[Risk factors for the complications of primary hypospadias urethroplasty with the urethral plate reserved].

OBJECTIVE: To investigate the risk factors for the complications of urethroplasty in patients with primary hypospadias by postoperative follow-up observation. METHODS: We retrospectively analyzed 110 cases of primary hypospadias repair performed from November 2010 to October 2015, including 70 cases of tubularized incised plate (TIP) urethroplasty and 40 cases of inlay internal preputial graft (IIPG) urethroplasty, all with the urethral plate reserved. We followed up the patients for 15.6－36 months, (27.3 ± 0.52) mo for those with and (26.9 ± 0.22) mo for those without complications. The mean age of the two groups of patients was (7.5 ± 0.2) and (7.0 ± 0.5) yr, respectively. RESULTS: The follow-up data were collected from all the patients, 17 (15.5%) with and 93 (84.5%) without complications. The success rate of surgery was 84.5%. There were no statistically significant differences in the follow-up time and age between the two groups of patients (P >0.05). Single-factor analysis of variance showed significant differences between the complication and non-complication groups in the preoperative urethral opening (P <0.01), ventral penile curvature (P <0.01), and length of urethral defect (P = 0.04), while multiple linear regression analysis exhibited that only ventral curvature was associated with the postoperative complications of the patients (OR = 1.12, 95% CI: 1.06－1.19, P<0.01). CONCLUSIONS: We chose single-stage urethroplasty with the urethral plate reserved for the treatment of primary hypospadias and achieved satisfactory outcomes. Ventral penile curvature is an independent risk factor for the complications of primary hypospadias, and a higher degree of curvature is associated with a higher incidnece of complications.

[Single nucleotide polymorphisms of the DGKK gene and hypospadias in Chinese children].

OBJECTIVE: To investigate the role of single nucleotide polymorphisms of the gene of diacylglycerol kinase κ (DGKK) in hypospadias in Chinese children. METHODS: We performed direct sequencing on 2 hypospadias-related candidate single nucleotide polymorphisms of the DGKK gene (rs1934179 and rs7063116, never previously reported in the Chinese population) from 300 children with sporadic hypospadias and 200 healthy controls, and compared the results between the two groups. RESULTS: The mutation frequencies of rs1934179 and rs7063116 were 5.0% (15/300) and 5.67% (17/300) respectively in the hypospadias patients, significantly higher than 1.5% (3/200) and 2.0% (4/200) in the normal controls (P <0.05). The mutation frequencies of rs1934179 and rs7063116 in the cases of distal and middle hypospadias were also remarkably higher (6.5%, [13/200] and 7.5% [15/200], P <0.05), but those in the proximal cases (both 2.0% [2/100]) showed no statistically significant difference from the control (P >0.05). CONCLUSION: The polymorphisms of the DGKK gene may be associated with hypospadias, particularly distal and middle hypospadias, in Chinese children.

Botryoid Wilms' tumor: report of two cases.

BACKGROUND: Botryoid Wilms' tumor is a rare kind of Wilms' tumor. We report two cases of this tumor. METHODS: Case 1, a 2-year-old boy, was admitted with macrohematuria for 5 months. Case 2, a 19-month-old boy, was referred for a palpable abdominal mass. The two cases were checked by 64-row multi-slice spiral CT (MSCT) and scanned with the dynamic contrast enhancement. The masses were excised and pathologically confirmed. RESULTS: In case 1, the mass occurred in the renal pelvis and calyx bilaterally, with heterogeneous density and prominent calcification. By contrast enhanced CT scan, the mass was mildly enhanced. In case 2, the left renal pelvis and ureter were filled with the tumor. Unenhanced scan revealed that the mass was homogeneous and non-calcified. In contrast, the mass was slightly and heterogeneously enhanced. Macroscopically, the mass filled in the pelvicalyceal system and had a botryoid appearance. Microscopically, the typical features of Wilms' tumor with blastemal, epithelial, and stromal components were evident. CONCLUSION: Botryoid Wilms' tumor should be included in the differential diagnosis of tumors in the pelvicalyceal system no matter it is unilateral or bilateral.

[Correction of penile curvature by various tunica albuginea plasty].

OBJECTIVE: To explore various tunica albuginea plasty for penile curvature and their efficacies. METHODS: From July 2005 to July 2008, there were a total of 8 patients with a mean age of 34 ± 9 years old (range: 23 - 47) undergoing corrective surgery for various types of penile curvature. Among them, 4 patients (3 with ventral curvature, 1 with lateral curvature) were treated by 16-dot plication technique, 2 patients of lateral curvature with tightening ring in tunica albuginea corrected by V-Y plasty and 2 patients (one caused by Peyronie's disease while the other by tunica scar contracture) repaired by venous graft patch. The pre-and post-operative levels of sexual satisfaction were evaluated by the International Index of Erectile Function (IIEF-5) scoring system. RESULTS: All cases were followed up at 3, 6 & 9 months postoperatively. Their mean curvature at maximal erection was (58.2 ± 9.7)°. And a postoperative office assessment revealed a functional straight in all patients [mean degree (11 ± 4)°]. One patient (12.5%) reported penile shortening without dissatisfaction about it. No patients complained of anesthesia or other sensory abnormality on their penile skin. An improvement of IIEF-5 scores was noted (21 ± 3 vs 15 ± 5, P < 0.05) and all patients were satisfied with their outcomes. No complications, such as hematoma, infection or erectile dysfunction, occurred. CONCLUSION: To achieve a better penile morphology and functional outcomes with fewer complications, various arthroplasty should be adopted according to the cause, degree and direction of penile curvature.

Single stage dorsal inlay buccal mucosal graft with tubularized incised urethral plate technique for hypospadias reoperations.

AIM: To report the experience with single stage dorsal inlay buccal mucosal grafts using the Snodgrass technique for complex redo cases. METHODS: From May 2004 to December 2005, a total of 53 patients aged from 3 to 34 years old (average 11.62 +/- 7.18 years) with failed previous hypospadias surgery were included in the present study. Indications included urethral strictures and repair breakdown. The unhealthy urethra was unroofed from the meatus in the ventral midline, a buccal mucosal graft was inlayed between the incised urethral plate and fixed to the corpora cavernosa. The neourethra was tubularized, and covered with subcutaneous (dartos) tissue and penile skin. Glanuloplasty was also performed in all cases. Outcome analysis included clinical follow-up, and endoscopy in 2 selected cases. RESULTS: The buccal mucosal graft was 3.0-7.5 cm in length and 0.7-2.0 cm in width. All patients required glanuloplasty, with buccal mucosal grafts extended to the tip of the glans. After a follow-up of 14-30 months (mean 22.6 months), the total complication rate was 15.1%, with five cases of fistula and three cases of stricture. CONCLUSION: Inlaying dorsal buccal mucosal grafts applying the Snodgrass technique is a reliable method for creating a substitute urethral plate for tubularization. The recurrent rate of urethral stricture and fistula is at an acceptable level for redo cases. This approach represents an effective, simple and safe option for reoperations.

Bilateral intrarenal pelvis Wilms' tumor with fibroepithelial polyp.

Intrarenal pelvis Wilms' tumor is rare in children. A case of a 28-month-old boy with bilateral intrarenal pelvis Wilms' tumor associated with a fibroepithelial polyp is reported in this article. The tumor was evaluated by ultrasonography, computed tomography, and intravenous pyelography. The boy underwent bilateral renal pelviotomies. Now he is being treated and followed up by pediatric oncologists.