Prospective Assessment of Genital Pain in Patients With Urethral Stricture: Incidence, Associations, and Impact of Urethroplasty.

OBJECTIVE: To assess the incidence of genital pain in patients with urethral stricture and examine the impact of urethroplasty. Genital pain is a common and challenging urological condition and potentially associated with urethral stricture. METHODS: From 2011-2019, patients were offered enrollment in a prospective single-center study assessing patient-reported genital pain pre- and 6-months posturethroplasty. Genital pain was assessed with the question, "Do you experience genital (scrotum or penis) pain?" answered on a five-point scale ["Never" (1), "Occasionally" (2), "Sometimes" (3), "Most of the Time" (4) or "All of the Time" (5)]. Responses of 3, 4, or 5 were considered clinically significant. Wilcoxon signed-rank test was used to compare pre- and postoperative states and logistic regression was used to evaluate the association between genital pain and clinical variables. RESULTS: Of the 387 patients completing enrollment, 36.4% (141/387) reported genital pain preoperatively. Patients with panurethral stricture reported higher rates (57.1%) of pain (Odds Ratio 2.93, 95%CI 1.32-6.50; P = .008). Posturethroplasty, pain scores improved with an incidence of 14.2% (P < .0001). In patients reporting preoperative pain, 88.7% (125/141) experienced improvement, 8.5% were unchanged and 2.8% reported worsening pain. On logistic regression, patients with penile strictures (O.R. 0.24, 95%CI 0.06-0.91; P = .04), hypospadias (O.R. 0.14, 95%CI 0.02-0.88; P = .04), and staged reconstruction (O.R. 0.22, 95%CI 0.05-0.90; P = .04) were less likely to report improvement. CONCLUSION: Genital pain is common in patients with urethral stricture and improves in the majority of patients undergoing urethroplasty but less so in patients with penile strictures, hypospadias and staged reconstruction.

Prevalence, assessment and surgical correction of penile curvature in hypospadias patients treated at one European Referral Center: description of the technique and surgical outcomes.

PURPOSE: Penile curvature (PC) is a common component of hypospadias, but its presence is inconstantly assessed. We aim to report prevalence of PC in hypospadias patients, as well as to report our method to assess and correct PC, with the associated postoperative outcomes. METHODS: We scrutinized 303 pediatric hypospadias patients operated (2013-2018) at our referral center. PC was routinely assessed and eventually corrected with dorsal plications (DP) as one-stage procedure, or ventral tunica attenuations ± DP as two-stage repair. PC severity and surgical treatment of PC were compared between primary and failed hypospadias. Finally, PC severity, failed repair and PC treatment were tested as predictors of perioperative complications. RESULTS: PC (> 10°) was identified in 274/303 (90.4%) patients, 86.1% with distal, 91.8% with midshaft, and 100% with proximal hypospadias, respectively. PC was found in 51/64 (79.7%) of failed hypospadias. One-stage and two-stage procedures were adopted in 211/274 (77%) and 63/274 (23%) children, respectively. PC severity (p = 0.1) and PC treatment (p = 0.4) did not differ between primary and failed hypospadias. PC severity (all p > 0.2), failed repair (p = 0.8), and PC treatment (all p > 0.09) were not predictors of perioperative complications. 95.6% of patients achieved a straight penis. CONCLUSION: Less than 1/10 patients did not require PC correction. High rate of residual PC in failed hypospadias and similar severity between failed and primary suggest that PC was usually under-corrected. It is possible to correct PC completely and the resulting complication would not be associated with PC severity, failed repair or treatment adopted.

A Critical Analysis of Stented and Unstented Tubularized Incised Plate Urethroplasty Through a Prospective Randomized Study and Assessment of Factors Influencing the Functional and Cosmetic Outcomes.

OBJECTIVE: To compare, functionally and aesthetically, stented and unstented tubularized incised plate urethroplasty (TIPU). In addition, predictors of repair success were investigated. MATERIALS AND METHODS: One hundred ten children with distal hypospadias were included in this study. The length and width of the urethral plate (UP) and transverse glans diameter (TGD) were measured. Patients were randomized into two groups: stented and unstented TIPU. Postoperative assessment of pain was done using Face, Legs, Activity, Cry, Consolability (FLACC) scale, and cosmetic outcome was evaluated using hypospadias objective scoring evaluation. Uroflow was assessed at 6 months in toilet-trained boys. Complications were graded by the Clavien classification system. RESULTS: In 93 cases, Face, Legs, Activity, Cry, Consolability score, hospital stay, and dressing time were in favor of the unstented group, whereas hypospadias objective scoring evaluation score and uroflow parameters were comparable. TGD and UP width varied significantly between successful and failed cases. Cutoff values of 13.5 mm and 8.5 mm for TGD and UP width, respectively, are required for successful outcome. Acute urinary retention was 12.8% after unstented repair. Detrusor spasm was 47.8% after stented and 8.5% after unstented repair. In both groups, urethrocutaneous fistula of 5.4%, glanular dehiscence of 1.1%, and meatal stenosis of 5.4% were found in cases with small TGD and narrow UP. CONCLUSION: Unstented TIPU evades the associated drawbacks of the stent along with lower postoperative pain, hospital stay, and dressing time. Even without a postoperative stent, the complication rate in infants with distal hypospadias is low, and short-term functional and aesthetic outcomes were not compromised.

