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Urethral advancement technique for repair of distal penile hypospadias: A revisit  [cached]
Awad Mohamed
Indian Journal of Plastic Surgery , 2006,
Abstract: Background: Numerous ingenious methods have been described to repair hypospadias with variable results. The anterior urethral advancement technique reported by Chang[1] to repair distal hypospadias has shown encouraging results. We have reevaluated this technique with some modifications to improve its results. Materials and Methods: This study was done on 72 patients, 19 cases with glanular hypospadias, 20 cases with coronal hypospadias, 22 cases of subcoronal hypospadias,and 11 cases with anterior penile hypospadias in the period between September 1999 and October 2003. The patients′ age ranged from two years to twenty five years (median age 5.6) years. All the patients were operated using Chang′s technique with our modifications. Results: There were no major complications in any of our patients, no postoperative fistulae or urethral stricture. Three patients had meatal stenosis and preputial edema occurred in 83.3% in non-circumcised patients. Conclusion: Modifications of the anterior advancement technique has produced excellent Results. It is easy to do and learn and also offers good cosmetic and functional results.
Penile Torsion: an Overlooked Anomaly with Distal Hypospadias
AAA Zeid, H Soliman
Annals of Pediatric Surgery , 2010,
Abstract: Purpose: To identify the incidence of penile torsion among patients with hypospadias, while using a simple and objective ethod to measure the degree of rotation. Materials & Methods: From December 2007 to March 2009, all boys presenting to our department for hypospadias repair (100 boys) were examined for associating penile torsion. The angle of penile rotation was measured on an end-on digital photograph of the penis, using MillenMed DICOM viewer program for image analysis. Two techniques were used to correct penile torsion. In group A (9 patients), we used the technique of degloving and repositioning the penile skin. In group B (10 patients), we applied the technique of dorsal dartos flap rotation. Results: Penile torsion was present in 19 out of 58 patients with anterior hypospadias (32.8%), while none of 42 patients with posterior hypospadias had associating penile torsion. Follow-up showed satisfactory correction of penile torsion in 3 out of 9 patients in group A; and in 8 out of 10 patients in group B. Conclusion: Penile torsion is a common association with anterior hypospadias (32.8%), and its correction can be simply performed during the hypospadias repair adding to a better cosmetic outcome. Dorsal dartos flap rotation seems to be more effective for correction of penile torsion than simply degloving and repositioning the penile skin. Index Word: penis; hypospadias; abnormalities.
Distally Folded Onlay Flap – A New Technique for Repair of Hypospadias
AM Abdel Moniem
African Journal of Urology , 2004,
Abstract: Objective: This study was carried out to evaluate the cosmetic and functional results of this new technique for repair of hypospadias. Patients and technique: 28 patients (2-22 years) with distal penile hypospadias were included in the study. Eleven of them had had a failed previous repair. An unhealthy urethral plate and/or thin ventral penile skin were found in 17 patients. The technique follows the steps of the island onlay preputial flap or dorsal penile fasciocutanous flap except in that the length of the flap is, at least, 1 cm longer than the length of the urethral plate. The proximal part of the flap is used for urethral reconstruction. The distal free part of the flap is reflected back to be sutured to the edges of the glanular wings and the penile skin. The urethral stent is removed after 5 days. The patients were followed monthly up to 6 months. Results: In 26 patients an excellent cosmetic appearance of both the penile shaft and glans was achieved with a slit-like or elliptic neo-meatus resulting in a good urine stream satisfying both the patients and their parents. Partial disruption of one side of the suture line and urethrocutanous fistula was reported in one patient each. These two complications were corrected surgically with good results. Conclusion: We conclude that this new technique that we named distally folded onlay flap is easy and versatile with excellent cosmetic and functional results and a low rate of complications when used for the repair of distal and mid-shaft hypospadias in either virgin or redo cases. It should also be considered as a salvage procedure when other techniques are no feasible options. Le lambeau croisé distal selon onlay. Une nouvelle technique de cure d\'hypospadias Objectifs: Evaluer les résultats esthétiques et fonctionnels de cette nouvelle technique pour la réparation d\'hypospadias. Patients