The comparison of results of our surgical techniques in the hypospadias treatment; a retrospective study

Öz

Objectives: The aim of this study was to investigate the results of hypospadias surgery. Methods: In this study the results of 87 patients who underwent hypospadias repair surgery between 2005 and 2010 were evaluated retrospectly. Results: 21 patients; Meatal Advancement and Glanuloplasty (MAGPI), 33 patients; Tubularized Incised Plate Urethroplasty (TIPU), 21 patients; Parameatal Based Flap (Mathieu), 6 patients; Mathieu and Incision Sutured (MAVIS) and the other 6 patients were operated via Transvers Tubularized Preputial Island Flap (TTPIF). To prevent fistula formation double layer dartos flap (DLDF) was applied to all patients to whom MAVIS had been applied and to 27 of the patients to whom TIPU had been applied, and tunica vaginalis flap over neourethra was placed to the patients to whom TTPIF was applied. While fistula was not seen in the patients to whom flap was used, it was seen that the urethrocutaneous fistula ratio was high in the patients without flap uses. Conclusions: TIPU is a kind of method which can be easily applied and preferred regardless of localization of urethral meatus. A barrier layer placed between skin and neourethra to prevent fistula formation significantly decreases the fistula ratio. Preputial dartos flap is a good preference, But tunica vaginalis must be kept in mind as an alternative to this flap in the patients who underwent urethroplasty with preputial dartos flap or who had circumflex before. TTPIF can be used as an alternative method to TIPU method in patients with more proximal localized hypospadias, especially if the urethral plate was exiced because of chordee and it is successful when combined with tunica vaginalis flap.

Anahtar Kelimeler

• Hypospadias, urocutaneous fistula, flap

Hipospadias tedavisinde uygulanan cerrahi tekniklerin retrospektif karşılaştırılması

Öz

Amaç: Bu çalışmanın amacı hipospadias cerrahisi uygulanan hastaların tedavi sonuçlarını incelmektir. Yöntemler: Bu çalışmada, 2005 ve 2010 tarihleri arasında hipospadias onarımı geçiren 87 hastanın sonuçları geriye dönük olarak incelendi. Bulgular: 21 hasta; Meatal Advancement and Glanuloplasty (MAGPI), 33 hasta; Tubularized Incised Plate Urethroplasty (TIPU), 21 hasta; Parameatal Based Flap (Mathieu), 6 hasta; Mathieu and Incision Sutured (MAVIS) ve kalan 6 hasta ise Transvers Tubularized Preputial Island Flap (TTPIF) yöntemi ile opere edildi. Fistül oluşumunu engellenmek amacı ile MAVIS yöntemi uygulanan hastaların tamamına, TIPU yöntemi uygulanan hastaların 27\'sine çift tabaka dartos flebi (ÇDF) ve TTPIF yöntemi uygulananların tamamına neoüretra üzerine tunika vaginalis flebi(TVF) yerleştirildi. Flep kullanılan hastalarda hiç fistül gözlenmezken, kullanılmayanlarda ürokütanöz fistül oranlarının yüksek olduğu görüldü. Sonuç: TIPU, uygulaması kolay ve üretral meanın lokalizasyonuna bakılmaksızın tercih edilebilecek bir yöntemidir. Fistül oluşumunun önlenmesinde neoüretra ile cilt arasına koyulan bir bariyer tabaka, fistül oranını anlamlı şekilde düşürmektedir. Prepüsiyal dartos flebi iyi bir tercihtir. Ancak üretroplasti için prepüsiyel dartos flebinin kullanıldığı veya evvelce sünnet olmuş hastalarda tunika vajinalis bu flebin alternatifi olarak akılda tutulmalıdır. Daha proksimal hipospadias vakalarında özellikle kordi nedeni ile üretral plağı eksize edilenlerde TTPIF yöntemi, TIPU yöntemine alternatif olarak kullanılabilen ve TVF ile kombine edildiğinde fistül oranları açısından başarılı bir tekniktir.

Anahtar Kelimeler

• Hipospadias, ürokütanöz fistül, flep

Kaynakça

1. Bauer SB, Retik AB, Colondny AH. Genetic aspect of hypo- spadias. Urol Clin North Am 1981;8:559-564.
2. Belman AB, Welch KJ, Randolph JG, Ravitch MM, O’Neill JA, Rove MI. Pediatric surgery, Chicago Year Book Medi- cal Pub-lishers Inc, pp, 1986;1286.
3. Czeizel A, Toth J. Correlation between the birth prevalence of isolated hypospadias and parental subfertility. Teratol- ogy 1990;41:167-170.
4. Dolk H. Epidemiology of hipospadias. In: Hadidi AT, Azmy AF. Hypospadias surgery. Springer Berlin 2004;51-57.
5. Czeizel A, Toth J, Erodi E. Etiological studies of hypospadias in Hungary. Hum Hered 1979;29:166-171.
6. Duckett JW; Hypospadias. In: Walsh PC, Retik AB, Vaughan ED, et al. Campell’s Urology. Philadelphia, WB Saun- ders,1998;2093-2119.
7. Barraza MA, Roth DR, Terry WJ, et al. One-stage re- construction of moderately severe hypospadias. J Urol 1987;137:714-715.
8. Uygur MC, Ünal D, Tan MÖ, et al. Factor effecting outcome - stage anterior hypospadias repair: Analysis of 422 cases. Pediatr Surg Int 2002;18:142-146.

