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Common complications and their managements after penoscrotal hypospadias repairs: comparison of one-stage and staged repairs

Yıl 2022, Cilt: 8 Sayı: 2, 256 - 265, 04.03.2022
https://doi.org/10.18621/eurj.1033348

Öz

Objectives: Surgical repair of hypospadias is challenging and the risk of complications is high, even for the most experienced specialists. In this study, we aim to present our experience with the management of the most common postoperative complications in patients who underwent proximal hypospadias repair.

Methods: We retrospectively reviewed the data of patients underwent proximal hypospadias surgery between December 2011 and February 2021. Patients who were repaired with single and staged methods were divided into two groups. Treatment methods of postoperative complications including wound dehiscence, fistula, stricture and diverticulum were examined and the results were noted and statistically compared.

Results: Forty-four patients, with a mean age of 34 months at the first surgery were reviewed, 17 of whom underwent a single-stage repair and 27 of whom staged. Except for a patient who underwent Onlay island flap urethroplasty, long TIPU was used in all single-session repairs, and Byar's and Bracka methods in 19 and 8 patients of the staged group, respectively. The overall complication rate was 34% at a mean follow-up of 41 months, and 18% in single-stage repair, and 44% in staged. Glans dehiscence, urethrocutaneous fistula, urethral stricture, and diverticula were seen 2 (4%), 4 (9%), and 4 (9%), respectively. All glans dehiscence and two fistulae along with distal stricture treated with Mathieu urethroplasty. Two proximal short strictures were relieved by single session dilation. Diverticula were repaired by urethroplasty. The complications were successfully treated, and no recurrence developed.


Conclusions:
The risk of complications is higher due to proximal hypospadias, long urethroplasty and defective penile tissue. Hypoplasic glandular urethra, distal stricture and a neourethra devoid of spongiosum appear to be related for complications. Despite the more encountered, postoperative complications of proximal hypospadias repairs have been shown to be successfully treated with the appropriate techniques.

