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World Journal of Urology

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Open Access 01-01-2022 | Hypospadia | Original Article

Single-stage versus staged interposition urethroplasty for glandular hypospadias with severe penile curvature: 15-year experience

Authors: Guanglun Zhou, Wanhua Xu, Jianchun Yin, Junjie Sun, Zhilin Yang, Shoulin Li

Published in: World Journal of Urology | Issue 1/2022

Abstract

Purpose

Our study examined the benefit of an alternative interposition urethroplasty (IU) procedure for glandular hypospadias (GH) with severe penile curvature (SPC). The technique involved transecting and reconstructing the urethra to preserve the distal glandular and coronal urethra and correct the curvature. We compared procedural characteristics, outcomes, and surgical complications for the single-stage and staged IU techniques.

Methods

We retrospectively studied 44 patients with GH with SPC who underwent single-stage or staged IU between March 2005 and June 2020. Demographics, operative details, complications, and uroflometry findings were analyzed.

Results

The median age at initial surgery was 37.5 months. Ten patients underwent single-stage IU repair, and 34 patients underwent staged IU repair. The median length of the interposition neourethra was 3.2 cm (2.2–4.3). The median follow-up duration was 58 months, and the overall complication rate was 13.6%. Complications were noted in 30% (3/10) and 8.8% (3/34) of patients in the single-stage and staged IU groups, respectively (p > 0.05). Fistula formation was noted in one and three patients in the single-stage and staged groups, respectively (8.8% vs. 10%, p > 0.05). Two cases of urethral stricture were documented in the single-stage group only. No chordee recurrence or urethral diverticula was noted in any of the patients.

Conclusion

IU is a reliable and durable technique for GH with SPC. It avoided penile shortening, preserved the distal urethra, and reduced the risk of chordee recurrence. The staged IU technique had more superior outcomes compared to the single-stage IU technique.

Baskin LS, Ebbers MB (2006) Hypospadias: anatomy, etiology, and technique. J Pediatr Surg 41(3):463–472. https://doi.org/10.1016/j.jpedsurg.2005.11.059CrossRefPubMed

Stanasel I, Le HK, Bilgutay A et al (2015) Complications following staged hypospadias repair using transposed preputial skin flaps. J Urol 194(2):512–516. https://doi.org/10.1016/j.juro.2015.02.044CrossRefPubMedPubMedCentral

Yz A, Zs B, Xz C et al (2020) Comparison of meatal-based flap (Mathieu) and tubularized incised-plate (TIP) urethroplasties for primary distal hypospadias: a systematic review and meta-analysis. J Pediatr Surg 55(12):2718–2727. https://doi.org/10.1016/j.jpedsurg.2020.03.013CrossRef

Kzlz H, Okelik S, Temel MC (2020) MAGPI under local anaesthesia without catheter as an alternative to standard TIP procedure in distal hypospadias repair. Andrologia 53(2):e13949. https://doi.org/10.1111/and.13949CrossRef

Bhat A, Saxena G, Abrol N (2008) A new algorithm for management of chordee without hypospadias based on mobilization of urethra. J Pediatr Urol 4(1):43–50. https://doi.org/10.1016/j.jpurol.2007.06.008CrossRefPubMed

Hadidi AT (2012) The slit-like adjusted Mathieu technique for distal hypospadias. J Pediatr Surg 47(3):617–623. https://doi.org/10.1016/j.jpedsurg.2011.12.030CrossRefPubMed

Seo S, Ochi T, Yazaki Y et al (2016) Correction of penile ventral curvature in patients with minor or no hypospadias: a single surgeon’s experience of 43 cases. Pediatr Surg Int 32(10):1–5. https://doi.org/10.1007/s00383-016-3950-xCrossRef

Greenfield JM, Lucas S, Levine LA (2006) Factors affecting the loss of length associated with tunica albuginea plication for correction of penile curvature. J Urol 175(1):238–241. https://doi.org/10.1016/S0022-5347(05)00063-7CrossRefPubMed

Moscardi P, Rafael G, Alfedo CM (2017) Management of high-grade penile curvature associated with hypospadias in children. Front Pediatr 4(5):189. https://doi.org/10.3389/fped.2017.00189CrossRef

10.

Hurwitz RS, Ozersky D, Kaplan HJ (1987) Chordee without hypospadias: complications and management of the hypoplastic urethra. J Urol 138(2):372–375. https://doi.org/10.1111/j.1464-410X.1987.tb04967.xCrossRefPubMed

11.

Moradi M, Kazemzadeh B, Hood B, Rezaee H, Kaseb K (2016) Meatal mobilization and glanuloplasty: a viable option for coronal and glanular hypospadias repair. Urology 94:204–207. https://doi.org/10.1016/j.urology.2016.05.006CrossRefPubMed

12.

Song B, Cai ZM (2012) Possible function of the frenulum of prepuce in penile erection. Andrologia 44(1):23–25. https://doi.org/10.1111/j.1439-0272.2010.01099.xCrossRefPubMed

13.

