OBJECTIVE: To investigate the surgical approach to repair hypospadias. METHODS: From 1992 to 2000, 42 cases with hypospadias accepted secondary urethroplasty after primary operation, which included urethral burying in penile skin, bladder mucosa and scrotal septal vascular pedicled flap urethroplasty, trans-scrotal skin flap covering the wounds with normal meatus urinarius. RESULTS: Only one, out of 42 cases, had early complication of urinary fistula in 7 days after urethroplasty, which was cured by scrotal septal vascular pedicled flap urethroplasty 3 months later and had no further complication. The others were all succeeded once for all, the successful rate was 97.6%. CONCLUSION: The surgical method to repair hypospadias by urethral burying and transscrotal skin flap technique is safe, reliable and recommendable for clinical use.
Objective To introduce an effective method to repair failed hypospadias. Methods From October 1998 to October 2002, 8 cases of failed penoscrotal junction hypospadias were repaired by repeated use of scrotal septum vesicular pedicle island flap to reconstruct urethra. The patientsranged in ages from 4 to 8 years. Results All flaps in 8 patients survived, the reconstructed urethra was big and smooth. After a follow up of 6-12 months, the satisfactory appearance and normal urinary stream were obtained. No complications were found. Conclusion This method is an effective operative procedure to repair failed hypospadias and is a simple and convenient operation.
Objective To investigate a method of repairing hypospadias by combining buccal mucosal graft with scrotal flap and its therapeutic effect. Methods From March 2002 to December 2007, 42 patients with hypospadias underwent primary urethral reconstruction using buccal mucosal graft and scrotal flap. The patients ranged in age from 18 months to 18 years. There were 21 cases of penoscrotal type, 12 cases of scrotal type and 9 cases of perineal type. Among them,8 cases were at initial operation, and 34 cases suffered from the failure of hypospadias repair 6-19 months (average 10 months) after initial operation. During operation, the defect of urethra was 3-7 cm (average 4.2 cm) when the penis was straightened; the buccal mucosa (3.0 cm × 1.2 cm-7.0 cm × 1.5 cm) was transplanted to the tunica albuginea in the ventral aspect of the penis, and was paired with the scrotal flap (3.0 cm × 1.5 cm-7.0 cm × 1.5 cm) to repair urethra. Results The incision of 38 cases healed by first intention, and no compl ication occurred. At 7 days after operation, 4 cases had urinary fistula at either coronary sulcus or anastomotic stoma, one of which spontaneously closed 2 months after operation and the rest 3 recovered by repairing urinary fistula 6 months after operation. All patients were followed for 3-48 months (average 18 months). Urination was smooth, the reconstructed urethral opening was at the tip of glans peins without retraction and with apperance similar to the normal urethral opening. The appearance of penis and scrotum was satisfying, and the penis was straightened completely. Conclusion Combined buccal mucosal graft and scrotal flap, with considerable tissue for uretha tract reconstruction and low incidence rate of urethral stricture, is one of the effective methods to repair hypospadias.
Objective To document the effect of surgical steps, including penile degloving, plate transection, dorsal plication, and fasciocutaneous coverage, in primary hypospadias repair on penile length. Methods A consecutive series of 209 prepubertal boys with primary hypospadias repair was included with the age ranged from 10 to 97 months (mean, 31.7 months). Intraoperative stretched penile length (SPL) was measured before operation (n=209), and after each step, namely penile degloving (n=152), plate transection (n=139), dorsal plication (n=170), and fasciocutaneous coverage (n=209). SPLs before and after each steps or the entire operation were analyzed. The SPL was compared between plate transection group and plate preservation group, dorsal plication group and non-plication group, and plate preservation with plication group and plate preservation without plication group, respectively. Differences of SPL between before and after each steps were analyzed with factors including neourethra length, rest dorsal penile length, rest ventral penile length, preoperative SPL, and the degree of penile curvature after penile degloving, with multivariate linear regression analysis. ResultsAll the four steps resulted in SPL difference. The SPL increased after penile degloving and plate transection (P<0.05), and decreased after dorsal plication and fasciocutaneous coverage (P<0.05). The SPL increased after all steps were completed (P<0.05). In patients with plate transection, postoperative SPL increased when compared with that before operation (P<0.05). No significant difference was noted in patients without plate transection (P>0.05). And there was significant difference in the increased length of SPL between patients with and without plate transection (P<0.05). In patients with dorsal plication, a significant increase of postoperative SPL (P<0.05) was noted. No significant difference was noted in patients without dorsal plication (P>0.05). And there was no significant difference in increased length between patients with and without dorsal plication (P>0.05). When patients with plate transection were excluded, dorsal plication resulted in no significant difference on postoperative SPL (P>0.05). The increased length of SPL after penile degloving, dorsal plication, or cutanofascial coverage was not related to the neourethra length, the rest dorsal penile length, the rest ventral penile length, the preoperative SPL, and the degree of penile curvature (P>0.05). However, the neourethra length and preoperative SPL were the influencing factors for the increased length of SPL after plate transection (P<0.05). ConclusionThe main steps in primary hypospadias repair can change SPL. The lengthening effect of plate transection would not be counteracted by dorsal plication. Dorsal plication makes no significant difference on postoperative SPL.