Kaynakça

  • 1. Cilento BG Jr, Atala A. Proximal hypospadias. Urol Clin North Am 2002;29:311-28.
  • 2. Snodgrass W, Prieto J. Straightening ventral curvature while preserving the urethral plate in proximal hypospadias repair. J Urol 2009;182:1720-5.
  • 3. Duckett JW. Transverse preputial island fap technique for repair of severe hypospadias. Urol Clin N Am 1980;7:423-30.
  • 4. Byars, L.T. Functional restoration of hypospa-dias deformities. Surg Gynaecol Obstet. 1951;92:149-54.
  • 5. Bracka A. A versatile two-stage hypospadias repair. Br J Plastic Surg. 1995;345-52.
  • 6. Stanasel I, Le HK, Bilgutay A, Roth DR, Gonzales ET Jr, Janzen N, et al. Complications following staged hypospadias repair using transposed preputial skin flaps. J Urol 2015;194:512-6.
  • 7. McNamara ER, Schaeffer AJ, Logvinenko T, Seager C, Rosoklija I, Nelson CP, et al. Management of proximal hypospadias with 2-stage repair: 20-year experience. J Urol 2015;194:1080-5.
  • 8. Pippi Salle JL, Sayed S, Salle A, Bagli D, Farhat W, Koyle M, et al. Proximal hypospadias: A persistent challenge. Single institution outcome analysis of three surgical techniques over a 10-year period. J Pediatr Urol 2016;12:28.e1-7.
  • 9. Long CJ, Chu DI, Tenney RW, Morris AR, Weiss DA, Shukla AR, et al. Intermediate-term followup of proximal hypospadias repair reveals high complication rate. J Urol 2017;197:852-8.
  • 10. Retik AB, Atala A. Complications of hypospadias repair. Urol Clin North Am 2002;29:329-39.
  • 11. Merriman LS, Arlen AM, Broecker BH, Smith EA, Kirsch AJ, Elmore JM. The GMS hypospadias score: assessment of inter-observer reliability and correlation with post-operative complications. J Pediatr Urol 2013;9:707-12.
  • 12. van der Horst HJ, de Wall LL. Hypospadias, all there is to know. Eur J Pediatr 2017;176:435-41.
  • 13. Snyder CL, Evangelidis A, Hansen G, St Peter SD, Ostlie DJ, Gatti JM, et al. Management of complications after hypospadias repair. Urology 2005;65:782-5.
  • 14. Al-Juraibah F, Lucas-Herald A, Nixon R, Toka C, Wang C, Flett M, et al. Association between extra-genital congenital anomalies and hypospadias outcome. Sex Dev 2019;13:67-73.
  • 15. Snodgrass W, Cost N, Nakonezny PA, Bush N. Analysis of risk factors for glans dehiscence after tubularized incised plate hypospadias repair. J Urol 2011;185:1845-9.
  • 16. White CM, Hanna MK. Salvaging the dehisced glans penis. J Pediatr Urol 2018;14:422.e1-5.
  • 17. Kolon TF, Gonzales ET Jr. The dorsal inlay graft for hypospadias repair. J Urol 2000;163:1941-3.
  • 18. Snodgrass WT, Bush NC. Surgical complications of hypospadias and their management. In: Godbole PP, Koyle MA, Wilcox DT, editors. Pediatric urology: surgical complications and management. Hoboken: Wiley-Blackwell; 2015. p. 259-69.
  • 19. Richter F, Pinto PA, Stock JA, Hanna MK. Management of recurrent urethral fistulas after hypospadias repair. Urology 2003;61:448-51.
  • 20. Fahmy O, Khairul-Asri MG, Schwentner C, Schubert T, Stenzl A, Zahran MH, et al. Algorithm for optimal urethral coverage in hypospadias and fistula repair: a systematic review. Eur Urol 2016;70:293-8.
  • 21. Seo S, Ochi T, Yazaki Y, Okawada M, Doi T, Miyano G, et al. Soft tissue interposition is effective for protecting the neourethra during hypospadias surgery and preventing postoperative urethrocutaneous fistula: a single surgeon's experience of 243 cases. Pediatr Surg Int 2015;31:297-303.
  • 22. Kiss A, Pirót L, Karsza L, Merksz M. Use of buccal mucosa patch graft for recurrent large urethrocutaneous fistula after hypospadias repair. Urol Int 2004;72:329-31.
  • 23. Elbakry A. Management of urethrocutaneous fistula after hypospadias repair: 10 years' experience. BJU Int 2001;88:590-5.
  • 24. Snodgrass WT, Bush NC. Management of urethral strictures after hypospadias repair. UrolClin North Am 2017;44:105-11.
  • 25. Malone P. Meatal stenosis and urethral strictures after hypospadias surgery. In: Hadidi AT, Azmy AF (eds.). Hypospadias Surgery. Berlin: Springer; 2004. p. 295-300.
  • 26. Gargollo PC, Cai AW, Borer JG, Retik AB. Management of recurrent urethral strictures after hypospadias repair: is there a role for repeat dilation or endoscopic incision? J Pediatr Urol 2011;7:34-8.
  • 27. Husmann DA, Rathbun SR. Long-term followup of visual internal urethrotomy for management of short [less than 1 cm] penile urethral strictures following hypospadias repair. J Urol 2006;176:1738-41.
  • 28. Radojicic ZI, Perovic SV, Djordjevic ML, Vukadinovic VM, Djakovic N. Pseudospongioplasty' in the repair of a urethral diverticulum. BJU Int 2004;94:126-30.
  • 29. Hueber PA, Salgado Diaz M, Chaussy Y, Franc-Guimond J, Barrieras D, Houle AM. Long-term functional outcomes after penoscrotal hypospadias repair: a retrospective comparative study of proximal TIP, Onlay, and Duckett. J Pediatr Urol 2016;12:198.e1-6.
  • 30. Vallasciani S, Berrettini A, Nanni L, Manzoni G, Marrocco G. Observational retrospective study on acquired megalourethra after primary proximal hypospadias repair and its recurrence after tapering. J Pediatr Urol 2013;9:364-7.
  • 31. Snyder CL, Evangelidis A, Snyder RP, Ostlie DJ, Gatti JM, Murphy JP. Management of urethral diverticulum complicating hypospadias repair. J Pediatr Urol 2005;1:81-3.
  • 32. Snodgrass W, Bush NC. Persistent or recurrent ventral curvature after failed proximal hypospadias repair. J Pediatr Urol 2019;15:344.e1-6.
  • 33. Palmer LS, Palmer JS, Franco I, Friedman SC, Kolligian ME, Gill B, et al. The "long Snodgrass": applying the tubularized incised plate urethroplasty to penoscrotal hypospadias in 1-stage or 2-stage repairs. J Urol 2002;168:1748-9.
Yıl 2022, Cilt: 8 Sayı: 2, 256 - 265, 04.03.2022
https://doi.org/10.18621/eurj.1033348

