Objective To document the effect of surgical steps, including penile degloving, plate transection, dorsal plication, and fasciocutaneous coverage, in primary hypospadias repair on penile length. Methods A consecutive series of 209 prepubertal boys with primary hypospadias repair was included with the age ranged from 10 to 97 months (mean, 31.7 months). Intraoperative stretched penile length (SPL) was measured before operation (n=209), and after each step, namely penile degloving (n=152), plate transection (n=139), dorsal plication (n=170), and fasciocutaneous coverage (n=209). SPLs before and after each steps or the entire operation were analyzed. The SPL was compared between plate transection group and plate preservation group, dorsal plication group and non-plication group, and plate preservation with plication group and plate preservation without plication group, respectively. Differences of SPL between before and after each steps were analyzed with factors including neourethra length, rest dorsal penile length, rest ventral penile length, preoperative SPL, and the degree of penile curvature after penile degloving, with multivariate linear regression analysis. ResultsAll the four steps resulted in SPL difference. The SPL increased after penile degloving and plate transection (P<0.05), and decreased after dorsal plication and fasciocutaneous coverage (P<0.05). The SPL increased after all steps were completed (P<0.05). In patients with plate transection, postoperative SPL increased when compared with that before operation (P<0.05). No significant difference was noted in patients without plate transection (P>0.05). And there was significant difference in the increased length of SPL between patients with and without plate transection (P<0.05). In patients with dorsal plication, a significant increase of postoperative SPL (P<0.05) was noted. No significant difference was noted in patients without dorsal plication (P>0.05). And there was no significant difference in increased length between patients with and without dorsal plication (P>0.05). When patients with plate transection were excluded, dorsal plication resulted in no significant difference on postoperative SPL (P>0.05). The increased length of SPL after penile degloving, dorsal plication, or cutanofascial coverage was not related to the neourethra length, the rest dorsal penile length, the rest ventral penile length, the preoperative SPL, and the degree of penile curvature (P>0.05). However, the neourethra length and preoperative SPL were the influencing factors for the increased length of SPL after plate transection (P<0.05). ConclusionThe main steps in primary hypospadias repair can change SPL. The lengthening effect of plate transection would not be counteracted by dorsal plication. Dorsal plication makes no significant difference on postoperative SPL.
Objective To investigate the safety, efficacy and morbidity of onestage urethroplasty by using bladder mucosa for treatment of hypospadias. Methods From August 1991 to August 2003, 38 cases of congenital hypospadias were given bladder mucosa flap procedure and one stage urethroplasty. Results Thirty-eight cases of hypospadias treated with one stageurethroplasty by using bladder mucosa were followed up 6 months-9 years afterthe procedure. The success rate of the operation was 95%. Three cases of urethral fistula after the procedure were surgically repaired again, 2 cases of urethral stricture recovered after distension. The complication markedly lessened, micturation became normal with the reconstructed meatussituated at the proper site on the glands. Conclusion one stage urethroplastyby using bladder mucosa for treatment of hypospadias is a simple, effective andsafe surgery.
Objective To explore the feasibility of one-stage repair of hypospadias using the meatalbased flap overlapping with buccal mucosal graft. Methods From March 2002 to May 2004, 21 patients with hypospadias were treated with the meatal-based flap overlapping with buccal mucosal graft. Their ages ranged from 14 months to 8 years. The procedure were as follows:urethralplate at proximal corona was cut to correct glandular tilt and chordee; the buccal mucosa taking from inner cheek was then fixed on tunica albuginea of ventral shaft with suture; and the meatalbased flap was rotated distally and overlaid with buccal mucosal graft to repair urethra.Results All patients were followed up 318 months (7 months on average). A cosmetic glans and a vertically oriented, normal appearing slit meatus were achieved. Two patients had fistulas on lateral corona. Fistula spontaneously healed in 1 case and the other one was repaired after 6months. Conclusion The technique of meatal-based flap overlapping with buccal mucosal graft can completely correct glandular tilt and chordee, prove good cosmetic and functional glans and meatus.
Twenty cases of hypospadiasundergone urethro-plasty with blad-der mucosa and correction of cordein one stage surgery are reported.Sixteen of 20 cases had satisfactoryresults .Two cases with structureof anastomosis have been improvedby urethral dilatation and the othertwo cases complicated with urethral-cutaneous fistula have gradually heal-ed with prolonged diversion of cysto- tomy. The indication and techniqueof this surgery are discussed indetail.
