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2.
Int Braz J Urol ; 45(6): 1238-1248, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808413

RESUMO

INTRODUCTION: Pubic hypertrophy, defined as an abnormal and abundant round mass of fatty tissue located over the pubic symphysis, is frequently underestimated in patients with hypospadias. We examined the prevalence of this condition, as well as the outcomes associated with its surgical treatment. MATERIAL AND METHODS: Within 266 hypospadias patients treated at our clinic, we assessed the prevalence of pubic hypertrophy, and we schematically described the surgical steps of pubic lipectomy. Multivariable logistic regression (MLR) tested for predictors of pubic hypertrophy. Finally, separate MLRs tested for predictors of fistula and any complications after pubic lipectomy. RESULTS: Of 266 hypospadias patients, 100 (37.6%) presented pubic hypertrophy and underwent pubic lipectomy. Patients with pubic hypertrophy more frequently had proximal hypospadias (44 vs. 7.8%), disorders of sex development (DSD) (10 vs. 0.6%), cryptorchidism (12 vs. 2.4%), and moderate (30°-60°) or severe (>60°) penile curvature (33 vs. 4.2%). In MLR, the loca-tion of urethral meatus (proximal, Odds ratio [OR]: 10.1, p<0.001) was the only signifi cant pre-dictor of pubic hypertrophy. Finally, pubic lipectomy was not associated with increased risk of fi stula (OR: 1.12, p=0.7) or any complications (OR: 1.37, 95% CI: 0.64-2.88, p=0.4) after multi-variable adjustment. CONCLUSIONS: One out of three hypospadias patients, referred to our center, presented pubic hypertrophy and received pubic lipectomy. This rate was higher in patients with proximal hypospadias suggesting a correlation between pubic hypertrophy and severity of hypospadias. Noteworthy, pubic lipectomy was not associated with increased risk of fistula or any complications.


Assuntos
Hipospadia/epidemiologia , Hipospadia/cirurgia , Lipectomia/métodos , Adolescente , Adulto , Humanos , Hipertrofia/epidemiologia , Hipertrofia/cirurgia , Modelos Logísticos , Masculino , Ilustração Médica , Pênis/cirurgia , Complicações Pós-Operatórias , Prevalência , Osso Púbico/cirurgia , Estudos Retrospectivos , Fatores de Risco , Sérvia/epidemiologia , Estatísticas não Paramétricas , Resultado do Tratamento , Adulto Jovem
3.
Cir. pediátr ; 32(4): 201-206, oct. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-184110

RESUMO

Introducción y objetivo. Los hipospadias peneanos proximales, escrotales y perineales son un reto para el cirujano. Tras toda una carrera dedicada a los hipospadias, la autora principal del trabajo resume su experiencia y demuestra que prácticamente cualquier tipo de hipospadias puede ser resuelto completamente en un único tiempo. Método. Se trata de una revisión retrospectiva y la discusión de una serie de hipospadias proximales consecutivos tratados en una única intervención por el mismo equipo quirúrgico entre 1999 y 2016. Resultados. 196 pacientes fueron intervenidos. El 68% de los casos quedaron satisfactoriamente resueltos tras la operación. Todos los hipospadias fueron reparados con una de las siguientes técnicas: onlay, colgajo prepucial tubularizado (Duckett) o injertos de mucosa. Los injertos se utilizaron solo hasta 2005; posteriormente, el refinamiento de las técnicas quirúrgicas expuestas permitió que cualquier hipospadias fuera reparado con las técnicas de onlay o Duckett. Solo un 13% de los casos necesitó algún tipo de procedimiento quirúrgico adicional, más allá del cierre de una fístula uretral puntiforme (presente en el 25% de los pacientes).Conclusión. El diseño de las incisiones cutáneas es fundamental en la reparación de los hipospadias. Cuando las incisiones siguen las líneas que de forma natural se forman en la piel del pene y escroto se obtiene como resultado un colgajo óptimo para realizar una neouretra y recubrirla con piel, evitando incluso los injertos de mucosa. Estas modificaciones permiten que cualquier tipo de hipospadias sea reparado en un único tiempo con muy buenos resultados a largo plazo


