BibTex RIS Cite

Ciddi Proksimal Hipospadias Nedeni ile Opere Edilen Olgularda Uzun Dönem İzlemde Neler Değişti?

Year 2017, Volume: 11 Issue: 1, 1 - 4, 01.04.2017

Abstract

Amaç: Ciddi proksimal hipospadiaslı olgularda uzun dönem sonuçlarınının değerlendirildiği çalışmalar oldukça kısıtlıdır. Çalışmamızda; daha önce yayınladığmız transvers ada flebi (Duckett) ile ventral deri flebi (Thiersch-Duplay) tekniklerini kombine ederek tek seanslı onarım yaptığımız ciddi proksimal hipospadiası olan 34 olgunun birinci beş yıllık değerlendirmesini, aynı hasta grubunun ikinci beş yıllık incelemesi ile karşılaştırarak uzun dönemde ortaya çıkan problemleri belirlemeyi amaçladık.Gereç ve Yöntemler: Mayıs 2000-Mayıs 2009 tarihleri arasında erken sonuçları daha önce bildirilmiş Duckett ve Thiersch- Duplay tekniklerinin kombine edilerek opere edilen 34 olgu, uzun dönem sonuçlarını değerlendirmek amacı ile kontrole çağırıldı. Erken ve geç dönem sonuçları üretral fonksiyon ve komplikasyonlar açısından karşılaştırıldı.Bulgular: Proksimal anastomotik darlık ilk değerlendirmede 3 olguda (%8.8) görüldü. Uzun dönem izleminde yeni belirlenen anastomotik darlık olmadı. İlk değerlendirmede 1 olguda divertikül (%2.9) saptanırken, ikinci değerlendirmede bir olgumuzda daha divertikül geliştiği ve divertikül oranının %5.8’e yükseldiği görüldü. Erken dönem değerlendirmede 7 olgumuz (%20.6) fistül nedeni ile opere edildi. Uzun dönem izlemlerinde iki yeni olguda fistül belirlenirken, iki olguda da fistül rekürrensi olduğu saptandı. Uzun dönem izlemde 2 olguda (%5.9) persistan kordi varlığı tesbit edildi. 4 olgumuz (%11.8) ise penis boyunun kısa olmasından yakınıyordu. Ergenliğe ulaşan toplam 16 olgudan ereksiyon ve ejakulasyon fonksiyonları hastalar tarafından normal olarak ifade edildi. 13 olgumuza %38.2 reoperasyon gerekti. Reopere edilen olguların %38.5’i uzun dönemde operasyon gerektirdi. Olguların uzun dönem kontrollerinde yapılan sorgulamalarında 34 olgunun 28’inde idrar yaparken herhangi bir yakınması olmadığı, 6 olguda ise idrarlarının ince çıktığı ve idrar yaparken güçlük çektikleri öğrenildi. İdrar yolu enfeksiyonu divertikülü olan iki olguda görüldü. 32 olguda ise idrar yolu enfeksiyonu saptanmadı.Sonuç: Uzun dönemde izlemde toplam %61.8 olgunun sorunsuz seyrettiği görülmüştür. Olguların %38.2’inde reoperasyon ihtiyacı olurken, son dönem kontrollerinde penis küçüklüğü, penis eğriliği gibi ilk dönemde olmayan farklı yakınmalar ortaya çıkmaya başlamıştır. Ciddi proksimal hipospadiaslı olguların kozmetik ve oluşabilecek penil kurvatür, divertikül, geç fistüller nedeni ile uzun dönem izlemlerine devam edilmesinin gerektiğini düşünmekteyiz.

References

  • Pierik FH, Burdorf A, Hijman JM, de Muinck Keizer-Schrama SM, Juttmann RE, Weber RF. A high hypospadias rate in the Netherlands. Hum Reprod 2002;17:1112-5.
  • Lund L, Engebjerg MC, Pedersen L, Ehrenstein V, Norgaard M, Sorensen HT. Prevalence of hypospadias in Danish boys: a longitudinal study, 1977-2005. Eur Urol 2009;55:1022-6.
  • Castagnetti M, El-Ghoneimi A. Surgical management of primary severe hypospadias in children: Systematic 20-year review. J Urol 2010;184:1469-75.
  • Algen AB, Khawand N, Skoog ST, Belman AB. Acquired megalourethra: An uncommon complication of the transverse preputial island flap urethroplasty. J Urol 1987;137:710-2.
  • Mieusset R, Soulie M. Hypospadias: Psychosocial, sexual and reproductive consequence in adult life. J Androl 2005;26:163-8.
  • Singh JC, Jayanthi VR, Gopalakrishnan G. Effect of hypospadias on sexual function and reproduction. Indian J Urol 2008;24:249- 52.
  • Ebert AK, Bals-Pratsch M, Seifert B, Reutter H, Rosch WH. Genital and reproductive function in males after functional reconstruction of the exstrophy-epispadias complex-long term results. Urology 2008;72:566-9.
  • Tiryaki T. Combination of tubularized island flap and ventral skin flap techniques in single- stage correction of severe proximal hypospadias. Urologia Internationalis 2010;84:269-74.
  • Ikoma F, Shima H, Yabumoto H. Classification of enlarged prostatic utricle in patients with hypospadias. Br J Urol 1985;57:334-7.