Objective To investigate the effect of scrotal septum vascular pedicle flap with two wing-l ike spl itthickness skin graft in reconstructing urethra in patients with hypospadias and in reducing the compl ications. Methods From January 2007 to March 2008, 30 cases of hypospadias were treated, with a median age of 10 years (2-20 years). There were 13 cases of proximal shaft type, 12 cases of penoscrotal type and 5 cases of scrotal type. There were 8 cases with operation history. The flap size ranged from 4.0 cm × 0.8 cm to 9.0 cm × 1.0 cm and 5 mm with two wing-l ike spl it-thickness skin graft.When the downward curvature corrected, length of the flap could be determined by the length of the urethra that neededto be reconstructed. Results All flaps survived. The incision healed by first intention in all patients except one whose incision healed after change dressing because of frequent erection. Incision at donor site healed well. Eighteen patients were followed up for 6-12 months, including 8 with second operation history. The reconstructed urethras were unobstructed and no urethrostenosis or urinary fistula happened. Conclusion This is an improved technique of the scrotal septum flap in urethra reconstruction. It takes advantages of both flap and spl it-thickness skin graft in reconstructing urethra and avoides the disadvantages of a single tissue. It is a good choice for treating hypospadias whose urinary meatus locates neighborly to penoscrotal junctional zone.
Objective To evaluate the effect of niti-alloy urethral stent on the prevention of urethrocutaneous fistula and urethral stricture in hypospadias repair. Methods From January 2001 to December 2004, niti-alloy urethral stents were applied to repair congenital hypospadias in 63 patients. Among 63 patients, 49( 19 cases of proximal hypospadias, 22 cases of penoscrotal hypospadias and 8 casesof perineoscrotal hypospadias) received one-stage surgical managements of urethral reconstruction, and 10 underwent postoperative fistular repairs and 4 received repeated urethral reconstruction because of urethral stricture after hypospadias repair. Results All patients gained healing by first intention without fistula or urethral stricture. The stents were left indwelling in the neourethra for 2 months to 3 months to prevent stricture. The longest indwelling period was about 1 year. No dysuria or other discomfort occurred during this period. Conclusion Niti-alloy urethral stent can effectively prevent the postoperative urethrocutaneous fistula and urethral stricture after hypospadias repair.
Objective To investigate a method of repairing hypospadias by combining buccal mucosal graft with scrotal flap and its therapeutic effect. Methods From March 2002 to December 2007, 42 patients with hypospadias underwent primary urethral reconstruction using buccal mucosal graft and scrotal flap. The patients ranged in age from 18 months to 18 years. There were 21 cases of penoscrotal type, 12 cases of scrotal type and 9 cases of perineal type. Among them,8 cases were at initial operation, and 34 cases suffered from the failure of hypospadias repair 6-19 months (average 10 months) after initial operation. During operation, the defect of urethra was 3-7 cm (average 4.2 cm) when the penis was straightened; the buccal mucosa (3.0 cm × 1.2 cm-7.0 cm × 1.5 cm) was transplanted to the tunica albuginea in the ventral aspect of the penis, and was paired with the scrotal flap (3.0 cm × 1.5 cm-7.0 cm × 1.5 cm) to repair urethra. Results The incision of 38 cases healed by first intention, and no compl ication occurred. At 7 days after operation, 4 cases had urinary fistula at either coronary sulcus or anastomotic stoma, one of which spontaneously closed 2 months after operation and the rest 3 recovered by repairing urinary fistula 6 months after operation. All patients were followed for 3-48 months (average 18 months). Urination was smooth, the reconstructed urethral opening was at the tip of glans peins without retraction and with apperance similar to the normal urethral opening. The appearance of penis and scrotum was satisfying, and the penis was straightened completely. Conclusion Combined buccal mucosal graft and scrotal flap, with considerable tissue for uretha tract reconstruction and low incidence rate of urethral stricture, is one of the effective methods to repair hypospadias.
ObjectiveTo explore the short-term effectiveness of hypospadias repairs with free inner prepuce tube. MethodsForty-two males with hypospadias were repaired with free inner prepuce tube between May and October 2015. The age ranged from 1 year and 1 month to 28 years and 2 months with a median of 2 years and 9 months. Initial operation for hypospadias was performed in 41 cases and re-operation in 1 case of chordee after 16 months of hypospadias repair. There were 36 cases of hypospadias (6 cases of proximal penile type, 1 case of penile scrotal type, 26 cases of scrotal type, and 3 cases of perineal type) and 6 cases of typeⅣchordee according to Donnahoo classification criteria. ResultsThe length of reconstructed urethra was 2.0-5.5 cm (mean, 3.6 cm). The patients were followed up 6-10 months (mean, 8 months). Urinary fistulae was noted in 10 patients, which healed spontaneously in 5 cases within 3 months after surgery, and was cured after repair in 5 cases. Urethral stenosis occurred in 4 cases (2 external orifice stricture and 2 distal urethral stricture) and urethral incision was performed. Wound infection was noted in 3 cases, 2 of them needed further surgery for a permanent fistula. Skin ischemic necrosis was found in 3 cases, 1 of them had infection and fistula, and needed further surgical repair. Diverticulum of scrotum developed in 1 case. Ten patients need re-operation, and the success rate was 76.2% (32/42). At 3 months after surgery, the HOSE score ranged from 11 to 16 (mean, 14.7). The maximum urinary flow rate was 1.9-28.4 mL/s (mean, 10.5 mL/s) in 22 cases of outpatient at 3 months after surgery. ConclusionFree inner prepuce tube can survive and play a role of normal neourethra. The short-term effectiveness has shown a relatively high complication rate and suggests this procedure should be carefully applied.