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A cover flap reduces the rate of fistula after urethroplasty whatever the severity of hypospadias

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Abstract

Objective

To determine which patients should benefit from the interposition of a well-vascularized flap between the neourethra and the penile skin and if it should be performed even in mild hypospadias.

Patients and methods

A retrospective study on patients with a primary hypospadias repair was performed (2003–2017). Only patients undergoing urethroplasty based on the principle of a tubularization were selected to ensure comparable groups. Patients were assigned in two groups according to the use or not of a cover flap. Univariate analysis and adjusted logistic regression were used to evaluate the relation between postoperative complications, the severity of hypospadias, the use of flap and patients’ characteristics.

Results

Three-hundred and seventy-six patients were included with anterior (59.3%), midshaft (27.4%) and posterior hypospadias (13.3%). The median follow-up was 54 months (24 months–17 years). The overall rate of fistula was 11.7% (n = 44). Comparing the outcome in children with flap (n = 217) to controls (n = 159) showed that the use of a flap reduces the rate of fistula (6.5 vs 18.9%, p < 0.001). Stratification of the study according to the phenotype reveals that the more severe the hypospadias, the more protective was the flap (OR = 2.6 for anterior, 5.5 for midpenile, 7.1 for posterior hypospadias). The flap remains nevertheless significantly effective whatever the phenotype (p < 0.05 for anterior, p = 0.01 for midpenile, p = 0.02 for posterior hypospadias).

Conclusions

The more severe the hypospadias, the more effective is the cover flap to avoid fistula. It remains nevertheless suitable even in anterior hypospadias and the use of a cover flap should not be limited to the surgery of severe phenotypes.

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References

  1. Schneuer FJ, Holland AJA, Pereira G et al (2015) Prevalence, repairs and complications of hypospadias: an Australian population-based study. Arch Dis Child 100:1038–1043. https://doi.org/10.1136/archdischild-2015-308809

    Article  PubMed  Google Scholar 

  2. Spinoit A-F, Poelaert F, Van Praet C et al (2015) Grade of hypospadias is the only factor predicting for re-intervention after primary hypospadias repair: a multivariate analysis from a cohort of 474 patients. J PediatrUrol 11:70.e1–6. https://doi.org/10.1016/j.jpurol.2014.11.014

    Article  Google Scholar 

  3. Thomas DT, KaradenizCerit K, Yener S et al (2015) The effect of dorsal dartos flaps on complication rates in hypospadias repair: a randomised prospective study. J PediatrUrol 11:23.e1–4. https://doi.org/10.1016/j.jpurol.2014.07.010

    Article  Google Scholar 

  4. Liao AY, Smith GH (2016) Urethrocutaneous fistulae after hypospadias repair: When do they occur? J Paediatr Child Health 52:556–560. https://doi.org/10.1111/jpc.13102

    Article  PubMed  Google Scholar 

  5. Guralnick ML, Al-Shammari A, Williot PE, Leonard MP (2000) Outcome of hypospadias repair using the tubularized, incised plate urethroplasty. Can J Urol 7:986–991

    CAS  PubMed  Google Scholar 

  6. Chao M, Zhang Y, Liang C (2017) Impact of pre-operative hormonal stimulation on post-operative complication rates after hypospadias repair: a meta-analysis. Minerva Urol Nefrol. 69:253–261

    PubMed  Google Scholar 

  7. Wong NC, Braga LH (2015) The influence of pre-operative hormonal stimulation on hypospadias repair. Front Pediatr 3:31. https://doi.org/10.3389/fped.2015.00031

    Article  PubMed  PubMed Central  Google Scholar 

  8. Djordjevic ML, Perovic SV, Slavkovic Z, Djakovic N (2006) Longitudinal dorsal dartos flap for prevention of fistula after a Snodgrass hypospadias procedure. EurUrol 50:53–57. https://doi.org/10.1016/j.eururo.2006.04.014

    Article  Google Scholar 

  9. Sozubir S, Snodgrass W (2003) A new algorithm for primary hypospadias repair based on tip urethroplasty. J PediatrSurg 38:1157–1161

    Google Scholar 

  10. Sugarman ID, Trevett J, Malone PS (1999) Tubularization of the incised urethral plate (Snodgrass procedure) for primary hypospadias surgery. BJU Int 83:88–90

    Article  CAS  Google Scholar 

  11. Elbakry A (2011) Tissue interposition in hypospadias repair: a mechanical barrier or healing promoter? Arab J Urol 9:127–128. https://doi.org/10.1016/j.aju.2011.06.002

