Ingrafts in hypospadias surgery: Longer-term outcomes
Autor: | Justin Loloi, Stephen Harrington, Ross M. Decter, Suzanne Boltz |
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Rok vydání: | 2020 |
Předmět: |
Male
medicine.medical_specialty Urologic Surgical Procedures Male Urology Fistula 030232 urology & nephrology Preputial gland Salvage therapy Buccal mucosa 03 medical and health sciences 0302 clinical medicine Urethra 030225 pediatrics medicine Humans Child Glans Retrospective Studies Hypospadias business.industry Infant medicine.disease Surgery Stenosis Treatment Outcome medicine.anatomical_structure Pediatrics Perinatology and Child Health Complication business Follow-Up Studies |
Zdroj: | Journal of Pediatric Urology. 16:555.e1-555.e5 |
ISSN: | 1477-5131 |
Popis: | Summary Background The technique of hypospadias repair with a dorsal inlay graft (ingraft) was initially reserved for boys with an unfavorable glans configuration or in previously failed repairs. Although the ingraft technique has been used for some time, there is scarce literature describing its longer term outcomes. Additionally, there is minimal data comparing inner preputial skin and buccal mucosal graft outcomes in primary and reoperative surgery. Objective To describe longer-term outcomes in the use of buccal mucosa and inner preputial skin ingrafts for primary and revisional hypospadias repairs. Study design We conducted a single-center retrospective review of our hypospadias repairs employing ingrafts along with a review of the literature. Results A total of 47 patients met inclusion criteria. Primary repair was performed in 38 patients, all with unfavorable glans characteristics at a mean age of 16 months and redo repairs in 9 boys at a mean age of 110 months. We used a buccal mucosal graft (BMG) in 19 boys and the remaining 28 were grafted with inner preputial skin. The complication rate was 32% in primary repairs and amongst those, 6 of 28 patients (21%) with skin grafts and 6 of 10 patients (60%) with BMGs suffered a complication. Only BMGs were used in reoperative situations and complications occurred in 2 of 9 cases (22%) of those cases. Overall, 8 patients (42%) with BMG and 6 patients (21%) with preputial skin ingrafts experienced a complication, at an average time of 17 months (range: 0.4–66 months) and 24 months (range: 1.1–113 months), respectively. Surgical correction of the complications resulted in resolution of symptoms in a majority of patients. Discussion In our experience, BMGs used as salvage therapy in revisional hypospadias surgery, had lower observed complication rates when compared to its use in primary repair. Inner preputial skin ingrafts for primary repair yielded an acceptable complication rate. Our study describes some of the longest follow-up times in the literature with complications observed even up to 10 years postoperatively. This reinforces the need for active long-term follow-up in reporting outcomes in hypospadias surgery. Summary Table . Outcomes in Primary versus Redo repair using ingrafts Primary repair Redo repair Total (n) 38 9 Total Complications: n (%) 12 (32) 2 (22) Complication type: n (%) Urethrocutaneous fistula 6 (16) 0 (0) Meatal stenosis 3 (8) 0 (0) Glans separation 2 (5) 2 (22) Urethral stricture 1 (3) 0 (0) Surgical correction of complication: n (%) 11 (92) 0 (0) Average time to complication (months) 23 (range: 0.7–113) 0.5 (range: 0.4–0.7) |
Databáze: | OpenAIRE |
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