Twelve patients met our inclusion criteria and were included in this retrospective case series study; however, one was lost during follow-up. Patient's medical records were reviewed and all patients were interviewed for clinical evaluation. Urinary function was assessed by history, uroflometry and retrograde urethrography, while, sexual function was assessed by questionnaire (Sexual Health Inventory for Men) and penile Doppler for patients with erectile dysfunction. Results: Patients’ mean age was 32.3 ± 7.5 years (range 21-43) and the mean follow-up period was 72.6 ± 45.4 months (range 14-187). Vigorous sexual intercourse was the main cause in 91% of our patients. No serious long term complications was found. Only 1 patient (9%) suffered from anterior urethral stricture, 1 patient (9%) complained of weak erection, 3 patients (27%) had a palpable fibrosis and 2 patients (18%) reported a slight penile curvature during erection. Ninety one percent of all our patients maintained their normal urinary and sexual functions. Conclusion: On the long term follow-up, most of the patients maintained their normal erectile and voiding functions with no harmful long-term complications. We advocate immediate surgical intervention and reconstruction of both corpora cavernous and urethra as a first line treatment for those patients.

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Surgical Reconstruction of Forefoot with Fallen Arches in Combination with Hallux Valgus

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto201017471-74 ◽

2010 ◽

Vol 17 (4) ◽

pp. 71-74 ◽

Cited By ~ 1

Author(s):

B Sh Minasov ◽

S P Gutov ◽

Azat Rinatovich Bilyalov ◽

B Sh Minasov ◽

S P Gutov ◽

...

Keyword(s):

Hallux Valgus ◽

Surgical Correction ◽

Long Term Results ◽

Surgical Reconstruction ◽

High Efficacy ◽

Forefoot Deformity ◽

Radiologic Examination

Tactics of surgical reconstruction of the forefoot with fallen arches in combination with hallux valgus has been described depending on the deformity severity. Original techniques for myotenoplastic reconstruction of the forefoot that enable to restore muscular balance as well as to eliminate forefoot deformity and hallux valgus are proposed. In 235 patients (329 feet) ana-lysis of long term results of surgical correction using radiologic examination and AOFAS criteria showed high efficacy of the proposed technique. Durable preservation of the achieved correction was noted.

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1053 LONG-TERM PATIENTS SATISFACTION AFTER SURGICAL CORRECTION FOR PENILE CURVATURE

European Urology Supplements ◽

10.1016/s1569-9056(07)61048-3 ◽

2007 ◽

Vol 6 (2) ◽

pp. 286

Author(s):

A. Paez ◽

J. Mejias ◽

J. Vallejo ◽

I. Romero ◽

M. De Castro ◽

...

Keyword(s):

Surgical Correction ◽

Penile Curvature ◽

Patients Satisfaction

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Long-Term Functional Outcomes After Surgical Correction of Congenital Penile Curvature

Urology ◽

10.1016/j.urology.2021.04.038 ◽

2021 ◽

Author(s):

Antoine Paris ◽

Nicolas Morel-Journel ◽

Damien Carnicelli ◽

Alain Ruffion ◽

Paul Neuville

Keyword(s):

Functional Outcomes ◽

Surgical Correction ◽

Penile Curvature ◽

Congenital Penile Curvature

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Fracture penis: rare occurrence

International Surgery Journal ◽

10.18203/2349-2902.isj20184656 ◽

2018 ◽

Vol 5 (11) ◽

pp. 3747

Author(s):

Akhilesh Kumar Yadav ◽

Sankalp Dwivedi ◽

Sagar Bassi ◽

Sunil Kumar Singh

Keyword(s):

Blunt Trauma ◽

Tunica Albuginea ◽

Corpus Cavernosum ◽

Penile Curvature ◽

Corpus Spongiosum ◽

Penile Fracture ◽

Immediate Surgery ◽

Almost All ◽

Erect Penis

Fracture Penis is not usual. It is a tear in the tunica albuginea of the corpora cavernosa with or without involvement of corpus spongiosum and urethra. The usual cause is abrupt bending of the erect penis by blunt trauma, most commonly during sexual intercourse. A crackling sound, pain, detumescences, bruising, swelling, and bleeding per urethra are the common symptoms reported by the patients. Early surgical management is treatment of choice. Diagnosis of Penile Fracture refers to a rupture of the corpus cavernosum induced by blunt trauma to erect penis. Mainly diagnosed clinically from their stereotypical crackling sound from the erect penis at the moment of injury, rapidly followed by acute swelling, pain and penile deformity. Treatment recommendations include immediate exploration and repair. Surgical repair requires evacuation of hematoma, identification of tear, repair of the tear and ligation of any disrupted vasculature. Long term complications after repair include penile deviation, painful intercourse, painful erection and erectile dysfunction. The diagnosis of penile fracture is mostly clinical. Based on physical examination and typical crackling sound at the time of injury. Prompt surgical exploration and repair are advocated in almost all cases. Immediate surgery reduces long term complication which is post-traumatic penile curvature.

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