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Objective To investigate the effect of a modified preputial flap urethroplasty in twostage treatment of severe hypospadias.Methods The clinical characteristics of the severe hypospadias patients (41 cases) who underwent the staged urethroplasty by using the procedure of preset urethral plate with preputial flap from January 2015 to December 2016 were analyzed retrospectively.We used a modified method (modified group,23 cases):Form the distal urethra with the transected distal urethral plate by using tubularize incised plate (TIP) procedure during the first stage operation,after completely straightened the penis,urethral plate was preseted with transverse preputial flap at the penis shaft.While in the traditional group (18 cases),urethral plate was preseted with preputial flap by using Bracka procedure after transecting urethral plate.The corresponding missing part of urethra underwent urethroplasty at the second stage operation six months later.The patients in the modified group were 9 to 18 months old,and the median age was 13 months;meatus were located at the penis shaft in 10 cases,scrotum in 12 cases,perineum in 1 case.The patients in the traditional group were 9 to 18 months old,and the median age was 13 months;meatus were located at the penis shaft in 6 cases,scrotum in 10 cases,and perineum in 2 cases.There was no statistic difference in age and meatus position between the two groups.Results During the first stage operation,distal urethra was repaired by 13-19 mm,with an average of (14.5 ± 1.3) mm,and the proximal urethra was repaired by 0-6 mm,with an average of (3.1 ± 2.4) mm at the modified group.While at the traditional group,the length of proximal urethra was repaired of 0-9 mm,with an average of (5.6:±:2.9) mm.The urethral length required for reconstruction was measured during the second stage operation,with an average of (26.3:t:4.4) mm in the modified group and (40.5 ± 3.3) mm in the traditional group (P ＜ 0.05).There were 3 case of urethral stricture after removed the catheter,with 2 cases in the modified group and 1 case in the traditional group.Postoperative follow-up was 2 to 3 years,with an average of 2.4 years.There were 3 cases (3/23,13.0％) of urethral fistula in the modified group and 3 cases (3/18,16.7％) in the traditional group.Ascended testis occured in 2 patients in the traditional group after operation.No case of urethrostenosis,diverticulum,chordee or concealed pennis was recorded.There was no significant difference in postoperative complications between the two groups (P ＞ 0.05).Conclusions The modified staged preputial flap method shorten the new forming urethra by making full use of its own materials at the second stage operation,which was helpful to reduce complications.
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Objective To compare the efficacy of Bracka method and Duckett method in the treatment of proximal hypospadias.Methods Forty patients with hypospadias were treated by 2 stages (Bracka),42 patients treated by transverse preputial island flap (Duckett) from January 2014 to January 2016.Mean age at first stage surgery were (19.70 ±6.62) months and (20.33 ±5.03) months in Bracka group and Duckett group,respectively.There were 10 cases of proximal penile type,25 cases of penoscrotal type,5 cases of perineal type in group 1.There were 11 cases of proximal penile type,27 cases of penoscrotal type,4 cases of perineal type in group 2.There was no significant difference in age and hypospadias classification between the two groups (P ＞ 0.05).All operations were performed by the same doctor.Urethral plate reconstruction with preputial graft was performed in group 1;stage Ⅱ Duplay urethroplasty repair was carried out 6-8 months after stage Ⅰ.Results Urine tube was placed for 2 weeks after operation and followed up for 36-63 months (mean 47.6 months).After stage Ⅰ repair,penile straightening and wide,smooth appearance of graft were confirmed.There was no fistula,split,urethral diverticulum or other complications,one case with urethral opening stenosis who was restored after urethral dilatation.After stage Ⅱ repair,urethral fistula was noted in 3 cases(7.5％),stricture in 1 cases(2.5％).No other complications occurred.The total rate of complications was 10％ (10/40).Urethral fistula was noted in 7 cases(16.7％),stricture in 3 cases(7.1％),penile head dehiscence in 3 cases(7.1％) and diverticulum in 1 case (2.4％) in group 2.The total rate of complications was 33.3％ (14/42).The incidence of total complications between the two groups was statistically significant (P =0.011).Conclusions Bracka method can be used to treat proximal hypospadias.It has high safety and low incidence of complications.