    Article  PubMed  PubMed Central  Google Scholar 

  12. Borer JG, Retik AB (1999) Current trends in hypospadias repair. UrolClin North Am 26(15–37):vii

    Google Scholar 

  13. Djordjevic ML, Perovic SV, Vukadinovic VM (2005) Dorsal dartos flap for preventing fistula in the Snodgrass hypospadias repair. BJU Int 95:1303–1309. https://doi.org/10.1111/j.1464-410X.2005.05500.x

    Article  PubMed  Google Scholar 

  14. Appignani A, Prestipino M, Bertozzi M et al (2009) Double-cross flap protection: new technique for coverage of neourethra in hypospadias repair. J Urol 182:1521–1527. https://doi.org/10.1016/j.juro.2009.06.054

    Article  PubMed  Google Scholar 

  15. Yiğiter M, Yildiz A, Oral A, Salman AB (2010) A comparative study to evaluate the effect of double dartos flaps in primary hypospadias repair: no fistula anymore. Int UrolNephrol 42:985–990. https://doi.org/10.1007/s11255-010-9735-6

    Article  Google Scholar 

  16. Jia W, Liu G, Zhang L et al (2016) Comparison of tubularized incised plate urethroplasty combined with a meatus-based ventral dartos flap or dorsal dartos flap in hypospadias. PediatrSurg Int 32:411–415. https://doi.org/10.1007/s00383-016-3860-y

    Article  Google Scholar 

  17. Bertozzi M, Yıldız A, Kamal B et al (2011) Multicentric experience on double dartos flap protection in tubularized incised plate urethroplasty for distal and midpenile hypospadias. PediatrSurg Int 27:1331–1336. https://doi.org/10.1007/s00383-011-2978-1

    Article  CAS  Google Scholar 

  18. Cimador M, Pensabene M, Sergio M et al (2013) Coverage of urethroplasty in pediatric hypospadias: randomized comparison between different flaps. Int J Urol 20:1000–1005. https://doi.org/10.1111/iju.12092

    Article  PubMed  Google Scholar 

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Funding

This work was supported by a public funding from the National Reference Network Genital Development, DSD DevGen.

Author information

Author notes

  1. B. Tessier and M. S. Sfar contributed equally to this work.

Authors and Affiliations

  1. Département de Chirurgie et Urologie Pédiatrique, Hopital Lapeyronie, CHU Montpellier et Université de Montpellier, 371 Av Giraud, 34295, Montpellier cedex 5, France

    Benoit Tessier, Sami Sfar, Sarah Garnier, Paula Borrego & Nicolas Kalfa

  2. Unité d’Epidémiologie et Biostatistiques, Institut Universitaire de Recherche Clinique, Université de Montpellier, Montpellier, France

    Amandine Coffy

  3. Department d’endocrinologie Pédiatrique, Hopital Arnaud de Villeneuve, CHU Montpellier et Université de Montpellier, Montpellier, France

    Laura Gaspari & Francoise Paris

  4. Centre de Référence Maladies Rares du Développement Génital, Constitutif Sud, Montpellier, France

    Laura Gaspari, Francoise Paris & Nicolas Kalfa

Authors
  1. Benoit Tessier
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  2. Sami Sfar
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  3. Sarah Garnier
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  4. Amandine Coffy
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  5. Paula Borrego
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  6. Laura Gaspari
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  7. Francoise Paris
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  8. Nicolas Kalfa
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Contributions

BT: protocol/project development, data collection or management, manuscript writing/editing. MSS: protocol/project development, data collection or management manuscript writing/editing. SG: data collection or management, data analysis, manuscript writing/editing. AC: data analysis, manuscript writing/editing. PB: data collection or management, manuscript writing/editing. LG: data collection or management, manuscript writing/editing. FP: data protocol/project development, manuscript writing/editing. NK: protocol/project development, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Nicolas Kalfa.

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Conflict of interest

There is no conflict of interest for all authors. This work was supported by a public funding from the National Reference Network Genital Development, DSD DevGen.

Research involving human participants and/or animals

The local ethic committee approved this retrospective and anonymized on-charts study (CPPSUDMED-1503.2016).

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Not concerned.

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Tessier, B., Sfar, S., Garnier, S. et al. A cover flap reduces the rate of fistula after urethroplasty whatever the severity of hypospadias. World J Urol 39, 2691–2695 (2021). https://doi.org/10.1007/s00345-020-03489-1

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  • DOI: https://doi.org/10.1007/s00345-020-03489-1

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