Hypospadias on Long-Term Follow-up? What Changed in Patients Operated for Severe Proximal

Year 2017, Volume: 11 Issue: 1, 1 - 4, 01.04.2017

Abstract

Objective: There are only a few studies evaluating long-term consequences of cases with severe proximal hypospadias. In this study, we compared the first 5 years and second 5 years of 34 severe proximal hypospadias cases that were treated by a combination of a transverse island flap (Duckett) and ventral skin flap (Thiersch-Duplay) in order to reveal long-term complications. Material and Methods: The 34 cases were operated between May 2000- May 2009 by combining the Duckett and Thiersch-Duplay techniques, for which the short-term results were previously published. These 34 cases were invited to evaluate long-term results. Then, short- and long-term results were compared in terms of urethral functions and complications.results: In the short term, a proximal anastomotic stricture was observed in 3 cases (8.8%). In the long-term, there was no new anastomotic stricture observed. In the first evaluation, a diverticulum was noted in 1 case (2.9%), however, in the second evaluation, one more diverticula was noted and the diverticulum rate increased to 5.8%. In the short-term evaluation, 7 cases (20.6%) were operated due to a fistula. In the long-term evaluation, a fistula was observed in 2 more cases and fistula recurrence was observed in 2 cases.Two patients (5.9%) were diagnosed with persistent chordee on long-term follow-up and 4 patients (11.8%) complained of short penile length. Erection and ejaculatory function was normal in 16 cases who reached adolescence. Reoperation was required in 13 patients (38.2%). A reoperation was required in 38.5% of the cases in the long term. 28 out of 34 patients had no symptoms during urination, while the other 6 cases urinated with difficulty and had a thin stream. Urinary tract infections were seen in two patients with diverticula while 32 patients had no urinary tract infection. conclusion: In the long-term evaluation, 61.8% of the cases did not show any complications. However, 38.2 % of the cases required reoperation. Various complications such as short penile length and chordee that were not seen in the short-term follow-up were noted in longterm follow-up. It is suggested that patients with severe proximal hypospadias should be followed up for cosmetic problems and potential penile curvature, diverticula and late fistula complications

References

  • Pierik FH, Burdorf A, Hijman JM, de Muinck Keizer-Schrama SM, Juttmann RE, Weber RF. A high hypospadias rate in the Netherlands. Hum Reprod 2002;17:1112-5.
  • Lund L, Engebjerg MC, Pedersen L, Ehrenstein V, Norgaard M, Sorensen HT. Prevalence of hypospadias in Danish boys: a longitudinal study, 1977-2005. Eur Urol 2009;55:1022-6.
  • Castagnetti M, El-Ghoneimi A. Surgical management of primary severe hypospadias in children: Systematic 20-year review. J Urol 2010;184:1469-75.
  • Algen AB, Khawand N, Skoog ST, Belman AB. Acquired megalourethra: An uncommon complication of the transverse preputial island flap urethroplasty. J Urol 1987;137:710-2.
  • Mieusset R, Soulie M. Hypospadias: Psychosocial, sexual and reproductive consequence in adult life. J Androl 2005;26:163-8.
  • Singh JC, Jayanthi VR, Gopalakrishnan G. Effect of hypospadias on sexual function and reproduction. Indian J Urol 2008;24:249- 52.
  • Ebert AK, Bals-Pratsch M, Seifert B, Reutter H, Rosch WH. Genital and reproductive function in males after functional reconstruction of the exstrophy-epispadias complex-long term results. Urology 2008;72:566-9.
  • Tiryaki T. Combination of tubularized island flap and ventral skin flap techniques in single- stage correction of severe proximal hypospadias. Urologia Internationalis 2010;84:269-74.
  • Ikoma F, Shima H, Yabumoto H. Classification of enlarged prostatic utricle in patients with hypospadias. Br J Urol 1985;57:334-7.
There are 9 citations in total.

Details

Other ID JA46SE22KA
Journal Section Research Article
Authors

Hüseyin Tuğrul Tiryaki This is me

Publication Date April 1, 2017
Submission Date April 1, 2017
Published in Issue Year 2017 Volume: 11 Issue: 1

Cite

Vancouver Tiryaki HT. Hypospadias on Long-Term Follow-up? What Changed in Patients Operated for Severe Proximal. Türkiye Çocuk Hast Derg. 2017;11(1):1-4.


The publication language of Turkish Journal of Pediatric Disease is English.


Manuscripts submitted to the Turkish Journal of Pediatric Disease will go through a double-blind peer-review process. Each submission will be reviewed by at least two external, independent peer reviewers who are experts in the field, in order to ensure an unbiased evaluation process. The editorial board will invite an external and independent editor to manage the evaluation processes of manuscripts submitted by editors or by the editorial board members of the journal. The Editor in Chief is the final authority in the decision-making process for all submissions. Articles accepted for publication in the Turkish Journal of Pediatrics are put in the order of publication, with at least 10 original articles in each issue, taking into account the acceptance dates. If the articles sent to the reviewers for evaluation are assessed as a senior for publication by the reviewers, the section editor and the editor considering all aspects (originality, high scientific quality and citation potential), it receives publication priority in addition to the articles assigned for the next issue.


The aim of the Turkish Journal of Pediatrics is to publish high-quality original research articles that will contribute to the international literature in the field of general pediatric health and diseases and its sub-branches. It also publishes editorial opinions, letters to the editor, reviews, case reports, book reviews, comments on previously published articles, meeting and conference proceedings, announcements, and biography. In addition to the field of child health and diseases, the journal also includes articles prepared in fields such as surgery, dentistry, public health, nutrition and dietetics, social services, human genetics, basic sciences, psychology, psychiatry, educational sciences, sociology and nursing, provided that they are related to this field. can be published.