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Objective@#To compare the efficacy of Bracka method and Duckett method in the treatment of proximal hypospadias.@*Methods@#Forty patients with hypospadias were treated by 2 stages(Bracka), 42 patients treated by transverse preputial island flap (Duckett) from January 2014 to January 2016. Mean age at first stage surgery were (19.70±6.62) months and (20.33±5.03) months in Bracka group and Duckett group, respectively. There were 10 cases of proximal penile type, 25 cases of penoscrotal type, 5 cases of perineal type in group 1. There were 11 cases of proximal penile type, 27 cases of penoscrotal type, 4 cases of perineal type in group 2. There was no significant difference in age and hypospadias classification between the two groups(P>0.05). All operations were performed by the same doctor. Urethral plate reconstruction with preputial graft was performed in group 1; stage Ⅱ Duplay urethroplasty repair was carried out 6-8 months after stage Ⅰ.@*Results@#Urine tube was placed for 2 weeks after operation and followed up for 36-63 months(mean 47.6 months). After stage I repair, penile straightening and wide, smooth appearance of graft were confirmed. There was no fistula, split, urethral diverticulum or other complications, one case with urethral opening stenosis who was restored after urethral dilatation .After stage II repair, urethral fistula was noted in 3 cases(7.5%), stricture in 1 cases(2.5%). No other complications occurred . The total rate of complications was 10%(10/40). Urethral fistula was noted in 7 cases(16.7%), stricture in 3 cases(7.1%), penile head dehiscence in 3 cases(7.1%) and diverticulum in 1 case(2.4%) in group 2. The total rate of complications was 33.3%(14/42). The incidence of total complications between the two groups was statistically significant (P=0.011).@*Conclusions@#Bracka method can be used to treat proximal hypospadias. It has high safety and low incidence of complications.
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A premature boy was born after 35 weeks gestation (1,561 g in weight) with a diagnosis of anomalous origin of the right pulmonary artery from the ascending aorta (AORPA) and perimembranous ventricular septal defect (VSD). The fourteenth day after birth, banding of the right pulmonary artery was performed as a palliative operation. At the age of 5 months (3.9 kg in weight), the right pulmonary artery branched from the ascending aorta, and was anastomosed to a flap made by the lateral wall of the main pulmonary artery with pericardial patch augmentation. VSD patch closure was performed concomitantly. Severe stenosis of the right pulmonary artery compressed by the ascending aorta and left pulmonary hypertension were revealed 3 weeks after the repair. At the age of 11 months, a surgical relief of the right pulmonary artery stenosis was performed. Transection of the ascending aorta provided an excellent exposure of the right posterior pulmonary artery. After patch plasty of the stenotic pulmonary artery, the divided ascending aorta was restored using a strip form patch on 4/5 circle of its posterior wall to extend the aorta and widen the space for the right pulmonary artery. This technique preserves growth potential of the ascending aorta. There are few reports of surgical repair of AORPA with VSD in low birth weight infants. We presented here a case with surgical relief of post-operative right pulmonary artery stenosis. Long term observation of repaired right pulmonary artery, and requiring residual slight hypertension of the left pulmonary artery.
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Hypospadias repair is highly challenging especially for those severe or cripple variants.Correction via single stage or staged repair is controvercial whereas the controversies are with different content with advancement of hypospadiology.Here the authors introduce the contemporary concepts of staged repair for hypospadias.
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OBJECTIVE: To explore the surgical outcome of Duckett urethroplasty-urethrotomy for staged hypospadias repair. METHODS: Fifty-three patients with hypospadias were treated by 2 stages between August 2013 and September 2014. The age ranged from 10 months to 24 years and 3 months (median, 1 year and 10 months). There were 5 cases of proximal penile type, 2 cases of penoscrotal type, 36 cases of scrotal type, and 10 cases of perineal type. Urethroplasty was performed with tubed transverse preputial island flap only in 27 cases or combined with urethral plate in the other 26 cases, thus a urethrocutaneous fistula was intentionally created; stage II fistula repair was carried out at 1 year after stage I repair. RESULTS: The length of the new urethra ranged from 2 to 8 cm with an average of 3.6 cm. The patients were followed up 5-17 months with an average of 8 months after stage II repair. After stage I repair, urethral fistula was noted at other site in 3 cases, skin necrosis in 1 case, glandular stricture in 2 cases, cicatric curvature in 1 case, and position and morphology of urethral orifice not ideal in 4 cases. After stage II repair, urethral fistula was noted in 2 cases, mild urethral diverticulum in 2 cases, and stricture at temporary repair site in 1 case. HOSE score was 12-16 at 3 months after stage II repair (mean, 14.5). At 3-14 months after stage II repair, the maximum flow rate ranged from 3.9 to 22.7 mL/s with an average of 8.6 mL/s. CONCLUSIONS: Duckett urethroplasty-urethrotomy can be used as staged repair for primary treatment of hypospadias because of high safety, low complication incidence, and satisfactory appearance.
