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PubMed2026

The transverse preputial onlay island flap: A reliable option for repair of small-glans hypospadias.

BACKGROUND: The Transverse Preputial Onlay Island Flap (TPOIF) technique is frequently used in cases with mild chordee and small glans. This study's objective was to evaluate the surgical outcomes of this technique at our center. MATERIALS AND METHODS: This study consisted of hypospadias patients diagnosed with small glans (diameter <14 mm) and mild chordee (<30°), underwent TPOIF urethroplasty. RESULTS: A total of 64 cases were included in this study. The mean glans diameter was 10.6 mm. The complication rate was 9.4 %. CONCLUSIONS: The TPOIF technique provides encouraging results for treating hypospadias with small glans, though larger studies are needed.

Humans↗

PubMed2006

[Tubularized incised plate urethroplasty for hypospadias in children].

OBJECTIVE: To present the experience of hypospadias repair using the tubularized incised plate urethroplasty (Snodgrass procedure). METHODS: From May 2001 to November 2004, 82 patients with hypospadias underwent the Snodgrass procedure and the clinical data were analysed retrospectively. The mean age was 5 years (1.5 to 16 years). These cases were divided into: the earlier stage group (34 cases) and the later stage group (48 cases); the proximal group (19 cases) and the distal and middle group (63 cases); the primary operational group (49 cases) and the preoperational group (33 cases). RESULTS: Fistulas occurred in 12 patients (14.6%), complete glans dehiscence in 1 case. Fistula were as follows: 11 cases in the earlier stage group (32.4%) and 1 case in the later stage group (2.1%); 2 cases in the proximal group (10.5%) and 10 cases in the group of distal and middle group (15.9%); 8 cases in the primary operational group (16.1%) and 4 cases in the preoperational group (12.1%). There was statistically significant difference in the incidence of fistula between the earlier stage group and the later stage group (P < 0.01). There was no statistically significant difference between the proximal group and the distal and middle group, between the primary operational group and the preoperational group (P > 0.05). All patients were followed up more than one month. The neo-meatus was in normal position. The results of penile cosmetic and urethral function were satisfactory. Of these cases, 15 were followed up 1.5-6.0 months. The average flow rate was 7.8 ml/s (6.8-10.5 ml/s). The mean of maximum flow rate was 10. 5 ml/s (8.8-14.5 ml/s). CONCLUSION: Excellent neourethral functional and superior cosmetic results with low rate of complication can be gained by using tubularized incised plate urethroplasty for the cases of hypospadias without chordee or with mild chordee. But the preputial flap procedure should be chosen in condition that the hypospadias was association with obvious chordee.

Adolescent↗

PubMed1991

Distal hypospadias repair by urethral sliding advancement and Y-V glanuloplasty.

Different techniques are available today for repairing distal (coronal and subcoronal) hypospadias but none is universally recommended. We developed the technique of a distal urethral advancement glanuloplasty operation that is specifically intended for distal hypospadias repair even with mild chordee. Mobilization of the distal urethra is performed for 1.0 to 1.5 cm. after subcoronal circumcision and a deep Y-shaped incision of the glans. The mobilized urethra is dorsally split and slid forward to the tip of the dart of the glans previously prepared. Glanuloplasty is performed using the 2 lateral flaps of glans tissue. From January 1987 to December 1989 we used this technique in 74 cases of distal hypospadias with mild or no chordee (patient age 18 months to 9 years, mean 3.5 years). A transurethral catheter was left indwelling for 3 to 4 days. Hospitalization time was 5 (plus or minus 1.5) days. Results after 4 to 40 months of followup are encouraging cosmetically and functionally. All patients were cured. In 3 cases (4%) meatal stenoses occurred requiring meatotomy and in 8 boys meatal dilations were performed on an outpatient basis. In 1 case (1.3%) a fistula developed, which was subsequently repaired without further complications. This operation may be successfully used in most cases of distal hypospadias, with a low complication rate and excellent cosmetic results. It also may be used if mild chordee is present, thus reducing the indications for flip-flap urethroplasty in those cases when meatal advancement procedures may not be effective.

Child↗

PubMed2005

Minimal impact urethroplasty allows same-day surgery in most patients.