Purpose. Proximal, scrotal and perineal hypospadias challenge the surgeon. After 40 years devoted to hypospadias surgery, the senior author summarizes her experience, share her tricks and shows that almost any hypospadias can be fully repaired in one surgery. Methods. Retrospective review and discussions of a large series of consecutive proximal hypospadias treated in one surgery by the same team from 1999 to 2016. Results. 196 patients were operated. 68% of all patients were successfully repaired after the surgery. All hypospadias were treated using one of the following techniques: onlay double flap, tubularized preputial flap or mucosal grafts (only until 2005). Urethrocutaneous fistula was present in 25% of cases, but only 13% of patients needed other further surgical procedures. Conclusion. Cutaneous incisions design is fundamental in hypo-spadias repair. When the incisions follow the natural folds that appear in penile and scrotal skin, it's possible to obtain optimal flaps for both urethroplasty and skin coverage (even avoiding the need for mucosal grafts). Consequently, almost all kinds of hypospadias can be repaired in one surgery with very good long-term results


Assuntos
Humanos , Masculino , Criança , Hipospadia/cirurgia , Uretra/cirurgia , Retalhos Cirúrgicos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Estudos Retrospectivos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Escroto/cirurgia
4.
Pediatr Surg Int ; 35(11): 1301-1308, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31372729

RESUMO

PURPOSE: To compare the two major complications, namely postoperative urethrocutaneous fistula and urethral stricture, between the Mathieu and tubularized incised plate (TIP) repair methods for distal hypospadias. METHODS: In this meta-analysis, electronic databases were searched for comparative studies on the two techniques. The Oxford Centre for Evidence-based Medicine Levels of Evidence was used to evaluate the included studies. The main outcome measure was the frequency of postoperative fistula and urethral stricture. RevMan 5.3 was used for statistical analyses, with P < 0.05 indicating statistical significance. RESULTS: A total of 17 studies, which included 1572 patients, met the inclusion criteria. The frequency of urethrocutaneous fistula did not differ between the Mathieu [115 (13%)] and TIP [90 (13%)] methods [odds ratio (OR) 1.1, 95% confidence intervals (CI) 0.6-1.9; P = 0.73)]. Urethral stricture was less frequent after the Mathieu [15 (2%)] method than after the TIP [37 (5%)] method (OR 0.5, 95% CI 0.3-0.8; P < 0.01), even after the subgroup analysis of eight randomized controlled trials was included. Overall, the quality of the included studies was determined to be satisfactory. The levels of evidence on which this review was based ranged from 1b to 2b using the CEBM Levels of Evidence. CONCLUSION: Compared with TIP repair, Mathieu repair for hypospadias had a significantly lower risk for urethral stricture; however, the risk for urethrocutaneous fistula was similar.


Assuntos
Fístula Cutânea/etiologia , Hipospadia/cirurgia , Estreitamento Uretral/etiologia , Fístula Urinária/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Humanos , Masculino , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
7.
Arch Esp Urol ; 72(5): 443-450, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31223122

RESUMO

OBJECTIVE: The objective of this study is to perform an analysis of the patients who underwent middle and distal penile hypospadias repair using the two most widely used techniques in our Pediatric Urology Unit. MATERIAL AND METHODS: We perform a retrospective analysis of patients with a diagnosis of middle penile and distal penile hypospadias and operated by the Snodgrass or Mathieu technique, between 2011 and 2016 ensuring minimal follow-up of one year. We will analyze the use of each one, the results obtained, and the possible factors that could influence their success rate. RESULTS: A total of 80 patients were included in the study, with a median age of 28 months at surgery (Range: 11 to 151). There were 34 patients (42.5%) with Snodgrass technique and there were 46 patients (57.5%) with Mathieu technique. We have not identified statistically significant differences in complications between both surgical techniques. The percentage of fistulas is higher in Snodgrass urethroplasty (12.1% vs 8.9%), decreasing in the last years of the series, at the same time meatal stenosis is higher in Snodgrass technique (3% vs 2.2%) while the meatal retraction is higher in the urethroplasty of Mathieu (20% vs 15.2%). CONCLUSIONS: The exhaustive selection of patients seems the key in the succesful correction of these types of hypospadias. Despite both techniques are comparable in terms of the type of patient in which they could be applied and both techniques present similar rates in terms of fistulas and stenosis/retractions of the neomeatus (most frequent complications in this type of repairs), we consider that the characteristics of the patient should be prioritized before the preference of the surgeon to reach higher success rates.