et Méthode: Vingt-huit patients (2-22 ans) présentant un hypospadias distal ont été inclus dans cette étude. Onze patients présentaient un échec d'une réparation antérieure. Une plaque urétrale de mauvaise qualité et/ou une peau pénienne ventrale épaisse ont été décrites chez 17 patients. La technique utilisée est celle de ONLAY du lambeau préputial ou du lambeau de fascia de la peau dorsale pénienne, par contre là le lambeau est de 1 cm plus long que la plaque urétrale. Le bout proximal du lambeau est utilisé pour l'urétroplastie alors que le bout distal libre est inversé pour être suturé aux berges de la peau pénienne et au gland. Le cathéter urétral est enlevé après 5 jours. Les malades ont un suivi mensuel jusqu\'à 6 mois. Résultats: Chez 26 patients l'esthétique de la verge et du gland est excellente, complétée par une fente ou un néo-méat elliptique qui permet un bon écoulement urinaire qui satisfait les patients et leurs parents. Des complications ont été rapportées chez deux patients: le lachage partiel d\'un c té de la ligne de suture chez un patient et fistule urétro cutanée chez l\'autre. Ces deux
What is the best choice for repair of distal penile hypospadias: The tubularized incised plate urethroplasty or anterior urethral advancement technique?  [cached]
Awad Mohamed,Tolba Adel,Saad Khaled,Zaghlol Mahmoud
Indian Journal of Plastic Surgery , 2007,
Abstract: Background and Aim: Numerous ingenious methods have been introduced to repair hypospadias with variable results. We tried to evaluate the two techniques, tubularized incised plate urethroplasty (TIP) and anterior urethral advancement (AUA) for repair of distal hypospadias and choose the best method to treat the distal type of penile hypospadias with the least complications. Materials and Methods : A total of 140 boys with distal penile hypospadias were divided into two groups. Group A (68 patients) was treated with TIP and Group B (72 patients) was treated with AUA. All the patients had an average age of three years (2-19) with variable meatal sites coronal (44) sub coronal (53) and anterior penile hypospadias (43). There was no significant difference between both groups with respect to the age and meatal sites. Results: The fistula rate in Group A was 8.8% versus 1.3% in Group B. There was no urethral stricture in both procedures. Wound dehiscence did not occur in Group A versus one case in Group B (1.3%). In Group A, 26 cases (38.3%) had mild glanular torsion and five (7.3%) had moderate glanular torsion versus none in Group B postoperatively. No postoperative chordee or binding in Group A, versus four patients (5.5%) in Group B. No significant difference was observed in both groups with respect to meatal stenosis (7.3% versus 5.5% respectively). There was a significant difference between both groups with regard to the operative time in favour of Group B. Good cosmetic appearance of the glans was achieved in both techniques. Conclusion: Both techniques can treat this anomaly with a high success rate but the modified AUA technique appears to be a good choice due to its simplicity, short operative time and less fistula rate with good cosmetic results.
OUR EXPERIENCE WITH TUBULARIZED INCISED PLATE URETHROPLASTY FOR DISTAL AND MID-PENILE HYPOSPADIAS  [PDF]
Ru?ica Mili?evi?,Milan Bojanovi?,Dragana Karad?i?,Ana Kosti?
Acta Medica Medianae , 2003,
Abstract: Hypospadias does not present an isolated genital anomaly but a complex urological, sex-ual, psychological and psychiatric, reproductive and aesthetic problem. Although there are over 200 operative techniques, this great surgical challenge presently does not have ideal operative solution. Nowadays, the use of urethral plate for urethroplasty, through various surgical tech-niques, presents a revolutionary concept in hypospadias surgery and it is being accepted by an ever-increasing number of hypospadiologists.Tubularized incised plate urethroplasty (TIP) -Snodgrass procedure was performed on a total of 22 boys; 16 distal (72.7%), 5 mid-penile (22.7%) and 1 proximal hypospadias in period from 1.1.2000 to 30.08.2003, by the same surgical team. The average patient age was 4.5 years (6 mon. to 12 years). All reconstructions have been done as primary urethroplasty while one distal hypospadias had one previous, unsuccessful MAGPI procedure. Complication included small urethrocutaneous fistulas in 4 (18%) and meatal stenosis in 1 (4.5%) child. Snodgrass pro-cedure is a successful method for reparation of distal hypospadias for it provides an excellent aesthetic result with acceptable complications. In order to evaluate the success of this method in reparation of mid- and proximal hypospadias, as well as the possibility of its application on previously unsuccessful or circumcised patients, it is necessary to gain additional experience al-though the first results are encouraging.