OBJECTIVES: To present our evaluation of the safety and feasibility of decreasing the impact of anterior urethroplasty by minimizing the surgery time, maximizing adjuvant pain therapy, and using anesthetic agents that decrease the incidence and severity of side effects, which allows most patients to leave the hospital comfortably within 4 hours of surgery. METHODS: A retrospective chart review of 54 consecutive anterior urethroplasty patients from August 2000 to August 2004 (34 anterior anastomotic and 20 ventral onlay buccal mucosal graft urethroplasty) was performed. RESULTS: Historically, 27% of patients had undergone same-day surgery (SDS). After the initiation of minimal impact surgery and early discharge, 85% did so. All but one admission was planned (1 patient [2%] had hypotension in the recovery room and was admitted). No postoperative readmissions or emergency room visits occurred. The admitted patients had comparable stricture length to, but slightly older age (49 years compared with 42 years) than, the SDS patients. The perioperative complications were mild (small wound gap, small scrotal hematoma) and were seen in 5% of SDS patients and 0% of admitted patients. Late complications (chordee, mild erectile dysfunction, and urinary tract infection) were seen in 19% of SDS patients and 18% of admitted patients. The incidence of recurrences after a mean follow-up of 27 months was comparable (3% for the SDS and 6% for the admitted group). CONCLUSIONS: Decreasing the impact of urethroplasty surgery allows safe early discharge for most patients. Unexpected admissions were uncommon, and we continue to plan for admission only for the extremely elderly, those with severe comorbidities, and those expected to undergo lengthy (longer than 5 hours) surgery.

Adolescent↗

PubMed2005

Split onlay skin flap for the salvage hypospadias repair.

PURPOSE: Following failed hypospadias repair absence of the penile foreskin, a shortage of ventral skin and residual chordee may all contribute to poor long-term results. We describe a technique called the split onlay skin (SOS) flap that has improved our surgical outcomes in boys requiring salvage hypospadias repair. MATERIALS AND METHODS: The SOS flap uses a transverse island of penile shaft skin that is mobilized on its vascular pedicle and rotated into position to the ventrum of the penis at the site of the urethral defect. The flap is transected transversely, and half of the flap is used as an onlay to repair the urethra and the other half is used for additional skin coverage where needed on the penile shaft. We treated 11 boys 30 to 124 months old (mean age 60.3 months) who had a mean of 2 previous failed hypospadias repairs. All 11 boys presented with complex combinations of urethrocutaneous fistulas, stricture or urethral diverticula. RESULTS: Of the 11 patients 6 (54.5%) had development of postoperative fistulas. Five of these fistulas were surgically closed with no further complications. One penoscrotal fistula closed spontaneously after 7 months. Mild chordee from contraction of the flap and a urethral diverticulum developed in 1 boy. At a mean followup of 24.5 months all patients, including those who underwent closure of the secondary fistula, were voiding well with excellent appearance. CONCLUSIONS: In cases where little local tissue is present the SOS flap procedure is an excellent way to transfer healthy dorsal tissue to the ventrum for an onlay salvage urethroplasty while providing additional coverage of the urethral defect and a tension-free skin closure. Despite the high fistula rate we encountered following the initial SOS procedure, we endorse this technique because the transferred dartos provides additional tissue, which facilitates subsequent fistula repair. These boys can achieve a successful cosmetic result without incorporation of scrotal tissue or a free graft, which we believe leads to more predictable results.

Child↗

PubMed2001

Outcome of pull-in procedure in children with severe post-disruption posterior urethral strictures.

A total of 17 children aged 5 to 15 years with the diagnosis of posttraumatic posterior urethral stricture were operated upon using a pull-in procedure during the last 9 years. Among the diagnostic tools, synchronous inspection of both the anterior and posterior urethra by cystoscopy yielded the most valuable information. A success rate of 70% was achieved with the procedure plus postoperative re-catheterization. A pedunculated tube prepared from the scrotal skin cured 2 patients after a series of failed operations. Difficult voiding occurring after removal of the stent due to an inappropriate pressure gradient created between the bladder neck and urethra usually benefits from short-term catheterization. Mild chordee was present in 1 patient. Ejaculation and erection were present in 3 children who reached puberty.

Adolescent↗

PubMed2001

Outcomes of one-stage techniques for proximal hypospadias repair.

