Procedures used for correction of isolated penile torsion: are they competitive or complementary?

OBJECTIVES: To report our experience in starting the correction of penile torsion, whatever its degree (moderate or severe) with one or more simple procedures either separately or complementary in the same session. PATIENTS AND METHODS: Between 2013 and 2018, 62 patients who have significant isolated penile torsion (> 45°) were involved in this study. Those patients were subjected to either simple degloving with skin reposition, degloving with skin overcorrection and/or dartos flap procedures. Those procedures were performed either separately or complementarily. All patients were examined postoperatively after 7 days and followed up at 3, 6, and 9 months postoperatively. RESULTS: 37 out of 62 patients had a moderate degree (45-90) of penile torsion; 21 of them were corrected using skin degloving-reattachment technique, 11 patients were corrected by degloving with skin overcorrection, and in the remaining 4 patients dartos flap technique was used for correction. In 25/62 patients who had severe degree (> 90°) of torsion; 9 patients were managed by degloving with skin overcorrection, while in 13 patients the procedure was shifted to dartos flap technique, and the remaining 3 patients, 2 of whom had 180° torsion, were managed by dartos flap with added skin overcorrection. CONCLUSION: Performing degloving and skin reattachment with or without skin overcorrection procedure and dartos flap procedure either separately or complementarily in the same patient whatever the degree of torsion (moderate or severe) is associated with good results and can protect some patients from exposure to more difficult and extensive procedures as corporopexy and corporeal plication.

Urethral Mobilization as an Alternative Procedure for Distal Hypospadias Repair.

OBJECTIVE: To evaluate the urethral mobilization procedure as the main technique in management of glanular, coronal, subcoronal, and distal penile hypospadias. PATIENTS AND METHODS: Sixty patients with distal hypospadias were included in this prospective study between January 2013 and January 2015. All of them had urethral mobilization. All patients were followed up at 2 weeks, and at 1, 3, 6, and 12 months postoperatively. Duration of the operation, hospital stay, position of meatus and its shape before and after the operation, and the postoperative complications were recorded. The force and direction of the postoperative voiding stream were observed and assessed subjectively. RESULTS: The mean operative time and hospital stay were 38 minutes and 2.2 days, respectively. Postoperatively, 2 patients developed wound infection, 1 of them developed glanular suture dehiscence managed by simple glanular suturing 3 months later. None of our patients developed urethrocutaneous fistula. Three months postoperatively, 2 patients developed meatal stenosis, 1 of them managed by meatal dilation whereas the other patient required ventral meatotomy. CONCLUSION: Hypospadias surgery aim to construct a functionally and cosmetically normal penis with minimal complications. Recently, urethral mobilization started to regain its position in distal hypospadias repair. Its results are comparable with other popular procedures or even better. Urethral mobilization is an easy and simple procedure and it has an excellent cosmetic and functional outcome with minimal complications.