The double-face onlay-tube-onlay transverse preputial flap: An advantageous alternative to the two-stage hypospadias repair?

Autor: Huen KH; Division of Pediatric Urology, UCLA Mattel Children's Hospital, Los Angeles CA, USA; Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles CA, USA., Macaraeg A; Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA., Davis-Dao CA; Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA., Williamson SH; Division of Urology, Children's Hospital of the King's Daughter, Norfolk, VA, USA; Department of Urology, Eastern Virginia Medical School, Norfolk VA, USA., Boswell TC; Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA., Suhale Z; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA., Chamberlin JD; Division of Pediatric Urology, Loma Linda University Children's Hospital, Loma Linda, CA, USA., Chuang KW; Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA., Stephany HA; Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA., Wehbi EJ; Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA., Khoury AE; Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA. Electronic address: aekhoury@hs.uci.edu.
Jazyk: angličtina
Zdroj: Journal of pediatric urology [J Pediatr Urol] 2023 Dec; Vol. 19 (6), pp. 701.e1-701.e8. Date of Electronic Publication: 2023 Aug 12.
DOI: 10.1016/j.jpurol.2023.08.007
Abstrakt: Objective: To compare the surgical outcomes and complications of boys who underwent double-face onlay-tube-onlay transverse preputial island flap (DFOTO) one-stage repair vs. two-stage repair for proximal hypospadias.
Study Design: Males with proximal hypospadias who underwent DFOTO or two-stage repair at a single institution from 2008 to 2021 were identified. Patients who had prior hypospadias surgery were excluded. Outcomes were surgical complications, number of surgical procedures, operative time, and post-operative uroflowmetry results.
Results: Fifty-three males who underwent DFOTO and 39 who underwent two-stage repair were included. Median age at surgery was 1.1 years (IQR 0.83-1.6) and median follow-up was 3.0 years (IQR 1.2-6.8). Although not statistically significant, the DFOTO group had higher rates of urethrocutaneous fistula (30% vs. 15%, p = 0.10), urethral stricture (15% vs. 3%, p = 0.07) and urethral diverticulum (8% vs. 3%, p = 0.39). Although the unplanned re-operation rate was higher in DFOTO (58% vs. 33%, p = 0.02), the mean number of procedures and median total surgical time were lower in DFOTO (1.8 ± 0.9 vs. 2.4 ± 0.8, p = 0.0004; 337 min [IQR 278-460] vs. 468 min [IQR 400-563], p = 0.008). There were no significant differences between groups for mean peak flow rates and post void residuals.
Conclusions: In males who underwent DFOTO, 42% achieved completion of their proximal hypospadias repair with one operation, while the remainder had largely minor complications. Accounting for reoperation rates, the mean number of procedures per patient was lower in the DFOTO group. Comparable results can be achieved with both techniques; the risks of higher unplanned operation rates in the DFOTO group should be considered with the benefit of fewer total procedures.
Competing Interests: Conflict of Interest The authors have no conflicts of interest to declare.
(Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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