Objective Scoring Evaluation and Uroflowmetry Assessment of Two-Stage Hypospadias Repair: Single Center Experience.

Background: Hypospadias is a common congenital anomaly affecting the penis, two-stage repair becoming more interesting in era of tubularized –incised urethral plate (TIP). Functional outcome of hypospadias repair either single or two stage is as important as cosmetic outcome. In contemporary series , structured scoring systems (Hypospadias Objective Scoring Evaluation-HOSE and Pediatric Penile Perception Scoring -PPPS), evaluation of photographs and uroflowmetry, were used to assess results of hypospadias repair. Objectives: We have assessed outcomes of two-stage hypospadias repair using Hypospadias Objective Scoring Evaluation(HOSE) and uroflowmetry. Material and Methods: Over a period of eight years, from January 1997 to December 2004, One hundred and twenty six hypospadias patients were treated, ninety of them had two-stage repair and36 single-stage repairs. The HOSE questionnaire and uroflowmetry were obtained to evaluate the long term outcome of two –stage hypospadias repair. Results: The age at time of assessment ranged from 8 to 23 year-old, with mean follow up of 39.78months. Thrifty five patients had proximal hypospadias and 20 had distal varieties of hypospadias. Operations performed were 37 Bracka?s and 18 Byar?s procedures. Of the 55 patients had complete two stage hypospadias repair and agree to participate in the study , Nineteen patients had acceptable HOSE and 36 had non-acceptable score. Uroflow rates of 43 subjects were below the fifth centile in three patients ,equivocal (between 5th and 25th centile ) in four patients and above 25 th centile in 36 subjects. Conclusion: Two –stage repair is a suitable technique for all types of hypospadias with versatile outcomes. HOSE and uroflowmetry are simple, easy, non invasive and non expensive tools to assess long term outcomes objectively.

Surgical Correction of Hypospadias Using Tubularized Incised Plate Urethroplasty / 대한비뇨기과학회지

PURPOSE: Numerous operative techniques have been developed to correct hypospadias. Tubularized incised plate (TIP) urethroplasty has recently been reported with good results. We analyzed the surgical outcome and complications in children with hypospadias using TIP urethroplasty. MATERIALS AND METHODS: Between July 1998 and July 2001, 28 patients with hypospadias were primarily corrected using TIP urethroplasty by one surgeon. The mean age of the patients was 4.2 years. A position of the meatus was coronal in six boys, at the posterior penile shaft in five, glandular in four, penoscrotal in four, at the anterior penile shaft in three, at the midshaft in three and the perineal in three. An 8 or 10 Fr Foley catheter was used as a urethral stent, which was removed at day 12 (10-15). RESULTS: Of the 28 patients, 23 were corrected with TIP urethroplasty only, and the other 5 combined with an onlay island flap. For the management of penile curvature, skin and ventral releases were used in 14 patients; with tunica albuginea placation used in the other 14. Postoperative complications were noted in 3 patients, of whom 2 developed urethrocutaneous fistula and one developed meatal stricture. The cosmetic results were very good in most patients. CONCLUSIONS: TIP urethroplasty can be used for all type of hypospadias. It has advantages, such as an excellent cosmetic appearance, preservation of the urethral plate and a lower complication rate than other urethroplasty techniques. Our results suggest that this technique is recommendable for the management of primary hypospadias as a first choice.

Outcome of Adult Hypospadias Repair / 대한비뇨기과학회지

PURPOSE: The modern era of hypospadias surgery has brought functional and cosmetic results to a high level in children. However, little data are available on the outcome of adult hypospadias repairs. The objective of this study was to evaluate the results of 46 adult patients with hypospadias repairs. MATERIALS AND METHODS: One surgeon performed forty-six consecutive adult hypospadias repairs. The mean age at the time of surgery was 22.1 years (range 13 to 59). Follow up ranged from 3 months to 7 years (mean 11.3 months). We retrospectively analyzed surgical outcomes, with respect to previous repair, surgical procedure and complications. RESULTS: Of 46 adult hypospadias patients, 20 had had previous repairs and 26 had had no previous repairs. Surgical procedures consisted of 7 onlay island flap, 6 pyramid, 4 transverse island flap, 2 King, 3 MAGPI, 2 Mathieu, 3 tubularized incised plate and 1 meatal advance in the group with no previous repairs. In the group that had undergone previous repairs there were 10 Thiersch-Duplay, 2 Johanson, 2 transverse island flap, 1 MAGPI, 1 King, 1 Durham-Smith, 1 Mustard, 1 meatal advance and 1 onlay island flap. Complications developed in 11 patients from the no previous repair group, including 6 fistula, 2 stricture, 4 wound infection, 2 wound dehiscence and 1 ventral curvature, and were as follows for the previous repair group; 12 fistula, 5 stricture, 3 wound infection and 4 wound dehiscence. CONCLUSIONS: For both groups analysed, adult hypospadias repair was much less successful than childhood repair. Further studies are necessary to decrease the complications.

Subcutaneous Tissue Coverage to Prevent Urethrocutaneous Fistula in Hypos- padias Repair / 대한비뇨기과학회지

Urethrocutaneous fistula is the most common complication of hypospadias surgery, Many techniques have been tried to prevent urethrocutaneous fistula. We introduce the technique of neourethral coverage using adjacent subcutaneous tissue or a dorsal pedicled subcutaneous flap in hypospadias repair. This method was used in a series of 25 cases between April 1996 and April 1997. We experienced only one urethrocutaneous fistula. The additional coverage of the neourethra with the subcutaneous tissue achieves the goal of non-overlapping suture lines and allows for increased vascularity. So, this technique appears to be effective in preventing urethrocutaneous fistula in hypospadias repair.

Clinical Observation on 52 Cases with Failed Hypospadias Repair / 대한비뇨기과학회지

A clinical observation, giving the first consideration to the complications after repair, was made on 52 hypospadias of the in-patients in the Department of Urology, Yonsei University Hospital during the period Jan. 1972 through Dec. 1981 and the following results were obtained. 1. Of 52 straightenings, 40 cases (91%) were succeed by Duplay's method and 8 cases (100%) were succeed by Nesbit's method. 2. Success rate of 52 urethroplasties was 53.8%. Among them 4 cases by Thiersch-Duplay, 22 cases by Ikoma, 2 cases by Cecil and Denis-Brown's method respectively. 3. The penile type showed best success rate of 66.6%. 4. Urinary fistula complicated the urethroplasty in 22 cases (42.3%). 5. Most of the fistulae developed in original meatus (81.8%). 6. Urethral stricture complicated the urethroplasty in 5 cases (9.6%), 3 of them combined with fistula.