Endocrine assessment of prepubertal boys with a history of cryptorchidism and/or hypospadias: a pilot study.

PURPOSE: Four disorders, including poor semen quality, testicular cancer, cryptorchidism and hypospadias, are thought to represent testicular dysgenesis syndrome and have been hypothesized to share a common etiology. We predicted testicular function in prepubertal boys with a history of cryptorchidism and/or hypospadias by measuring serum hormone levels. MATERIALS AND METHODS: A total of 82 prepubertal boys who underwent orchiopexy and/or hypospadias repair in childhood were enrolled in the study. Patients were surgically treated for cryptorchidism (23 in group 1), hypospadias (49 in group 2), cryptorchidism and hypospadias (10 in group 3), and hydrocele testis (7 in control group 4). Serum hormones, including luteinizing hormone, follicle-stimulating hormone and total testosterone, were measured separately by age less than 12.5, 12.5 to 13.5 and greater than 13.5 years, and by Tanner pubertal stage. RESULTS: Follicle-stimulating hormone in group 3 was significantly higher than in groups 1, 2 and 4 at ages 12.5 to 13.5 and greater than 13.5 years, and for Tanner stages 2 and 3 (p <0.05). However, luteinizing hormone and testosterone did not differ among the groups regardless of age or Tanner stage. Group 3 patients had significantly higher follicle-stimulating hormone regardless of the severity of cryptorchidism or hypospadias. CONCLUSIONS: Data suggest that testicular function in patients with cryptorchidism plus hypospadias is more severely impaired than that in patients with cryptorchidism or hypospadias, lending clinical support to the testicular dysgenesis syndrome hypothesis of a common origin.

Evaluación del comportamiento y evolución clínica de los pacientes con hipospadias manejados quirúrgicamente en el Hospital Manuel de Jesús Rivera “La Mascota”, Managua, durante le 2006-2007 / Performance assessment and clinical course of patients with hypospadias managed surgically at the Hospital Manuel de Jesus Rivera

El objetivo de este estudio fue evaluar el comportamiento y evolución clínica de los pacientes con hipospadias manejados quirúrgicamente en el Hospital Manuel de Jesús Rivera “la Mascota”, Managua, durante el 2006-2007. El tipo de estudio fue descriptivo de serie de casos, en el Servicio de Urología del Hospital Manuel de Jesús Rivera “La Mascota”, Managua. Se consideró como caso a todos aquellos pacientes ingresados e intervenidos quirúrgicamente en el Servicio de Urología con diagnóstico de hipospadias, correspondiente a los códigos Q54.0 y Q54.9 de la Clasificación Internacional de Enfermedades, décima revisión (CIE-10).24 0). La fuente de información fue primaria, basada en los expedientes clínicos de los pacientes. El software utilizado fue el SPSS versión 10.0. La mayoría de pacientes operados tenían más de 5 años de edad, contrario a lo recomendado por la Sección de Urología de la Academia Americana de Pediatría. Las principales hipospadias fueron anteriores, media y posterior, respectivamente. Las principales cirugías fueron Bracka y Snodgrass. La incidencia de complicaciones fue de 51.4%, predominando las fístulas, dehiscencias, estenosis del meato e infección de la herida quirúrgica. Las cirugías con mayor índice de complicaciones fueron Byars, Snodgrass, y técnicas sin especificar. El tiempo quirúrgico fue de 140.7 minuto y la estancia hospitalaria de 7.9 días En el 11.4% de caso se registraron anomalías congénitas, predominando la criptorquidia. Se recomienda realizar estudios para determinar las razones por las cuales estos pacientes buscan atención quirúrgica tardíamente; y estudios de evaluación de la atención en salud. Siempre y cuando se mejore el registro en los expedientes clínicos. Además, promover en la atención primaria la detección temprana para referirlos oportunamente a consulta especializada...

Inguinal hernias and genital abnormalities in young Jordanian males.

This study was carried out to document the prevalence of inguinal hernia, hypospadias, undescended testis and varicocele in 3057 male applicants to the military wing of Mu'ta University in the south of Jordan. Age range was 17-20 years. A total of 250 men had one the 4 conditions: 93 (3.0%) had inguinal hernia; 15 (0.5%) had undescended testis (26.7% bilateral); 59 (1.9%) had hypospadias; 83 (2.7%) had varicocele (98.79% on the left side). Prevalence of inguinal hernia and undescended testis were comparable with international prevalence rates, while the rate for hypospadias was higher and that for varicocele lower. A birth defects registration system would help in planning preventive and treatment strategies.

The assessment of nocturnal REM erection in the differential diagnosis of sexual impotence.

A new method for differentiating psychogenic from organic cases of sexual impotence is described based on the assesst of nocturnal REM erection in nine patients. It is our tentative impression that in psychogenic impotence nocturnal REM erection may be normal in amount and degree and an excellent indicator of erectile potential. In these cases a marked discrepancy exists between the amount and degree of nocturnal erection and the patient's daytime performance level attained during attempted coitus or masturbation. In the organic patients, on the contrary, such a discrepancy does not exist; instead, the maximal nocturnal erection attained corresponds closely to and mirrors the patient's impaired waking performance. This new method may be very useful in the diagnosis, prognosis, and decision as to type of treatment, especially in difficult cases.