Experience with transverse preputial island flap for repair of hypospadias in Ile-Ife, Nigeria  [cached]
Sowande A,Olajide A,Salako A,Olajide F
African Journal of Paediatric Surgery , 2009,
Abstract: Objective: To review our experience with the use of transverse preputial island flap in the repair of hypospadias in the paediatric surgical unit of our University Teaching Hospital, Nigeria. Patients and Methods: We reviewed the cases of hypospadias managed by transverse preputial island flap repair over a ten year period (1996 and 2006) in the paediatric surgical unit of our institution. Data was retrieved from the case notes and analysed. Results: Fifty-one patients had hypospadias repair during the period, 22 of whom were by transverse preputial island flap repair. Hypospadisas were in penile shaft in 16 (72.7%), penoscrotal in 5 (22.7%) and perineal in 1 (4.55%). All the patients had intact prepuce at presentation and chordee was present in 18 (81.8%). The commonest complication was urethrocutaneous fistula in five patients, which closed spontaneously in three leaving 2 patients (9.1%) with persistent urethrocutaneous fistular. Conclusion: Transverse preputial island flap urethroplasty remains aviable option in the management of hypospadias especially when the meatal opening is proximal, with associated chordee limiting the options in the repair.
DISTAL HYPOSPADIAS
MUHAMMAD IQBAL
The Professional Medical Journal , 2009,
Abstract: Objective: To assess the efficacy, safety and complication of Barcat_Redman urethroplasty technique in the management of distal hypospadias. Place of Study: Prospective study was completed at Urology Department, Services Hospital Lahore and larkana from 1998 to 2007. Material and Methods: Fifty patients of distal hypospadias were selected from the Urology Department of Services Hospital Lahore and Larkana for Barcat_Redman urethroplasty technique. Results: Age of the patients range from 5 to 25 years. the mean age was 11 years. Forty (80%) patients belonged to urban areas while 10(20%) were of rural areas.All the patients presented with dystopia of external urethral meatus and chordee (ventral curvature) while 25 (50%) presented wih misdirected stream, 3(5%) spraying of urine and 3(5%) narrow stream . The subcoronal type of distal hypospadias was commonly seen in our study. forty (80%) patients had subcoronal and 10 (20%) distal penile urethral opening. Following barcat-redman technique 35(70%) patients had good result and 8(16%) patients were declared as fair result while 4 (14%) decleared failure. The overall morbidity rate was 30% while hospital stay was 3 days. Conclusion: Barcat-Redman urethroplasty technique is simple, less time consuming and has better success rate for the management of Distal hypospadias.
