Modification in Distal Hypospadias Surgery That Leads to A Better Appearance: Frenuloplasty

Öz

To present our results regarding the frenuloplasty modification, which we added to the techniques commonly used in distal hypospadias surgery. We retrospectively reviewed 306 children who underwent distal hypospadias surgery modified with frenuloplasty between June 2008 and December 2019. In our technique, the penis was incised approximately 1 cm proximal to the coronal sulcus posteriorly and laterally, and this incision was continued anteriorly along the oblique mucocutaneous junction to form frenular wings, instead of linear circumscribing incision joined the urethral plate. Glans wings must be dissected sufficiently for successful implementation of frenuloplasty modification. The glans wings and frenular wings were re-approximated without tension after uretroplasty. Instead of suturing the penile skin just to the end of the glans ventrally, the frenulum was formed, resulting in an appearance similar to the penis of a circumcised child. The mean age of the patients was 3.93±3.3 years. The mean follow-up was 19±6.17 months. Location of hypospadias was glanular in 15 (4.9%), coronal in 72 (23.5%), subcoronal in 143 (46.7%) and penil in 67 (21.9%) patients. Nine (2.9%) patients had megameatus intact prepuce. MAGPI was used in 16 (5.2%), TIPU in 264 (86.3%), urethral mobilization/advancement in 17, and GAP technique in 9 cases. The following complications occurred in 28 patients (9.2%): urethrocutaneous fistula formation in 11 (3.6 %), meatal stenosis in 17 (5.6 %) and dehiscence in one (0.3%). Frenuloplasty modification provides satisfactory cosmetic outcomes with the appearence of normal circumcised penis. It can be performed regardless of meatal location and technique used. 

Anahtar Kelimeler

• Cosmetic Outcomes
• Frenulum
• Glans
• Hypospadias
• Urethroplasty

Distal Hipospadias Cerrahisinde Daha İyi Bir Görünüme Yol Açan Modifikasyon: Frenuloplasti

Öz

Distal hipospadias cerrahisinde yaygın olarak kullanılan tekniklere eklediğimiz frenuloplasti modifikasyonu ile ilgili sonuçlarımızı sunmak. Haziran 2008 ile Aralık 2019 tarihleri arasında frenuloplasti ile modifiye edilmiş distal hipospadias cerrahisi uygulanan 306 çocuk geriye dönük olarak incelendi. Bizim tekniğimizde, üretral plağa kadar uzanan çepeçevre sünnet insizyonu yerine, koronal sulkusun yaklaşık 1 cm proksimalinden posterior ve lateralden insize edildikten sonra bu insizyon anteriorda oblik seyreden mukokutanöz bileşke boyunca devam ettirilerek frenular kanatlar oluşturuldu. Frenuloplasti modifikasyonunun başarılı bir şekilde uygulanması için glans yeterince disseke edildi. Üretroplasti sonrası glans kanatları ve frenular kanatlar gergin olmayacak şekilde yaklaştırıldı. Penis derisini ventralde glansın hemen altına dikmek yerine frenulum oluşturuldu ve sünnetli bir çocuğun penisine benzer bir görünüm elde edildi. Hastaların ortalama yaşı 3.93±3.3 yıl idi. Ortalama takip süresi 19±6.17 aydı. Hastaların 15'inde (%4.9) glanüler, 72'sinde (%23.5) koronal, 143'ünde (%46.7) subkoronal ve 67'sinde (%21.9) penil yerleşimli üretral meatus mevcuttu. Dokuz (%2.9) hastada megamatus ve intakt prepisyum tespit edildi. 16 (%5.2) olguda MAGPI, 264 hastada (%86.3) TIPU, 17 olguda üretral mobilizasyon/ilerletme ve 9 hastada GAP tekniği kullanıldı. 28 (%9.2) hastada komplikasyon meydana geldi. Hastaların 11’inde (%3.6) üretrokutanöz fistül oluşumu, 17’sinde (%5.6) meatal darlık ve 1 (%0.3) olguda onarımda ayrılma gözlendi. Meatusun yerinden ve kullanılan hipospadias onarım tekniğinden bağımsız olarak kullanılabilen frenuloplasti modifikasyonu, normal sünnetli penis görünümü oluşturarak tatmin edici kozmetik sonuçlar sağlamaktadır. 

Anahtar Kelimeler

• Frenulum
• Glans
• Hipospadias
• Kozmetik Sonuçlar
• Üretroplasti

Destekleyen Kurum

yok

Kaynakça

1. 1. Borer JG, Retik AB. Hypospadias. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders Elsevier, 2007;3703–44.
2. 2. Snodgrass W. Tubularized, incised plate urethroplasty for distal hypospadias. J Urol. 1994;151(2):464-5.
3. 3. Duan SX, Li J, Jiang X ve ark. Diagnosis and Treatment of Hypospadias With Megameatus Intact Prepuce. Front Pediatr. 2020;31(8):128.
4. 4. Kızılöz H, Okçelik S, Temel MC. MAGPI under local anaesthesia without catheter as an alternative to standard TIP procedure in distal hypospadias repair. Andrologia. 2021;53(2):e13949.
5. 5. Gite VA, Nikose JV, Bote SM ve ark. Anterior Urethral Advancement as a Single-Stage Technique for Repair of Anterior Hypospadias: Our Experience. Urol J. 2017;14(4):4034-7.
6. 6. Karakus‚ SC, Koku N. Modified tubularized incised plate urethroplasty repair: frenuloplasty and long-term results in 155 patients. Indian J Surg. 2015;77(2):212-5.
7. 7. Scott S. Anatomy and physiology of the human prepuce. In: Denniston GC, Hodges FM, Milos MF, eds. Male and female circumcision: medical, legal, and ethical considerations in paediatric practice. New York: Kluwer Academic/Plenum Publishers, 1999;9-18.
8. 8. Baskın LS. Hypospadias and urethral development. J Urol. 2000;163(3):951-6.

9. 9. Gairdner D. The fate of the foreskin, a study of circumcision. Br Med J. 1949;2(4642):1433-7.
10. 10. Favorito LA, Balassiano CM, Costa WS ve ark. Development of the human foreskin during the fetal period. Histol Histopathol. 2012;27(8):1041-5.
11. 11. Shapiro E, Cremer M, Hongying H. An indepth study of the formation of the frenulum and meatus in the human male fetus. J Urol 2009;181(Suppl):253.
12. 12. Decter RM. M inverted V glansplasty: a procedure for distal hypospadias. J Urol. 1991;146(2(Pt2)):641–3.
13. 13. Özbey H, Etker S. Hypospadias repair with the glanular-frenular collar (GFC) technique. J Pediatr Urol. 2017;13(1):34.1-6.
14. 14. Al-Ghorairy BA, Elashry OM, Al-Housain AE ve ark. Analysis of five-year experience with tubularized incised plate urethroplasty for anterior and mid penile hypospadias. Eur J Pediatr Surg. 2009;19(2):90–5.
15. 15. Sarhan OM, El-Hefnawy AS, Hafez AT ve ark. Factors affecting outcome of tubularized incised plate (TIP) urethroplasty: single-center experience with 500 cases. J Pediatr Urol. 2009;5(5):378–82.