Staged repair of proximal hypospadias: Reporting outcome of staged tubularized autograft repair (STAG)
| Autor: | Akram Assem, M.M. Youssef, Haytham Badawy, Waly Mahfouz, Ashraf Saad Soliman, Ahmed Aboulfotouh Eid, Ahmed Fahmy, Ahmed Moussa, Shaymaa Elsayed, Ahmed Hanno, Waleed Dawood, Ahmed Gawan |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Urologic Surgical Procedures Male Fistula Dehiscence 03 medical and health sciences 0302 clinical medicine Urethra 030225 pediatrics Medicine Humans Staged repair Stage (cooking) Autografts Hypospadias business.industry Infant General Medicine medicine.disease Meatal stenosis Surgery medicine.anatomical_structure Treatment Outcome 030220 oncology & carcinogenesis Pediatrics Perinatology and Child Health business Penis Follow-Up Studies |
| Zdroj: | Journal of pediatric surgery. 55(12) |
| ISSN: | 1531-5037 |
| Popis: | Introduction Proximal hypospadias (PPH) repair is a challenge. Dilemma exists whether to do it in single or staged repair. Staged repair is our adopted procedure which was recently modified by Snodgrass into staged tubularized autograft repair (STAG), in which attention was given to ventral straightening of the penis together with some other technical details. Herein, we report our experience with STAG in a cohort of primary posterior hypospadias. Patients and methods In the period from 2011 to 2018 we operated 43 primary posterior hypospadias. Two principal surgeons (HB, MY) and multiple assistants operate children the same way, and data are recorded in a prospectively designed data base. In all children, inner prepuce graft was utilized, when curvature is more than 30 degrees, plate transection with or without ventral corporotomies were adopted. Results Forty-three children with PPH and ventral curvature more than 30 degrees underwent first stage with median age 12 months (6–132 IQR16). Penile curvature was corrected by plate transection in 27 children (62.8%), ventral corporotomies in 16 children (37.2%). Graft take was successful in 90.7%, 4 children needed revision of fibrotic graft. Second stage was completed in 37 children, success was 56.8%, 21.6% fistula, 24.3% glanular dehiscence. Overall success after third surgery to correct complications was 78.4%. In a mean follow up of 3.2 years, we had recurrence of curvature in 2 children taking success rate to 72.9%. No meatal stenosis, no diverticulum, no stricture, no urethral dehiscence was encountered. Cosmetic appearance was excellent in follow up. Conclusion STAG achieves proper straightening of the penis and allows for reconstruction of a good urethra, yet urethrocutaneous fistula and glanular dehiscence remain the main complications. Follow up is important to address results of ventral corporotomies. Type of study Therapeutic. Level of evidence Level IV case series with no comparison group. |
| Databáze: | OpenAIRE |
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