Urethral reconstruction in severe hypospadias using buccal mucosa graft and penile skin flap
Majstorovi? Marko,Bi?i? Marta,Kojovi? Vladimir,Stojanovi? Borko
Srpski Arhiv za Celokupno Lekarstvo , 2011, DOI: 10.2298/sarh1110631m
Abstract: Introduction. Hypospadias represents the most frequent penile anomaly. The most challenging part of hypospadias surgery is urethral reconstruction. Many various tissues are used (local skin flaps, bladder mucosa grafts, buccal mucosa grafts etc.) for the reconstruction of the neourethra. Objective. Our aim was to evaluate advantages and disadvantages of combined buccal mucosa graft and penile skin flap in urethral reconstruction in severe hypospadias repair. Methods. Between December 2005 and August 2009, 48 patients with severe hypospadias, aged from nine months to 12 years (mean age 23 months) underwent surgery. Thirty-four (71%) had penoscrotal and 14 (29%) scrotal hypospadias. Ventral penile curvature was present in all cases, and was corrected by incision of the short urethral plate. Urethroplasty was performed using a buccal mucosa graft combined with dorsal penile skin flap. Results. Mean follow-up was 22 months (range from 9 months to 3 years). Satisfactory functional and aesthetic results were achieved in 40 (83%) patients. Fistula was noted in six cases and was solved by minor revision. Urethral stenosis in two cases was resolved by simple dilatation. Conclusion. Urethral reconstruction using the buccal mucosa graft and dorsal penile skin flap in severe hypospadias repair could be the method of choice. Using this technique, single stage urethral reconstruction is possible with satisfactory esthetical and functional results.
The Treatment of Complex Urethral Strictures Using Ventral Onlay Buccal Mucosa Graft or Ventral Onlay Penile Skin Island Flap Urethroplasty: A Prospective Case Series
F Claassen, S Wentzel
African Journal of Urology , 2011,
Abstract: Objectives: To compare the outcome of free onlay Buccal Mucosa Graft (BMG) with onlay penile Skin Island Flap (SIF) urethroplasty in the treatment of complex urethral strictures. Patients and Methods: A prospective comparative study was conducted at the Universitas Academic Hospital in Bloemfontein, South Africa. Patients presenting with complex urethral strictures were allocated to receive either ventral onlay penile SIF urethroplasty or ventral onlay BMG urethroplasty. A complex urethral stricture was defined as a stricture length of more than 2.5 cm or previous failed procedures, including urethral dilatation, internal Optical Urethrotomy (OU) and urethroplasty. Successful treatment outcome or cure was defined as no further treatment of the urethral stricture required after urethroplasty. Statistical analysis was performed with the t-test or chi-square test as appropriate. Results: BMG and SIF urethroplasty were performed on 18 and 17 patients, respectively. The mean age of the patients was 49.1 years (range 21–77) for the SIF group and 44.3 years (range 27–73) for the BMG group (p= 0.28). The mean urethral stricture length in the BMG group was 2.9 cm (range 2.4–4.0) and 4.5 cm (range 2.4–7.0) in the SIF group (p= 0.002). The urethral stricture site was bulbar in 67% in the BMG group and 59% in the SIF group. The cure rate was 11/17 (64.7%) for the SIF group and 13/18 (72.2%) for the BMG group (p= 0.63). Conclusions: No statistically significant difference in outcome between BMG and SIF urethroplasty was observed. However, given the longer operation time and more extensive surgical dissection of SIF reported in other studies, we recommend onlay BMG urethroplasty for the treatment of complex strictures. Key Words: Urethral stricture, Urethroplasty, Buccal mucosa graft, Skin island flap
Penile abnormalities  [cached]
Yunus S?ylet
Turk Pediatri Ar?ivi , 2010,
Abstract: Hypospadias is a congenital development anomaly of penis. The meatus is located in between glans penis and perineum. Frenulum is absent. The glans does not fuse on the ventral side. Ventral preputial development is incomplete. There is usually associated a variable degree of chordee. Hypospadias is classifed according to level of meatus. Severe hypospadias and chordee, bilateral undescended testis, small penis may be the signs of a sexual development disorder and further diagnostic evaluation is indicated. Circumcision without repair of hypospadias is contraindicated. Surgical correction of hypospadias should be completed by 15 months of age. Epispadias, penile agenesis, diphallia, penile torsion, penoscrotal fusion, concealed penis, micropenis, priapism and penoscrotal transposition are the other penile anomalies. This section is basically written for the diagnosis of penile anomalies and associated malformations, timing of surgery and to give take home messages for the pediatricians. Surgical correction of penile anomalies requires experiences in the field of pediatric urology and it is performed by Pediatric Surgeons and Pediatric Urologists. (Turk Arch Ped 2010; 45 Suppl: 94-9)
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