OBJECTIVES: To evaluate the success of three preputial flap techniques in the one-stage correction of proximal hypospadias. METHODS: From 1993 to 1999, 43 children underwent one-stage proximal hypospadias repair using preputial flaps, which were performed by a single surgeon. Of the 43 patients, 21 (48.8%), 10 (23.2%), and 12 (27.9%) underwent tubularized island flap urethroplasty, double-faced tubularized island flap urethroplasty, and onlay island flap urethroplasty, respectively. The age range of the patients at surgery was 18 months to 14 years (mean 3.4). Dorsal plication was required for chordee repair in 12 patients (3 in tubularized island flaps, 3 in double-faced tubularized island flaps, and 6 in onlay island flaps). In addition to the dorsal plication, posterior dissection of the urethral plate without division was performed on 3 of the 6 patients with mild to severe chordee in the onlay island flap group. The incidence of complications requiring repeated surgery was evaluated for each group. RESULTS: The follow-up was 8 months to 7 years (mean 4.1 years). The overall complication rate was 90% for the double-faced tubularized island flap repair, 38% for the tubularized island flap repair, and 33% for the onlay island flap repair. Recurrent chordee was observed in 2 (66.6%) of the 3 patients who underwent onlay island flap repair with urethral plate dissection. CONCLUSIONS: The use of a tubularized island flap is suggested for one-stage repair of proximal hypospadias, especially in the patients with severe chordee. Because of the high complication rates, the double-faced tubularized island flap technique is not advocated. The onlay island flap may also be used for proximal hypospadias repair if mild chordee is present. Because of the high recurrent chordee rate, dissection of the urethral plate without division is not suggested in the onlay island flap technique.

Adolescent↗

PubMed2003

Tubularized, incised plate urethroplasty in hypospadias repair: experience at Queen Sirikit National Institute of Child Health.

BACKGROUND: Hypospadias is the most common penile anomaly. Many techniques have evolved during the past 150 years to address chordee and construct a neourethra. The current concept of understanding of chordee and emphasis upon preserving the urethral plate have brought hypospadias surgery over the last decade near its ultimate goal of a reconstructed penis that is functional and cosmetically normal. Warren T Snodgrass primarily reported successful urethral plate preservation urethroplasty in 1994. The urethral plate can be primarily tubularized without an additional skin flap after a dorsal midline relaxing incision is made known as tubularized incised plate urethroplasty. It is currently used worldwide by pediatric urologists due to its advantages. The authors also performed this technique and initial experience at Queen Sirikit National Institute of Child Health, Bangkok, Thailand is reported. MATERIAL AND METHOD: 88 of 180 hypospadias boys were treated with tubularized incised plate urethroplasty for primary repair of hypospadias over a 24 month period. All had moderate to severe chordee. Urethral plate preservation is the principle concept of this technique and the entire length of the urethral plate was incised along the midline and the neourethra was tubulized over a 6 or 8 Fr. catheter. The chordee usually disappeared after the penis was degloved. Dorsal plication was performed in mild residual chordee. A subdartos flap was created to cover the neourethra and pressure dressing applied with bactracin gauze for 7 days. The urethral stent was removed on the 7th post-operative day. RESULTS: The tubularized, incised plate urethroplasty was performed in 88 boys, age range from 6 months to 12 years. The operative time was 60 to 100 minutes. Follow-up was up to 18 months. There were 13 distal penile, 60 midshaft and 15 penoscrotal types. All penes had excellent cosmetic appearance, even in complicated cases. The pinhole and large fistulas were noticed in 10 and 3 penes respectively (14%). All fistulas were repaired successfully at a later date. Twenty cases had a mild degree of meatal stenosis of which 18 had good response to self meatal dilatation by their parents and 2 underwent a meatotomy procedure. No urethral diverticulum or stricture was noticed during follow-up. CONCLUSION: Even though high percentages of fistula complications were noticed in the authors' experience, they seemed to be acceptable and easy to correct. This technique seems to be suitable for both distal and proximal hypospadias. The advantages of this technique include its simplicity, low complication rate, very good appearance of the glans penis and normal meatus in most boys. Tubularized incised plate urethroplasty is now the procedure of choice for distal and proximal hypospadias repair.