Assuntos
Fístula , Hipospadia , Criança , Pré-Escolar , Humanos , Hipospadia/cirurgia , Lactente , Masculino , Pênis , Estudos Retrospectivos , Resultado do Tratamento , Uretra , Procedimentos Cirúrgicos Urológicos Masculinos
9.
BMC Urol ; 19(1): 55, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221140

RESUMO

BACKGROUND: Many factors including vasoconstrictor agents can interfere with wound healing process. This study aimed to compare the histopathological outcome of injection of two sympathomimetic drugs used during urologic surgery, including phenylephrine and epinephrine, on the structure of spongy tissue and urethra in a rat model of experimental hypospadias repair using stereological methods. METHODS: Male rats were allocated into three groups. The first group underwent surgery without using any agents. The second and third groups underwent surgery with diluted phenylephrine (1:5000) and diluted epinephrine (1:100000) injection in the urethral plate before operation, respectively. Quantitative histological evaluation of all penises was performed after 3 weeks. RESULTS: The results indicated no significant differences among the three groups regarding the vessels and urethral lumen and epithelium. However, the volumes of the spongy tissue and collagen bundles and the number of fibroblasts were significantly higher (35-55%) in surgery + phenylephrine and surgery + epinephrine groups in comparison to the surgery group (p < 0.05), with no preferences. CONCLUSIONS: Hypospadias repair using phenylephrine and epinephrine injection showed no adverse effects. Furthermore, they might lead to better postoperative structural outcomes without any preferences. However, further experimental and human studies are required to draw a firm conclusion.


Assuntos
Epinefrina/administração & dosagem , Hipospadia/tratamento farmacológico , Hipospadia/cirurgia , Pênis/cirurgia , Fenilefrina/administração & dosagem , Simpatomiméticos/administração & dosagem , Animais , Hipospadia/patologia , Masculino , Pênis/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
10.
Pediatr Surg Int ; 35(7): 823-827, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31049665

RESUMO

PURPOSE: To evaluate the intermediate outcomes of our institution's experience with staged TPIF urethroplasty for proximal hypospadias repair. METHODS: We retrospectively evaluated the medical records of patients who underwent repair of proximal hypospadias using staged TPIF urethroplasty at our hospital from 2011 to 2017. RESULTS: One hundred and two patients were included in the present study. The mean follow-up was 52.4 months (range 13-74 months). The mean age at the time of the first surgery was 13.5 months (range 11-65 months). There were two main types of initial complications including meatal stenosis in four (3.9%) and urethrocutaneous fistula in three (2.9%) patients after the first stage. Surgical complications were seen in 15 patients after second stage, including urethrocutaneous fistulas in 8 (7.8%), urethral strictures in 5 (4.9%), urethral diverticula in 2 (1.9%). Overall complication rates after second stage were 14.7%. The incidence of fistulas was lower in patients who underwent repair with a tunica vaginalis flap (1/29, 3.4%) than with the dartos fascia (7/73, 9.6%; p = 0.435). CONCLUSIONS: Our results show that staged TPIF urethroplasty is a viable and durable technique for primary severe proximal hypospadias. This procedure was associated with a 14.7% complication rate in the present study. Staged TPIF urethroplasty can reduce the incidence of urethral strictures and diverticula associated with the second stage.


Assuntos
Prepúcio do Pênis/cirurgia , Hipospadia/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Uretra/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Pré-Escolar , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento
11.
Andrologia ; 51(6): e13289, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30983030

RESUMO

Lipomas are the most common benign tumours that originate from adipose tissue and can develop in any anatomical location where the adipose tissue layer is present in the body. Penile lipoma cases are very rare in the literature. Our case is a 21-year-old male patient who underwent TIPU operation 8 years ago due to distal hypospadias. One year after the operation, a palpable swelling at the midline of the ventral portion of the penis occurred and this lesion grew over time. In this case report, we present a patient with lipoma that was developed in the surgical area 1 year after hypospadias surgery. To the best of our knowledge, this is one of the first cases of penil lipoma related to hypospadias procedure.


