Abstract
Objective
To critically evaluate inner preputial graft (IPG) used in staged proximal hypospadias with severe chordee regarding cosmetic and functional outcomes.
Patients and methods
In this prospective study, patients with primary proximal hypospadias with moderate to severe chordee (> 30°) after penile degloving were considered candidates for staged repair between June 2011 to July 2017. After transection of the urethral plate (UP) and penile straightening, the bare shaft was covered with IPG. Tubularization of the graft was done as a second stage. Cosmetic and functional outcomes were assessed using HOSE score and uroflowmetry (UF). Additionally, factors influencing success were analyzed.
Results
In all, 38 consecutive cases were included. Native meatus was at proximal penile in 17, penoscrotal in 11, scrotal in 7, and perineal in 3 cases. Median age was 26 and 32 months at the first stage and the second stage, respectively. Preoperative testosterone was given for ten patients with a small penis and/or severe curvature. The mean follow-up was 18 ± 8.2, median 15 months. Grafts took well in all cases after the first stage except one. Cosmetic success achieved in 33 (86.8%). A total of ten complications occurred in six cases. Unplanned intervention was needed in 5/38 cases. Functionally, UF study revealed normal flow in 7/23 (30.4%), equivocal in 11/23(47.8%), and obstructed flow in 5/23(21.7%).
Conclusion
Inner preputial graft use in proximal hypospadias with moderate to severe chordee seems to have a good technical outcome and functionally mimic the normal urethral function and could be considered an ideal option for substitution urethroplasty.
Similar content being viewed by others
References
Snodgrass W, Elmore J (2004) Initial experience with staged buccal graft (Bracka) hypospadias re-operations. J Urol 172:1720–1724
McNamara ER, Schaeffer AJ, Logvinenko T et al (2015) Management of proximal hypospadias with 2-stage repair: 20 year experience. J Urol 194:1080–1085
Bracka A (2008) The role of two-stage repair in modern hypospadiology. Indian J Urol 24:210–218
Springer A, Krois W, Horcher E (2011) Trends in hypospadias surgery: results of a worldwide survey. Eur Urol 60:1184–1189
Ludwig G (1999) Micropenis and apparent micropenis—a diagnostic and therapeutic challenge. Andrologia 31(1):27–30
Bush NC, DaJusta D, Snodgrass W (2013) Glans penis width in patients with hypospadias compared to healthy controls. J Pediatr Urol 9:1188
Bologna RA, Noah TA, Nasrallah PF et al (1999) Chordee: varied opinions and treatments as documented in a survey of the American Academy of Pediatrics, Section of Urology. Urology 53:608–612
Snodgrass W, Prieto J (2009) Straightening ventral curvature while pre-serving the urethral plate in proximal hypospadias repair. J Urol 182:1720–1725
Baskin LS, Erol A, Li YW, Cunha GR (1998) Anatomical studies of hypospadias. J Urol 160:1108–15, (discussion 1137).