Child↗

PubMed1988

Experience with 1-stage repair of hypospadias and chordee using free graft of prepuce.

From August 1978 to September 1987 a total of 103, 1-stage hypospadias-chordee operations was performed using a free graft of prepuce by the method of Devine and Horton. There were 94 primary cases and 9 secondary cases in which prior operations had been done. Chordee was mild in 11 patients, moderate in 67 and severe in 25. The meatus was at the distal shaft in 56 patients, midshaft in 34 and penoscrotal in 13. All patients underwent temporary perineal urethrostomy diversion of the urine. Postoperative complications included 6 fistulas that required closure and 3 meatal stenoses treated by meatotomy but no strictures, residual chordee or other complications. We found that the Devine-Horton technique gave an essentially normal-appearing penis with a low over-all complication rate.

Adolescent↗

PubMed1998

Single and multiple dermal grafts for the management of severe penile curvature.

PURPOSE: Conventional techniques result in chordee correction in the majority of patients. However, some with extensive chordee require further treatment to correct persistent extraordinary penile curvature. Our practice has been to treat this condition with interpositional dermal grafting. We review our experience with this procedure. MATERIALS AND METHODS: During a 5-year period dermal grafts harvested from the nonhair-bearing inguinal skin fold were placed in 51 patients with a mean age of 29 months. The primary diagnosis was penoscrotal or perineal hypospadias in 36 patients (hypospadias cripple in 4), the exstrophy-epispadias complex in 3, mid shaft or distal hypospadias with severe chordee in 10 and chordee without hypospadias in 2. A total of 49 patients (96%) underwent staged urethroplasty. RESULTS: One graft was placed in 29 patients (57%), 9 (18%) received 1 graft and underwent a Nesbit plication, (14%) received 2 grafts, 5 (10%) received 2 grafts and underwent dorsal plication, and 1 (2%) received 3 grafts. Second stage urethral reconstruction was done using a Thiersch-Duplay tube in the majority of cases. In 5 patients mild residual chordee was easily corrected at the time of second stage repair. CONCLUSIONS: In a staged repair the first priority of the initial stage is to achieve a straight phallus. While our experience indicates that a single dermal graft is sufficient in approximately 57% of cases, when it does not result in complete straightening, we have had success with placing additional graft(s) and/or performing dorsal plication. We believe that the additional penile length achieved with dermal grafting results in a dependent phallus and cosmesis preferable to that of plication only.

Adolescent↗

PubMed2006

[Surgical approaches to the correction of congenital penile curvature].

OBJECTIVE: To evaluate some currently used surgical approaches to the correction of congenital penile curvature. METHODS: Seventy-six patients with congenital penile curvature underwent surgical correction, of whom 67 were accompanied with hypospadias, 5 with epispadias and 4 with normal urethral meatus. The methods for straightening the phallus included 5-week preoperative hCG treatment, complete degloving of penile skin, release of periurethral fibrous bands extending proximally to the meatus, plication of dorsal or ventral tunica albuginea, and embedding of dermis and tunica vaginalis grafts. RESULTS: All the cases were followed up for 2 months to 2 years, and the mean follow-up time was 9.3 months. Satisfactory phallus straightening was achieved in 67 cases (88%), mild residual chordee remained in 6 (8%), which needed no reoperation for the time being unless warranted by follow-up, and relapse occurred in 3 (4%), which needed further operation. CONCLUSION: Most cases of congenital penile curvature can be corrected sufficiently with the above methods.

Child↗

PubMed1985

Comparative study of Hodgson I and King's methods of 1-stage hypospadias repair.

We compared the surgical results of the Hodgson I and King's methods of repair with and without urinary diversion in 33 patients with juxtaglandular to mid shaft hypospadias and mild to moderate chordee. Over-all, fistulas developed along the suture line in 4 patients, of whom only one underwent urinary diversion. Of 21 cases in which King's method of repair was done only 1 fistula developed. Of the 12 cases repaired by the Hodgson I method fistulas developed in 3 and 1 had a stricture at the site of the new urethro-urethral anastomosis. The best surgical results were achieved in those patients who had undergone King's method of repair with urinary diversion.

Child↗

PubMed1981

Repair of mild hypospadias.