9. Abu-Arafeh W, Chertin B, Zilberman M, Farkas I. One stage repair of hypospadias experience with 856 cases. Eur Urol 1998;34:365-367.
10. Ghali AMA, El-Malik EMA, Al-Malki T, İbrahim AH. One stage hypospadias repair. Eur Urol 1999;36:346-442.
11. Snodgrass W, Kolye M, Manzoni G, et al. Tubularized in- cised plate hypospadias repair: result of multicenter experi- ence. J Urol 1996;156:839-841.
12. Snyder H. The Island Onlay Hypospadias Repair, In Hadidi AT, Azmy AF eds; Hypospadias Surgery, Sprınger, Berlin; pp.2004;163-168.
13. Baskin LS, Duckett JW, Ueoka K et al. Changing concepts of hypospadias curvature lead to more onlay island flap procedures. J Urol 1994;151:191-196.
14. Duckett JW; MAGPI (meatoplasty and glanuloplasty). A procedure for subcoronal hypospadias. Urol Clin North Am 1981;8:513.
15. Cunha G, Baskin L. Development of the penile urethra: Hypospadias and genital development, Kluwer Academic/ Plenum, Phil-adelphia, 2004;87-100.
16. Duckett JW, Synder HM. Metal advancement and glanu- loplasty hypospadias repair after 1000 cases: avoidance of metal steno-sis and regression. J Urol1992;147:665-659.
17. Mathieu P. Treitment en un temps de I’hypospadias bala- nique et juxta-balanique. J Chir 1932;39:481-484.
18. Hakim S, Merguerian PA, rabinowitz R, Shortliffe LD, Mc Kenna PH. Outcome analysis of the modified Mathieu hy- pospadias repair: conparison of stented and unstented re- pairs. J Urol 1996;156:836-838.
19. Retik AB, Mandell J, Bauer SB, Atala A. Meatal based hy- pospadias repair with the use of a dorsal subcutaneous flap to prevent urethrocutaneous fistula. J Urol 1994;152:1229- 1231.
20. Oswald J, Körner I, Riccabona R. Comparison of the perimeatal- based flap (Mathieu) and Tubularized in- cised plate urethro-plasty (Snodgrass) procedure. J Urol 2000;153:1655-1656.
21. Buson H, Smiley D, Reinberg Y, Gonzales R. Distal hy- pospadias repair without stents: Is it better? J Urol 1994;151:1059-1060.
22. Dindar H, Yağmurlu A, Gökçura H. Distal hypospadias repair; comprasion of two different tecniques. Int Urol Nephrol 2002; 33:113-116.
23. Hayashi Y, Kojima Y, Kurukawa S, et al. Scrotal dartos flap forthe prevention of the urocutaneous fistula on hypospa- dias ure-throplasty. Int J Urol 2005;12:280-283.
24. Kamal BA. Double dartos flaps in tubularized incised plate hypospadias repair. Urology 2005;66:1095-1098.
25. Boddy SA, Samuel M. A naturel glanuler meatus after ‘’Ma- thieu and V İncision stured’’ MAVIS. BJU Int 2000;86:394- 397.
26. Snodgrass W. Tubularized, incised plate uretroplasty for distal hypospadias. J Urol 1994;151:464-465.
27. Snodgrass W, Lorenzo A. Tubularized incised-plate urethro- plasty for proximal hypospadias. BJU Int 2002;89:90-93.
28. Erol A, Kayikci A, Memik O, et al. Single vs. double dartos interposition flaps in preventing urethrocutaneous fistula after tubu-larized incised plate urethroplasty in primary distal hypospadias: a prospective randomized study. Urol Int 2009;83:354-358.
29. Snodgrass W, Yucel S. Tubularized incised plate for mid shaft and proximal hypospadias repair. J Urol 2007;177:698-702.
30. Abolyosr A. Snodgrass hypospadias repair with onlay over- lapping double-layereddorsal dartos flap without urethro- cutaneous fistula: experience of 156 cases. J Pediatr Urol 2009;6:403-407.
31. Stehr M, Lehner M, Schuster T, et al. Tubularized incised plate (TIP) urethroplasty (Snodgrass) in primary hypospa- dias repair. Eur J Pediatr Surg 2005;15:420-424.
32. Abramovic V. Operative treatment of severe forms of hypo- spadias. Urol Clin North Am 1981;8:421-430.
33. Duckett JW. Transverse preputial island flap technique for repair of severehypospadias. Urol Clin North Am 1980;7:423-430.
34. Kureel SN, Vasudeva P, Sinha SK, Dalela D. “Limited” double dorsal dartos flap coverage. An effective alternative to conven-tional flap coverage of the neourethra follow- ing Mathieu repair for subcoronal hypospadias. Int Urol Nephrol 2008; 40:569-572.
35. Perovic SV, Vukadinovic V. Onlay island flap urethroplasty for sever hypospadias; A variant of the technique. J Urol 1994;151:711-714.
36. Hollowell JG, Keating MA, Snyder HM , Duckett JW. Preservation of the urethral plate in hypospadias repair: ex- tended appli-cations and further experience with the onlay island flap urethroplasty. J Urol 1990;143:98-100.
37. Snow BW. Use of tunica vaginalis to prevent fistulas in hy- pospadias surgery. J.Urol 1986;136:861-863.
38. Wiener JS, Sutherland RW, Roth DR, Gonzales ET Jr. Com- parison of onlay and tubularized island flaps of inner pre- putial skin for the repair of proximal hypospadias. J Urol 1997;158:1172-1174.