Robinson AJ, Harry LE, Stevenson JH (2013) Assessment of long term function following hypospadias reconstruction: do flow rates, flow quality and cosmesis improve with time? Results from the modified Bretteville technique. J Plast Reconstr Aesthet Surg 66(1):120–125. https://doi.org/10.1016/j.bjps.2012.07.011CrossRefPubMed

14.

Sylvia M, Palmer LS (2011) Abnormalities of penile curvature: chordee and penile torsion. Sci World J 28(11):1470–1478. https://doi.org/10.1100/tsw.2011.136CrossRef

15.

Tang YM, Chen SJ, Huang LG, Wang MH (2007) Chordee without hypospadias: report of 79 Chinese prepubertal patients. J Androl 28(4):630–633. https://doi.org/10.2164/jandrol.106.002436CrossRefPubMed

16.

Singh S, Rawat J, Kureel SN, Pandey A (2013) Chordee without hypospadias: operative classification and its management. Urol Ann 5(2):93–98. https://doi.org/10.4103/0974-7796.110005CrossRefPubMedPubMedCentral

17.

Faure A, Bouty A, Nyo YL, Brien MO’, Heloury Y (2016) Two-stage graft urethroplasty for proximal and complicated hypospadias in children: a retrospective study. J Pediatr Urol 12(5):286.e1-286.e7. https://doi.org/10.1016/j.jpurol.2016.02.014CrossRef

18.

Mahmoud AY, Gouda S, Gamaan I, Baky Fahmy MA (2019) Autologous platelet-rich plasma covering urethroplasty versus dartos flap in distal hypospadias repair: a prospective randomized study. Int J Urol 26(4):475–480. https://doi.org/10.1111/iju.13912CrossRefPubMed

19.

Sunay M, Dadal M, Karabulut A, Emir L, Erol D (2007) Our 23-year experience in urethrocutaneous fistulas developing after hypospadias surgery. Urology 69(2):366–368. https://doi.org/10.1016/j.urology.2006.12.012CrossRefPubMed

20.

Wang C, Song HC, Zhang WP (2019) Staged transverse preputial island flap urethroplasty for proximal hypospadias: a single-center experience. Pediatr Surg Int 35(7):823–827. https://doi.org/10.1007/s00383-019-04480-7CrossRefPubMed

21.

Helmy TE, Ghanem W, Orban H et al (2018) Does grafted tubularized incided plate improve the outcome after repair of primary distal hypospadias: a prospective randomized study? J Pediatr Surg 53(8):1461–1463. https://doi.org/10.1016/j.jpedsurg.2018.03.019CrossRefPubMed

22.

Chen C, Yang TQ, Chen JB, Sun N, Zhang WP (2016) The effect of staged transverse preputial island flap urethroplasty for proximal hypospadias with severe chordee. J Urol 196(5):1536–1540. https://doi.org/10.1016/j.juro.2016.05.098CrossRefPubMed

23.

Price RD, Lambe GF, Jones RP (2003) Two-stage hypospadias repair: audit in a district general hospital. Br J Plast Surg 56(8):752–758. https://doi.org/10.1016/j.bjps.2003.08.015CrossRefPubMed

24.

Snodgrass WT (2015) Opposing views: flap versus graft 2-stage repair of severe hypospadias with chordee. J Urol 193:760–762. https://doi.org/10.1016/j.juro.2014.12.063CrossRefPubMed

25.

Catti M, Lottmann H, Babloyan S, Lortat-Jacob S, Mouriquand P (2009) Original Koyanagi urethroplasty versus modified Hayashi technique: outcome in 57 patients. J Pediatr Urol 5(4):300–306. https://doi.org/10.1016/j.jpurol.2009.03.010CrossRefPubMed

26.

Castagnetti M, El-Ghoneimi A (2010) Surgical management of primary severe hypospadias in children: systematic 20-year review. J Urol 184(4):1469–1475. https://doi.org/10.1016/j.juro.2010.06.044CrossRefPubMed

27.

Braga L, Lorenzo AJ, Bägli DJ et al (2008) Ventral penile lengthening versus dorsal plication for severe ventral curvature in children with proximal hypospadias. J Urol 180(4):1743–1748. https://doi.org/10.1016/j.juro.2008.03.087CrossRefPubMed

28.

Hueber PA, Antczak C, Abdo A, Franc-Guimond J, Barrieras D, Houle AM (2015) Long-term functional outcomes of distal hypospadias repair: a single center retrospective comparative study of TIPs Mathieu and MAGPI. J Pediatr Urol 11(2):68.e1-68.e7. https://doi.org/10.1016/j.jpurol.2014.09.011CrossRef

Title: Single-stage versus staged interposition urethroplasty for glandular hypospadias with severe penile curvature: 15-year experience
Authors: Guanglun Zhou
Wanhua Xu
Jianchun Yin
Junjie Sun
Zhilin Yang
Shoulin Li
Publication date: 01-01-2022
Publisher: Springer Berlin Heidelberg
Keywords: Hypospadia
Urethral Stricture
Published in: World Journal of Urology / Issue 1/2022
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-021-03829-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Single-stage versus staged interposition urethroplasty for glandular hypospadias with severe penile curvature: 15-year experience

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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