A one stage repair is presented for mild hypospadias with or without chordee, entailing a local flap of shaft skin rotated forward to the tip of the glans and tubularized. The two halves of the glans penis are brought together to enclose the neourethra. This procedure results in a normal appearing penis. In 50 cases complications were limited to two meatal stenoses. There were no fistulas. This procedure is not used in cases with greater than minimal deformity.

Humans↗

PubMed1981

Mobilization of the urethra in the surgical treatment of hypospadias.

Urethral mobilization is an adjunctive surgical technique for improving the position of the urethral meatus in a hypospadias operation. In patients with mild degrees of hypospadias and chordee the mobilized urethral meatus can be placed out onto the glans without constructing a neourethra. In more severe cases of hypospadias urethral advancement distally will reduce the length requirement for the neourethra. Mobilization of the urethra has been done in 21 children in conjunction with standard hypospadias repair techniques and the outcome has been highly successful for the majority.

Child↗

PubMed1986

Use of the Hodgson XX (modified Asopa) procedure to correct hypospadias with chordee: surgical technique and results.

The management of patients with hypospadiac anomalies requires sound surgical judgment to obtain optimal results. From January 1983 to June 1985, 150 patients were operated on for hypospadias. Of these patients 37 underwent the Hodgson XX (modified Asopa) repair. Two patients suffered urethral fistulas, 1 had meatal stenosis and 1 had mild torsion. No strictures were noted. Based on our findings it appears that the Hodgson XX (modified Asopa) procedure provides excellent results for patients with hypospadias and chordee.

Humans↗

PubMed1997

Characterization of an isodicentric Y-chromosome for the long arm in a newborn with mixed gonadal dysgenesis.

A newborn infant was referred for evaluation because of ambiguous genitalia. Examination of the genitalia revealed a hypospadiac phallus measuring 1.5 cm in length with chordee. Subtle phenotypic features consistent with Turner syndrome were present including hypertelorism, anti-mongoloid slant to the eyes, mild widening of the neck, but no definitive webbing, shield like chest and positive cubitus valgus. A pelvic and renal sonogram confirmed the presence of a uterus and normal-appearing kidneys. There was incomplete fusion of the scrotum. No gonads were palpable within the scrotal sac. The patient was assigned a female gender on the basis of the presence of a uterus, the phenotypic appearance of the genitalia and the malignant potential of the gonads. The cytogenetic findings with QFQ-banding revealed an abnormal karyotype, i.e., mos 46,X,idic(Y) (p11.2)[77]/45,X[29]/46,X,idic(Y) (p11?) [2]/ 47,XY,idic(Y)(p11.2)[2]/47,X,idic(Y)(p11.2), + idic(Y)(p11.2)[1]/46,XY[1]. The presence of an abnormal isodicentric Y-chromosome was evaluated by FISH-technique to ensure a finer characterization than routine methods. The genotype-phenotype correlation could not be established since mosaicisms of highly variable nature can exhibit an unpredictable outcome.

Female↗

PubMed2005

Spontaneous penile (cavernosal) abscess: case report with discussion of aetiology, diagnosis, and management with review of literature.

The rare presentation of spontaneous, corpus cavernosal abscess with evident pus discharge is reported. The 19-year-old English man was successfully treated with surgical drainage and antibiotics with long-term sequelae in form of mild, left-sided penile deviation, but normal erectile function. Though he did not require any further surgical intervention for correction of chordee at that time, there remains a possibility of it getting worse over time, which may ultimately need surgery for correction. The possible aetiology, diagnosis, and treatment of this rare condition are briefly discussed.

Abscess↗

PubMed1989

The failed MAGPI: management and prevention.

Of 142 patients with hypospadias seen at this institute over the past 2 years, 8 developed meatal regression following repair of their anterior hypospadias with the meatal advancement and glanuloplasty technique (MAGPI); 5 had meatal regression which was attributed to a technical failure and 3 had severe regression of the meatus with significant subcoronal positioning, suggesting poor patient selection. None of these patients had chordee on intraoperative artificial erection. Five were treated successfully with a repeat MAGPI procedure and the remaining 3 required a Mathieu procedure. Although best indicated for mild degrees of anterior hypospadias, the success of the MAGPI procedure still requires meticulous technique and proper patient selection.

Adolescent↗