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Incomplete hypospadiac urethral duplication with posterior urethral valves

Ramanujam TM, Sergius A, Usha V, Ramanathan S

Pediatr Surg Int, 1998 Nov;14(1-2):134-7.
PMID: 9880724

Urethral duplication (UD) is an uncommon malformation. Obstruction rarely occurs in hypospadiac UD. We describe two children with incomplete hypospadiac UD in association with posterior urethral valves, a combination not previously recognised. The embryonic significance of this anomaly is discussed. Keywords Urethral duplication. Hypospadias. Posterior urethral valve. Megalourethra

Matched MeSH terms: Hypospadias/surgery
Hypospadias repair: Byar's two stage operation revisited

Arshad AR

Br J Plast Surg, 2005 Jun;58(4):481-6.
PMID: 15897031

Hypospadias is a congenital deformity characterised by an abnormally located urethral opening, that could occur anywhere proximal to its normal location on the ventral surface of glans penis to the perineum. Many operations had been described for the management of this deformity.

Matched MeSH terms: Hypospadias/surgery*
Fulltext Hypospadias from the perspective of a single-surgeon practice in Malaysia

Yeap BH, Mohan N

Med J Malaysia, 2008 Dec;63(5):388-90.
PMID: 19803297 MyJurnal

The last decade has witnessed an alarming increase in the worldwide incidence of hypospadias. For non-hypospadiologists, the surgical correction of hypospadias will be increasingly demanding. This paper aims to evaluate the effectiveness of a treatment strategy devised by a single-surgeon practice in Malaysia to tackle this anticipated surge of caseload. Over a period exceeding eight years, 254 boys underwent corrective hypospadias surgery by a single paediatric surgeon at Alor Star Hospital, Malaysia. Patient demographics, racial distribution and meatal location were among the data collected retrospectively. The various types of corrective procedure employed, their outcome as well as complications were evaluated. Distal type of hypospadias dominated this series. There was an explainable peculiarity in the age distribution of hypospadias. For all types of repair, the complication rate was 33% consisting mainly of urethrocutaneous fistula (18%) and meatal stenosis (9%). Complication rate for tubularised incised plate (TIP) urethroplasty, the commonest technique of repair, was 30%, mainly from meatal stenosis (15%) and urethrocutaneous fistula (13%). Univariate analysis revealed that proximal hypospadias, repairs done during the initial four years of study and utilisation of repair other than TIP to be adverse risk factors. Tubularised incised plate urethroplasty was appropriate for almost all types of hypospadias. For the remainder, the two stage repair is satisfactorily employed. This study from a primary referral centre also dispelled the notion that proximal hypospadias predominate in this region. The versatility and reliability of TIP urethroplasty lends itself readily in tackling primary and repeat hypospadias surgery within a single-surgeon practice.

Matched MeSH terms: Hypospadias/surgery*
Algorithm for Optimal Urethral Coverage in Hypospadias and Fistula Repair: A Systematic Review

Fahmy O, Khairul-Asri MG, Schwentner C, Schubert T, Stenzl A, Zahran MH, et al.

Eur Urol, 2016 08;70(2):293-8.
PMID: 26776935 DOI: 10.1016/j.eururo.2015.12.047

CONTEXT: Although urethral covering during hypospadias repair minimizes the incidence of fistula, wide variation in results among surgeons has been reported.
OBJECTIVE: To investigate what type of flap used during Snodgrass or fistula repair reduces the incidence of fistula occurrence.
EVIDENCE ACQUISITION: We systematically reviewed published results for urethral covering during Snodgrass and fistula repair procedures. An initial online search detected 1740 reports. After exclusion of ineligible studies at two stages, we included all patients with clear data on the covering technique used (dartos fascia [DF] vs tunica vaginalis flap [TVF]) and the incidence of postoperative fistula.
EVIDENCE SYNTHESIS: A total of 51 reports were identified involving 4550 patients, including 33 series on DF use, 11 series on TVF use, and seven retrospective comparative studies. For distal hypospadias, double-layer DF had the lowest rate of fistula incidence when compared to single-layer DF (5/855 [0.6%] vs 156/3077 [5.1%]; p=0.004) and TVF (5/244, 2.0%), while the incidence was highest for single-layer DF among proximal hypospadias cases (9/102, 8.8%). Among repeat cases, fistula incidence was significantly lower for TVF (3/47, 6.4%) than for DF (26/140, 18.6%; p=0.020). Among patients with fistula after primary repair, the incidence of recurrence was 12.2% (11/90) after DF and 5.1% (5/97) after TVF (p=0.39). The absence of a minimum follow-up time and the lack of information regarding skin complications and rates of urethral stricture are limitations of this study.
CONCLUSION: A double DF during tubularized incised plate urethroplasty should be considered for all patients with distal hypospadias. In proximal, repeat, and fistula repair cases, TVF should be the first choice. On the basis of these findings, we propose an evidence-based algorithm for surgeons who are still in their learning phase or want to improve their results.
PATIENT SUMMARY: We systematically reviewed the impact of urethral covering in reducing fistula formation after hypospadias repair. We propose an algorithm that might help to maximize success rates for tubularized incised plate urethroplasty.

Matched MeSH terms: Hypospadias/surgery*
The use of octyl cyanoacrylate (superglue) in hypospadias repair including its use as a fixator for urethral stents

Tan HL, Nah SA, Budianto II, Sehat S, Tamba R

J Pediatr Surg, 2012 Dec;47(12):2294-7.
PMID: 23217892 DOI: 10.1016/j.jpedsurg.2012.09.022

Octyl cyanoacrylate has been used for many years for simple skin closure, but its use in hypospadias repair and as a urethral stent fixator has not been previously reported. We report our experience.

Matched MeSH terms: Hypospadias/surgery*