Öz

Kaynakça

  • 1. Cilento BG Jr, Atala A. Proximal hypospadias. Urol Clin North Am 2002;29:311-28.
  • 2. Snodgrass W, Prieto J. Straightening ventral curvature while preserving the urethral plate in proximal hypospadias repair. J Urol 2009;182:1720-5.
  • 3. Duckett JW. Transverse preputial island fap technique for repair of severe hypospadias. Urol Clin N Am 1980;7:423-30.
  • 4. Byars, L.T. Functional restoration of hypospa-dias deformities. Surg Gynaecol Obstet. 1951;92:149-54.
  • 5. Bracka A. A versatile two-stage hypospadias repair. Br J Plastic Surg. 1995;345-52.
  • 6. Stanasel I, Le HK, Bilgutay A, Roth DR, Gonzales ET Jr, Janzen N, et al. Complications following staged hypospadias repair using transposed preputial skin flaps. J Urol 2015;194:512-6.
  • 7. McNamara ER, Schaeffer AJ, Logvinenko T, Seager C, Rosoklija I, Nelson CP, et al. Management of proximal hypospadias with 2-stage repair: 20-year experience. J Urol 2015;194:1080-5.
  • 8. Pippi Salle JL, Sayed S, Salle A, Bagli D, Farhat W, Koyle M, et al. Proximal hypospadias: A persistent challenge. Single institution outcome analysis of three surgical techniques over a 10-year period. J Pediatr Urol 2016;12:28.e1-7.
  • 9. Long CJ, Chu DI, Tenney RW, Morris AR, Weiss DA, Shukla AR, et al. Intermediate-term followup of proximal hypospadias repair reveals high complication rate. J Urol 2017;197:852-8.
  • 10. Retik AB, Atala A. Complications of hypospadias repair. Urol Clin North Am 2002;29:329-39.
  • 11. Merriman LS, Arlen AM, Broecker BH, Smith EA, Kirsch AJ, Elmore JM. The GMS hypospadias score: assessment of inter-observer reliability and correlation with post-operative complications. J Pediatr Urol 2013;9:707-12.
  • 12. van der Horst HJ, de Wall LL. Hypospadias, all there is to know. Eur J Pediatr 2017;176:435-41.
  • 13. Snyder CL, Evangelidis A, Hansen G, St Peter SD, Ostlie DJ, Gatti JM, et al. Management of complications after hypospadias repair. Urology 2005;65:782-5.
  • 14. Al-Juraibah F, Lucas-Herald A, Nixon R, Toka C, Wang C, Flett M, et al. Association between extra-genital congenital anomalies and hypospadias outcome. Sex Dev 2019;13:67-73.
  • 15. Snodgrass W, Cost N, Nakonezny PA, Bush N. Analysis of risk factors for glans dehiscence after tubularized incised plate hypospadias repair. J Urol 2011;185:1845-9.
  • 16. White CM, Hanna MK. Salvaging the dehisced glans penis. J Pediatr Urol 2018;14:422.e1-5.
  • 17. Kolon TF, Gonzales ET Jr. The dorsal inlay graft for hypospadias repair. J Urol 2000;163:1941-3.
  • 18. Snodgrass WT, Bush NC. Surgical complications of hypospadias and their management. In: Godbole PP, Koyle MA, Wilcox DT, editors. Pediatric urology: surgical complications and management. Hoboken: Wiley-Blackwell; 2015. p. 259-69.
  • 19. Richter F, Pinto PA, Stock JA, Hanna MK. Management of recurrent urethral fistulas after hypospadias repair. Urology 2003;61:448-51.
  • 20. Fahmy O, Khairul-Asri MG, Schwentner C, Schubert T, Stenzl A, Zahran MH, et al. Algorithm for optimal urethral coverage in hypospadias and fistula repair: a systematic review. Eur Urol 2016;70:293-8.
