Outcome of severe hypospadias repair using three different techniques
| Autor: | Mure Pierre-Yves, Daniela Gorduza, Frédéric Hameury, Elisângela de Mattos E. Silva, D. Demède, Pierre Mouriquand, Massimo Catti, Anne Frédérique Valmalle |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
Male
medicine.medical_specialty Urologic Surgical Procedures Male Adolescent Urinary Fistula Urology Fistula Urethroplasty medicine.medical_treatment Urethrocele Dehiscence Severity of Illness Index Surgical Flaps Young Adult Postoperative Complications Urethra medicine Humans Child Retrospective Studies Hypospadias business.industry Mouth Mucosa Infant Buccal administration medicine.disease Bandages Surgery medicine.anatomical_structure Treatment Outcome Child Preschool Pediatrics Perinatology and Child Health Complication business Penis Follow-Up Studies |
| Zdroj: | Journal of pediatric urology. 5(3) |
| ISSN: | 1873-4898 |
| Popis: | Objective To compare the outcomes of three different urethroplasty techniques (onlay, buccal mucosa, Koyanagi type I) used in the reconstruction of severe hypospadias. Patients and methods Over 10 years (1997–2007), 300 severe hypospadias cases were treated with a mean follow up of 2 years (1–105 months); 203 were operated by the same surgeon of whom 184 completed follow up. Three main techniques were used according to the quality of the urethral plate: onlay urethroplasty (133), buccal graft urethroplasty (25) and Koyanagi type I (26). The mean age at surgery was 36 months (8–298); 76 required preoperative androgen stimulation (onlay 37, buccal 11, Koyanagi 26); 18 required a corporoplasty to straighten the penis (onlay 13, buccal 3, Koyanagi 2). Results Thirty-eight onlay (28.5%); 14 buccal (56%); 16 Koyanagi (61.5%) urethroplasties had a complication. The fistula rate was 15% for the onlay group; 32% for the buccal mucosa group; 19.2% for the Koyanagi cases. The dehiscence rate was, respectively, 11.3%, 20% and 42.3%. The stricture rate was, respectively, 1.5%, 20% and 34.6%. Urethrocele was found in seven Koyanagi patients. Final functional and cosmetic results were satisfactory in 126/133 (94.7%) onlay, 20/25 (80%) buccal and 14/26 Koyanagi (53.8%) urethroplasties. Primary cases had better results (89%) than redo cases (75.9%). Patients submitted to preoperative androgen therapy developed more complications (onlay: 40.5% vs 23.9%; buccal: 70% vs 43.7%). Conclusion Two striking results are the low number of severe hypospadias cases requiring an additional corporoplasty, and the increased complication rate found in androgen-stimulated patients. The excellent results of the onlay procedure could be related to the use of dorsal preputial tissue, which in hypospadias is characterized by a well-balanced protein platform compared to the ventral tissues. |
| Databáze: | OpenAIRE |
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