ObjectiveTo discuss the reoperation methods of urethral stricture after urethroplasty of hypospadias and their effectiveness.MethodsBetween September 2010 and April 2018, 169 patients with urethral stricture after urethroplasty of hypospadias, who underwent ineffective conservative treatments first, were accepted. The age ranged from 1 year and 7 months to 41years with a median age of 5 years and 8 months. The stricture located at the external urethral orifice in 80 cases, internal anastomosis connection in 87 cases, and constructed urethra in 2 cases. The symptoms of urethral stricture occurred at 2 weeks to 52 months after urethroplasty, with a median time of 4.5 months. The patients with external urethral orifice stenosis were treated with urethral meatus augmentation (74 cases) and urethral advancement (6 cases). The patients with internal anastomosis connection stenosis were treated with internal urethrotomy with urethroscopy (10 cases), urethrotomy and one-stage urethroplasty (26 cases), and urethrostomy (51 cases) including 43 cases of two-stage urethroplasty. The patients with constructed urethral stricture were treated with urethrolysis.ResultsOne hundred and fifty-four patients were followed up 6–86 months with an average of 47 months. The stenosis was relieved in 137 cases, and re-stenosis in 12 cases, urethral fistula in 4 cases, all of which were treated successfully. In addition, 1 case with mild urethral diverticulum did not need to be treated.ConclusionIf it is ineffective for the conservative treatment of urethral stricture after urethroplasty of hypospadias, appropriate surgical treatments could be selected according to the location and length of the stricture, local tissue conditions, complications, and so on.
Objective To evaluate the effect of niti-alloy urethral stent on the prevention of urethrocutaneous fistula and urethral stricture in hypospadias repair. Methods From January 2001 to December 2004, niti-alloy urethral stents were applied to repair congenital hypospadias in 63 patients. Among 63 patients, 49( 19 cases of proximal hypospadias, 22 cases of penoscrotal hypospadias and 8 casesof perineoscrotal hypospadias) received one-stage surgical managements of urethral reconstruction, and 10 underwent postoperative fistular repairs and 4 received repeated urethral reconstruction because of urethral stricture after hypospadias repair. Results All patients gained healing by first intention without fistula or urethral stricture. The stents were left indwelling in the neourethra for 2 months to 3 months to prevent stricture. The longest indwelling period was about 1 year. No dysuria or other discomfort occurred during this period. Conclusion Niti-alloy urethral stent can effectively prevent the postoperative urethrocutaneous fistula and urethral stricture after hypospadias repair.
Objective To assess the analgesic effect of caudal bupivacaine with neostigmine for hypospadias surgery in children. Methods We searched The Cochrane Library (Issue 2, 2008), MEDLINE (1966-2008), EMbase (1980-2008), CBMdisc (1978-2008), CNKI (1989-2008) and Wanfang Database using the keywords “bupivacaine”, “neostigmine” and “hypospadias” to identify randomized control trials (RCTs) of caudal bupivacaine with neostigmine versus bupivacaine alone for hypospadias surgery in children. The methodological quality of included RCTs was evaluated by two reviewers independently, and Meta-analysis was conducted using RevMan 5.0.13 software. Results We identified 3 RCTs including 160 patients which had an uncertain risk of bias. The results of meta-analysis showed no significant difference found between bupivacine alone and bupivacine plus 1 µg/kg neostigmine (WMD= 0.05, 95%CI – 6.76 to 6.86, P= 0.99), but a difference was found between bupivacine alone and bupivacine plus 1 µg/ kg, 2 µg/kg, or 3 µg/ kg neostigmine (WMD= 12.79, 95%CI 10.96 to 14.62, Plt; 0.000 01; WMD= 12.10, 95%CI – 6.76 to 6.86, Plt; 0.000 01; WMD= 11.90, 95%CI 9.17 to 14.63, Plt;0.000 01). The duration of postoperative analgesia of the bupivacaine with neostigmine group was longer than that of bupivacine alone. Conclusions Because of the small sample size and the unclear risk of bias in the included RCTs, the effectiveness of caudal bupivacaine with neostigmine for postoperative pain management after hypospadias surgery in children is not completely confirmed. So more large sample size, double-blind RCTs are needed.
