Abstract
Introduction
To review the surgical treatment of hypospadias (HP) associated with disorders of sex development (DSD).
Patients and methods
HP cases were assessed for DSD by gross examination for atypical external genitalia, and assessment of hormone levels and karyotype. There were 58 HP cases with concomitant DSD treated between 1999 and 2017. DSD classification, type of HP, sex assignment, hormonal abnormality, surgical strategy, and post-urethroplasty complications (post-UPC) were reviewed.
Results
DSD were sex chromosome abnormalities (n = 4), 46,XY (n = 51), 46,XX (n = 1), and 47,XY + 21 (n = 2). HP was perineal: (n = 26), scrotal: (n = 16), penoscrotal: (n = 15), and midshaft: (n = 1); repair was primary (n = 6) or staged (n = 52). Mean age at final urethroplasty (UP) was 4.12 ± 0.21 years; all cases had soft tissue interposition at UP. At mean follow-up 5.16 ± 0.56 years after final UP, observed post-UPC (n = 8; 13.8%) were urethral stenosis (n = 3), urethral diverticulum (n = 2), urethrocutaneous fistula (n = 2), and curvature (n = 1). Mean onset of post-UPC was 1.24 ± 0.77 years (range 0.1–6.3). The second half of our cases (n = 29; treated 2015 ~) had significantly less post-UPC (0/29; 0%) than the first half (8/29; 27.6%) (p = 0.0075).
Conclusions
Although UP for HP + DSD was formidably challenging, we achieved a significant decrease in post-UPC through a combination of surgical techniques and experience.
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Abbreviations
- HP:
-
Hypospadias
- DSD:
-
Disorders of sex development
- UP:
-
Urethroplasty
- Post-UPC:
-
Post-UP complications
- UCF:
-
Urethrocutaneous fistula
- UDT:
-
Undescended testis
- SF-1:
-
Steroidogenic factor-1
References
Hughes IA, Houk C, Ahmed SF et al (2006) Consensus statement on management of intersex disorders. J Pediatr Urol 2:148–162
Lambert SM, Vilain EJ, Kolon TF (2010) A practical approach to ambiguous genitalia in the newborn period. Urol Clin N Am 37:195–205
Baskin LS, Ebbers MB (2006) Hypospadias: anatomy, etiology, and technique. J Pediatr Surg 41:463–472
Sircili MH, e Silva FA, Costa EM et al (2010) Long-term surgical outcome of masculinizing genitoplasty in large cohort of patients with disorders of sex development. J Urol 184:1122–1127
Chertin B, Koulikov D, Hadas-Halpern I et al (2005) Masculinizing genitoplasty in intersex patients. J Urol 174:1683–1686
Sueyoshi R, Seo S, Ochi T et al (2016) Reinforcing the ventral penile shaft with pedicled fat/connective tissues before urethroplasty lowers the risk for post-urethroplasty complications in hypospadias. J Pediatr Surg 51:2021–2024
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
Ishiyama A, Seo S, Murakami H et al (2015) Staged segmental urethroplasty for scrotal/perineal hypospadias: a new concept. Pediatr Surg Int 32:403–409
Seo S, Ochi T, Yazaki Y et al (2015) Soft tissue interposition is effective for protecting the neourethra during hypospadias surgery and preventing postoperative urethrocutaneous fistula: a single surgeon’s experience of 243 cases. Pediatr Surg Int 31:297–303
Yamataka A, Ando K, Lane GJ et al (1998) Pedicled external spermatic fascia flap for urethroplasty in hypospadias and closure of urethrocutaneous fistula. J Pediatr Surg 33:1788–1789
Snodgrass WT, Nguyen MT (2002) Current technique of tubularized incised plate hypospadias repair. Urology 60:157–162
Yamataka A, Shimotakahara A, Koga H et al (2012) Modified Snodgrass tubularized incised plate urethroplasty prevents fistula formation in hypospadias. Pediatr Surg Int 28:919–923
Retik AB, Mandell J, Bauer SB et al (1994) Meatal based hypospadias repair with the use of a dorsal subcutaneous flap to prevent urethrocutaneous fistula. J Urol 152:1229–1231
Pippi Salle JL, Sayed S, Salle A et al (2016) Proximal hypospadias: a persistent challenge. Single institution outcome analysis of three surgical techniques over a 10-year period. J Pediatr Urol 12:28 e21–e27
Gupta D, Bhardwaj M, Sharma S et al (2010) Long-term psychosocial adjustments, satisfaction related to gender and the family equations in disorders of sexual differentiation with male sex assignment. Pediatr Surg Int 26:955–958
Castagnetti M, El-Ghoneimi A (2011) The influence of perioperative factors on primary severe hypospadias repair. Nat Rev Urol 8:198–206
No authors listed (1996) Timing of elective surgery on the genitalia of male children with particular reference to the risks, benefits, and psychological effects of surgery and anesthesia. American Academy of Pediatrics. Pediatrics 97:590–594
Migeon CJ, Wisniewski AB, Gearhart JP et al (2002) Ambiguous genitalia with perineoscrotal hypospadias in 46,XY individuals: long-term medical, surgical, and psychosexual outcome. Pediatrics 110:e31
Garnier S, Maillet O, Cereda B et al (2017) Late surgical correction of hypospadias increases the risk of complications: a series of 501 consecutive patients. BJU Int 119:942–947
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Ochi, T., Ishiyama, A., Yazaki, Y. et al. Surgical management of hypospadias in cases with concomitant disorders of sex development. Pediatr Surg Int 35, 611–617 (2019). https://doi.org/10.1007/s00383-019-04457-6
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DOI: https://doi.org/10.1007/s00383-019-04457-6