Objective To investigate the effect of ventral urethroplasty for postoperative anastomotic stricture in patients with hypospadias. Methods From August 2000 to December 2005, 20 patients with anastomotic stricture after hypospadias repair were treated with ventral urethroplasty. The age ranged from 2 to 27 years with an average of 6.4 years. All patients showed dysuria after operation. Main clinical manifestation included dysuria and acraturesis. Interruption of urinary stream occurred in 17 cases; of them, 3 cases had urinary stasis and 4cases had frequent micturition, urgent micturition and pain in urination. Urethrography and cystourethrography showed 0.5-1.0 cm stricture with proximal dilat ion of urethra in 16 cases and obvious diverticularization in 9 cases. Urine routine examination showed that white blood cell was ++ to ++++ in 16 cases and pus cell was ± to++ in 13 cases.Results Twenty cases were followed up 2 months to 4 years (mean 2.3 years). All the cases achieved good results in urination with normosthenuria and normal force of urinary stream. No recurrent stricture, urethrocutaneous fistula, or penile curvature occurred. The cosmesis was satisfactory, and the results of urine routine examination was normal. Conclusion Ventral urethroplasty for postoperative anastomotic stricture inpatients with hypospadias is a simple and effective procedure.
ObjectiveTo explore the short-term effectiveness of hypospadias repairs with free inner prepuce tube.
MethodsForty-two males with hypospadias were repaired with free inner prepuce tube between May and October 2015. The age ranged from 1 year and 1 month to 28 years and 2 months with a median of 2 years and 9 months. Initial operation for hypospadias was performed in 41 cases and re-operation in 1 case of chordee after 16 months of hypospadias repair. There were 36 cases of hypospadias (6 cases of proximal penile type, 1 case of penile scrotal type, 26 cases of scrotal type, and 3 cases of perineal type) and 6 cases of typeⅣchordee according to Donnahoo classification criteria.
ResultsThe length of reconstructed urethra was 2.0-5.5 cm (mean, 3.6 cm). The patients were followed up 6-10 months (mean, 8 months). Urinary fistulae was noted in 10 patients, which healed spontaneously in 5 cases within 3 months after surgery, and was cured after repair in 5 cases. Urethral stenosis occurred in 4 cases (2 external orifice stricture and 2 distal urethral stricture) and urethral incision was performed. Wound infection was noted in 3 cases, 2 of them needed further surgery for a permanent fistula. Skin ischemic necrosis was found in 3 cases, 1 of them had infection and fistula, and needed further surgical repair. Diverticulum of scrotum developed in 1 case. Ten patients need re-operation, and the success rate was 76.2% (32/42). At 3 months after surgery, the HOSE score ranged from 11 to 16 (mean, 14.7). The maximum urinary flow rate was 1.9-28.4 mL/s (mean, 10.5 mL/s) in 22 cases of outpatient at 3 months after surgery.
ConclusionFree inner prepuce tube can survive and play a role of normal neourethra. The short-term effectiveness has shown a relatively high complication rate and suggests this procedure should be carefully applied.
Objective To explore the feasibility of one-stage repair of hypospadias using the meatalbased flap overlapping with buccal mucosal graft. Methods From March 2002 to May 2004, 21 patients with hypospadias were treated with the meatal-based flap overlapping with buccal mucosal graft. Their ages ranged from 14 months to 8 years. The procedure were as follows:urethralplate at proximal corona was cut to correct glandular tilt and chordee; the buccal mucosa taking from inner cheek was then fixed on tunica albuginea of ventral shaft with suture; and the meatalbased flap was rotated distally and overlaid with buccal mucosal graft to repair urethra.Results All patients were followed up 318 months (7 months on average). A cosmetic glans and a vertically oriented, normal appearing slit meatus were achieved. Two patients had fistulas on lateral corona. Fistula spontaneously healed in 1 case and the other one was repaired after 6months. Conclusion The technique of meatal-based flap overlapping with buccal mucosal graft can completely correct glandular tilt and chordee, prove good cosmetic and functional glans and meatus.
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 explore an effective method to repair penile-scrotal or perineal hypospadias in one stage with prepuce island flap.Methods Different prepuce island flaps were designed according to thedifferent pathological anatomy of the penile-scrotal or perineal hypospadias. The prepuce island flaps were thus translocated and sutured to form the urethra.Thirty-one cases of hypospadias (21 cases of peinil-scrotal type, 10 cases of perineal type) were repaired with prepuce island flap.The biggest length and the width of the prepuce island flapwere 7.5 cm and 1.5-1.8 cm respectively.Results All the cases resulted in a good contour of the penis and a normal anatomic position of urethral meatus without any redundancy or tortuosity.The urination was perfect and acceptable.Conclusion One stage repair of penilescrotal or perineal hypospadias with prepuce island flap can be considered as an acceptable effective surgical technique.
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 search for a new method to repair distal urethral stricture resulting from urethroplasty of hypospadias. Methods FromFebruary 2000 toMarch 2004, 16 patients with distal urethral stricture were treated by use of cutting stricture urethra and their distal urethra were reconstructed with phallic flap. Results All operations were successful without complication of flap necrosis. After 7 days of operation, the patients had free micturition and thick stream of urine. Eleven patients were followed 2 months to 4 years, the satisfactory result was obtained. Conclusion It is a simple and good method to reconstruct the distal urethra by superimposing the phallic flap on the cut stricture urethra after urethroplasty of hypospadias.
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.
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.
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.