  • 21. Seo S, Ochi T, Yazaki Y, Okawada M, Doi T, Miyano G, et al. Soft tissue interposition is effective for protecting the neourethra during hypospadias surgery and preventing postoperative urethrocutaneous fistula: a single surgeon's experience of 243 cases. Pediatr Surg Int 2015;31:297-303.
  • 22. Kiss A, Pirót L, Karsza L, Merksz M. Use of buccal mucosa patch graft for recurrent large urethrocutaneous fistula after hypospadias repair. Urol Int 2004;72:329-31.
  • 23. Elbakry A. Management of urethrocutaneous fistula after hypospadias repair: 10 years' experience. BJU Int 2001;88:590-5.
  • 24. Snodgrass WT, Bush NC. Management of urethral strictures after hypospadias repair. UrolClin North Am 2017;44:105-11.
  • 25. Malone P. Meatal stenosis and urethral strictures after hypospadias surgery. In: Hadidi AT, Azmy AF (eds.). Hypospadias Surgery. Berlin: Springer; 2004. p. 295-300.
  • 26. Gargollo PC, Cai AW, Borer JG, Retik AB. Management of recurrent urethral strictures after hypospadias repair: is there a role for repeat dilation or endoscopic incision? J Pediatr Urol 2011;7:34-8.
  • 27. Husmann DA, Rathbun SR. Long-term followup of visual internal urethrotomy for management of short [less than 1 cm] penile urethral strictures following hypospadias repair. J Urol 2006;176:1738-41.
  • 28. Radojicic ZI, Perovic SV, Djordjevic ML, Vukadinovic VM, Djakovic N. Pseudospongioplasty' in the repair of a urethral diverticulum. BJU Int 2004;94:126-30.
  • 29. Hueber PA, Salgado Diaz M, Chaussy Y, Franc-Guimond J, Barrieras D, Houle AM. Long-term functional outcomes after penoscrotal hypospadias repair: a retrospective comparative study of proximal TIP, Onlay, and Duckett. J Pediatr Urol 2016;12:198.e1-6.
  • 30. Vallasciani S, Berrettini A, Nanni L, Manzoni G, Marrocco G. Observational retrospective study on acquired megalourethra after primary proximal hypospadias repair and its recurrence after tapering. J Pediatr Urol 2013;9:364-7.
  • 31. Snyder CL, Evangelidis A, Snyder RP, Ostlie DJ, Gatti JM, Murphy JP. Management of urethral diverticulum complicating hypospadias repair. J Pediatr Urol 2005;1:81-3.
  • 32. Snodgrass W, Bush NC. Persistent or recurrent ventral curvature after failed proximal hypospadias repair. J Pediatr Urol 2019;15:344.e1-6.
  • 33. Palmer LS, Palmer JS, Franco I, Friedman SC, Kolligian ME, Gill B, et al. The "long Snodgrass": applying the tubularized incised plate urethroplasty to penoscrotal hypospadias in 1-stage or 2-stage repairs. J Urol 2002;168:1748-9.
Toplam 33 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Çocuk Sağlığı ve Hastalıkları
Bölüm Original Article
Yazarlar

Esra Ozcakir 0000-0002-0773-7430

Sefer Tolga Okay 0000-0002-2716-6006

Mete Kaya 0000-0002-8877-5737

Yayımlanma Tarihi 4 Mart 2022
Gönderilme Tarihi 6 Aralık 2021
Kabul Tarihi 11 Şubat 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 8 Sayı: 2

Kaynak Göster

AMA Ozcakir E, Okay ST, Kaya M. Common complications and their managements after penoscrotal hypospadias repairs: comparison of one-stage and staged repairs. Eur Res J. Mart 2022;8(2):256-265. doi:10.18621/eurj.1033348

e-ISSN: 2149-3189 


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