Objective To present the experience of hypospadias repair using the tubularized incised plate urethroplasty (Snodgrass procedure). Methods FromMay 2001 to November 2004, 82 patients with hypospadias underwent the Snodgrassprocedure and the clinical data were analysed retrospectively. The mean age was5 years (1.5 to 16 years). These cases were divided into: the earlier stage group(34 cases) and the later stage group (48 cases); the proximal group (19 cases)and the distal and middle group (63 cases); the primary operational group (49 cases) and the reoperational group (33 cases). Results Fistulas ocurred in 12 patients (14.6%), complete glans dehiscednce in 1 case. Fistula were as follows: 11 cases in the earlier stage group (32.4%) and 1 case in the later stage group（2.1%）;2 cases in the proximal group (10.5%) and 10 cases in the group of distal and middle group (15.9%); 8 cases in the primary operational group (16.1%) and 4 cases in the reoperational group (12.1%). There was statistically significant difference in the incidence of fistula between the earlier stage group and the later stage group (Plt;0.01). There was no statistically significant difference between the proximal group and the distal and middle group, between the primary operational group and the reoperational group (Pgt;0.05). All patients were followed up more than one month. The neo meatus was innormal position. The results of penile cosmetic and urethral function were satisfactory. Of these cases, 15 were followed up 1.5-6.0 months. The average flow rate was 7.8 ml/s(6.8-10.5 ml/s). The mean of maximum flow rate was 10.5 ml/s (8.8-14.5 ml/s).Conclusion Excellent neourethrol functional and superior casmetic resalts with low rate of complication can be gained by using tubularized incised plate urethroplasty for the cases of hypospadias without chordee or with mild chordee. But the preputialflap procedure should be chosen in condition that the hypospadias was association with obvious chordee.
Objective To investigate the safety, efficacy and morbidity of onestage urethroplasty by using bladder mucosa for treatment of hypospadias. Methods From August 1991 to August 2003, 38 cases of congenital hypospadias were given bladder mucosa flap procedure and one stage urethroplasty. Results Thirty-eight cases of hypospadias treated with one stageurethroplasty by using bladder mucosa were followed up 6 months-9 years afterthe procedure. The success rate of the operation was 95%. Three cases of urethral fistula after the procedure were surgically repaired again, 2 cases of urethral stricture recovered after distension. The complication markedly lessened, micturation became normal with the reconstructed meatussituated at the proper site on the glands. Conclusion one stage urethroplastyby using bladder mucosa for treatment of hypospadias is a simple, effective andsafe surgery.
ObjectivTo investigate the incidence of depression and its etiological factors in patients with hypospadias after operation. MethodsFrom January to June 2015, we investigated the incidence of depression symptoms among patients with hypospadias after surgical treatment from January 1990 to December 1994 in Zhangzhou Affiliated Hospital of Fujian Medical University, and we matched them with mentally healthy adults of the same age to 1:1 ratio. Zung Self-Rating Depression Scale and Correlation Factor Questionnaire were used to investigate and analyze the related factors of depression symptoms between the patients with hypospadias and the healthy males. ResultsA total of 80 patients with hypospadias after surgical treatment and 80 healthy males as control were included. There were no significant differences in male secondary sexual development, testis development, serum testosterone levels and postoperative length and girth of the penis in two groups. The incidence rate of depression symptoms was 45.0% (16/80) in the hypospadias patients after operation, extremely significantly higher than 6.3% (5/80) in the control group (χ2=6.632, P=0.01). The result of multiple stepwise regression analysis showed that the main risk factors of depression symptoms were worries about dissatisfaction with penile and scrotal appearance (F=16.210 3, P=0.001), sexual satisfaction (F=4.621 2, P=0.036) and sexual function (F=4.103 2, P=0.043). ConclusionSymptoms of depression often occur in hypospadias patients after operation, and the major etiological factors are dissatisfaction with penile and scrotal appearance, sexual satisfaction and sexual function.