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Primary repair of the tetralogy of Fallot with absent pulmonary valve syndrome (TOF/APV) is associated with high mortality rates of 17-33%, especially in neonates. Our standard strategy involves a staged repair with a first palliation, performed during the neonatal period, that includes main pulmonary septation with an ePTFE patch, pulmonary arterioplasty for reduction of vascular dilation, and a modified Blalock-Taussig shunt. We performed successful repairs on two neonates with TOF/APV, one symptomatic and the other non-symptomatic, with this strategy. Case 1 : A 7-day-old boy had TOF/APV, with progressively worsening respiratory distress. His left bronchi, superior vena cava and left atrium were compressed by a dilated pulmonary artery, which was repaired by emergency surgery. Decreasing the diameter of the pulmonary artery (PA index from 2,550 to 525) relieved the compressed organs. Case 2 : A 16-day-old boy with TOF/APV with a main pulmonary artery that increased in diameter from 8 to 17 mm in the course of a single day. He was treated in the same fashion as Case 1. At 1 year of age, an intracardiac repair with tricuspid anuuloplasty was performed successfully. This strategy is much safer than a primary repair and is a good choice for neonatal repair of TOF/APV.
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Objective To investigate the value and strategy of staged repair in hypospadias surgery.Methods One hundred and sixty-three cases of severe proximal and complex hypospadias were retrospectively analyzed.According to the operation process,all the cases were divided into 2 groups.Staged repair group:there were 46 cases in all,included 31 cases of severe proximal hypospadias and 15 cases cases of complex hypospadias,the diorthosis for penis curvature and urethral reconstruction were completed by staged.One-stage repair group:there were 117 cases as control group,included 108 cases of severe proximal hypospadias and 9 cases of complex hypospadias,their diorthosis for penis curvature and urethral reconstruction were completed in single stage.Results The adverse factors such as a serious deformity in penis or limited local tissue were more common in staged repair group,and the conditions of repair were worse than one-stage repair group.In severe proximal hypospadias,the incidence of penis curvature in staged repair group was obvious lower than one-stage repair group (P ＜ 0.05),within the period of follow up,which only 1 case (3.2％) showed a slight penis curvature.However,there were 23 cases (21.3％) with penis curvature in one-stage repair group,in which 7 cases showed up penis torsion,20 cases with a bowstring shape of breviate urethra in penile ventral,and 19 cases(17.6％) needed reoperation.Compared of 2 groups,the incidences of urinary fistula,urethral stricture and urethral diverticulum showed no difference in statistics (all P ＞ 0.05).In complex hypospadias,the incidence of urinary fistula in staged repair group was significantly lower than one-stage repair group,and then the rate of urinary fistula was 20.0％ vs 66.7％ (P ＜ 0.05).The incidence of penis curvature,urethral stricture and urethral diverticulum showed no difference in statistics (all P ＞ 0.05).Conclusions Staged repair is relatively simple and effective,can be used in the treatment of severe proximal or complex hypospadias,especially in the cases with a worse condition.The mode of operation should be chosen not only according to the penial state and tissue conditions,but also combined with the technology and experience of the surgeon,and avoid the forced of one-staged repair for hypospadias.
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Bladder exstrophy is a rare condition with an incidence of between 1 in 10,000 and 1 in 50,000 live births and the male-to-female ratio ranges 2.3:1 to 6:1. The basic defect of bladder exstrophy is an abnormal overdevelopment of the cloacal membrane, preventing medial migration of the mesenchymal tissue and proper lower abdominal wall development. Although there are some recent successful reports of the one-stage repair of bladder exstrophy that involves complete primary repair of exstrophy and total disassembly of the epispadiac penis, staged repair still represents the most common operation for correction of this anomaly. A successful initial closure of the infant born with bladder exstrophy is the single most important determinant of continence in the staged repair of exstrophy patient. We report a case of bladder exstrophy with successful initial closure of bladder using posterior iliac osteotomy and paraexstrophy skin flap.