Mingin G, Baskin LS (2002) Management of chordee in children and young adults. Urol Clin North Am 29(2):277–284
Saleh A (2010) Correction of incomplete penoscrotal transposition by a modified Glenn-Anderson technique. Afr J Paediatr Surg 7(3):181–184. https://doi.org/10.4103/0189-6725.70422
Holland AJ, Smith GH, Ross FI, Cass DT (2001) HOSE: an objective scoring system for evaluating the results of hypospadias surgery. BJU Int 88:255–258
Gupta DK, Sankhwar SN, Goel A (2013) Uroflowmetry nomograms for healthy children aged between 5 and 15 years. J Urol 190:1008–1014
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Yang T, Zou Y, Zhang L, Su C, Li Z, Wen Y (2014) Byars two-stage procedure for hypospadias after urethral plate transection. J Pediatr Urol 10(6):1133–1137
Steven L, Cherian A, Yankovic F, Mathur A, Kulkarni M, Cuckow P (2013) Current practice in paediatric hypospadias surgery; a specialist survey. J Pediatr Urol 9(6):1126–1130. https://doi.org/10.1016/j.jpurol.2013.04.008
Castagnetti M, El-Ghoneimi A (2010) Surgical management of primary severe hypospadias in children: systematic 20-year review. J Urol 184:1469–1475
Pfistermüller KL, Manoharan S, Desai D, Cuckow PM (2017) Two-stage hypospadias repair with a free graft for severe primary and revision hypospadias: a single surgeon’s experience with long-term follow-up. J Pediatr Urol 13(1):35.e1–35.e7
Snodgrass W, Bush N (2011) Tubularized incised plate proximal hypospadias repair: continued evolution and extended applications. J Pediatr Urol 7:2–9
Sharma N, Bajpai M, Panda SS, Singh A (2013) Tunica vaginalis flap cover in repair of recurrent proximal urethrocutaneous fistula: a final solution. Afr J Paediatr Surg 10:311–314
Fahmy O, Khairul-Asri MG, Schwentner C, Schubert T, Stenzl A, Zahran MH, Gakis G (2016) Algorithm for optimal urethral coverage in hypospadias and fistula repair: a systematic review. Eur Urol 70(2):293–298. https://doi.org/10.1016/j.eururo.2015.12.047(Epub 2016 Jan 15. Review)
Hardwicke JT, Bechar JA, Hodson J, Osmani O, Park AJ (2015) Fistula after single-stage primary hypospadias repair—a systematic review of the literature. J Plast Reconstr Aesthet Surg 68:1647–1655
Braga LHP, Pippi Salle JL, Lorenzo AJ, Skeldon S, Dave S, Farhat WA et al (2007) Comparative analysis of tubularized incised plate versus onlay island flap urethroplasty for penoscrotal hypospadias. J Urol 178:1451–1456
Al-Adl AM, El-Karamany TM, Bassiouny AS (2014) Distal extension of the midline urethral-plate incision in the Snodgrass hypospadias repair: an objective assessment of the functional and cosmetic outcomes. Arab J Urol 12(2):116–126
Pippi Salle JL, Sayed S, Salle A, Bagli D, Farhat W, Koyle M, Lorenzo AJ (2016) Proximal hypospadias: a persistent challenge. Single institution outcome analysis of three surgical techniques over a 10-year period. J Pediatr Urol 12(1):281–287
Snodgrass WT, Bush N (2015) Surgery for primary proximal hypospadias with ventral curvature %3e 30°. Curr Urol Rep 16:69
Erickson BA, Breyer BN, McAninch JW (2010) The use of uroflowmetry to diagnose recurrent stricture after urethral reconstructive surgery. J Urol 184:1386–1390
Bush NC, Villanueva C, Snodgrass W (2015) Glans size is an independent risk factor for urethroplasty complications after hypospadias repair. J Pediatr Urol 11(6):355.e1–5. https://doi.org/10.1016/j.jpurol.2015.05.029(Epub 2015 Aug 13)
Netto JMB, Ferrarez CEPF, Schindler Leal AA, Tucci S Jr, Gomes CA, Barroso U Jr (2013) Hormone therapy in hypospadias surgery: a systematic review. J Pediatr Urol 9:971–979
Author information
Authors and Affiliations
Contributions
AMA: conception and design, data acquisition, data analysis and interpretation, drafting the manuscript and critical revision of the manuscript for scientific and factual content. AMAA: data acquisition and critical revision of the manuscript for scientific and factual content. TMEK: data acquisition and critical revision of the manuscript for scientific and factual content. YAN: data acquisition and interpretation, and critical revision of the manuscript for scientific and factual content.
Corresponding author
Ethics declarations
Conflict of interest
All authors declare no conflict of interest and no financial support.
Ethical statement
This study was conducted in concordance with the Declaration of Helsinki 2013 and in accordance with Benha Faculty of Medicine ethical standards, and after obtaining informed consents.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Al-Adl, A.M., Abdel Aal, A.M., El-Karamany, T.M. et al. Two-stage repair of proximal hypospadias with moderate to severe chordee using inner preputial skin graft: prospective evaluation of functional and cosmetic outcomes. World J Urol 38, 2873–2879 (2020). https://doi.org/10.1007/s00345-020-03075-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-020-03075-5