Assuntos
Hipospadia/cirurgia , Lipoma/etiologia , Neoplasias Penianas/etiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Humanos , Lipoma/diagnóstico , Masculino , Neoplasias Penianas/diagnóstico , Pênis/anormalidades , Pênis/diagnóstico por imagem , Pênis/cirurgia , Complicações Pós-Operatórias/diagnóstico , Resultado do Tratamento , Ultrassonografia , Adulto Jovem
12.
Int Urol Nephrol ; 51(5): 783-788, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30895503

RESUMO

AIMS: To compare the short-term complications between Onlay and Duckett urethroplasty and to analyze the various risk factors cause the complications. METHODS: The children with hypospadias who underwent treatment with Onlay or Duckett urethroplasty from November 2014 to June 2016 were followed up. The difference in complications between the two groups was analyzed. Moreover, a single-factor ANOVA was performed to analyze the length and curvature of the penis and the length of the urethral defect. RESULTS: 40 patients were treated by Duckett, while 54 by Onlay. In comparison to the Onlay group, the Duckett group showed the initial penile length was shorter (P = 0.044), the initial urethral defect (P = 0.024) and after the correction of chordee was longer (P < 0.001), and the initial penile curvature (P < 0.001) and after degloving (P < 0.001) was greater. Furthermore, the incidence of urethra percutaneous fistula (P = 0.041) and urethral stenosis (P < 0.001) in Duckett group was significantly higher. The analysis of risk factors showed that the age at the time of surgery, the initial penile curvature, the initial urethral defect, and the urethral defect after the correction of chordee were not correlated with the complications. The degree of penile curvature after skin degloving and urethra stenosis was significantly correlated (P = 0.019). CONCLUSION: The incidence of complications of urethra percutaneous fistula and urethral stenosis after 1 year of Duckett was higher than that by Onlay approach. The greater the curvature of the penis after skin degloving, the more likely the occurrence of urethral stenosis after surgery.


Assuntos
Hipospadia/cirurgia , Complicações Pós-Operatórias/epidemiologia , Uretra/cirurgia , Pré-Escolar , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
13.
J Pediatr Surg ; 54(9): 1825-1831, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30850151

RESUMO

PURPOSE: To analyze agreement on postoperative complications after hypospadias surgery according to medical records and parents' reports. MATERIALS & METHODS: In this retrospective cohort study, data were collected from 409 children who received an initial one-stage hypospadias correction in the Radboudumc, The Netherlands. Postoperative complications according to medical records were compared with parent-reported complications in an online questionnaire. Main complications studied were wound-related complications, urinary tract infections, fistulas, stenosis, and prepuce-related complications. Agreement was determined by Cohen's kappa coefficient. RESULTS: Slightly less complications were mentioned in medical records (37%) compared to parents' reports (42%). Overall agreement was moderate (κ = 0.50, 95% confidence interval (CI):0.41-0.59), but poor for some specific complications. Agreement was higher for complications that needed reoperation compared to when no reoperation was performed (κ = 0.53, 95% CI: 0.43-0.62 and κ = 0.18, 95% CI: 0.06-0.31) and for patients with recent surgery (<5 years before questionnaire completion) compared to less recent surgeries (κ = 0.69, 95% CI: 0.55-0.84 and κ = 0.43, 95% CI: 0.33-0.54). CONCLUSIONS: Agreement on complications according to medical records and parents' reports was poor to moderate, but better after reoperation and more recent surgery. Some complications mentioned in medical records were missing from parents' reports and the other way around. Better agreement will give physicians and parents a more reliable view on postoperative outcome after hypospadias surgery. TYPE OF STUDY: Diagnostic test. LEVEL OF EVIDENCE: Level III.


Assuntos
Hipospadia/cirurgia , Complicações Pós-Operatórias , Criança , Humanos , Masculino , Registros Médicos , Países Baixos , Pais , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
14.
Horm Behav ; 109: 64-70, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30742831

RESUMO

BACKGROUND: Hypospadias is a common malformation of the male external genitalia that results in urethral displacement with different levels of severity. Male genital development during the fetal period is dependent on androgen function, while the etiology of hypospadias differs and can be multifactorial. The psychosocial outcome is sometimes affected, but according to several studies acceptable. The question of whether hypospadias is associated with differences in psychosexual development has been investigated previously, with mixed results. There are no previous investigations of cognitive abilities in men with hypospadias. OBJECTIVE: The aim of this study was to investigate whether hypospadias is associated with differences in performance on cognitive tests and/or gender role behavior. PARTICIPANTS: Eighty-six men with hypospadias were compared to male and female controls from the general population. PROCEDURE: Cognitive tasks, previously shown to yield group level sex differences and questions regarding self-reported childhood gender role behavior, were administered either at an outpatient clinic visit or via online participation. RESULTS: The cognitive performance of men and women in the control groups differed significantly in the expected directions. Men and women also differed on self-reported childhood gender role behavior questions. There were no significant differences between men with and without hypospadias on any of the measures. Men with proximal hypospadias performed slightly lower on many of the cognitive tasks in comparison to men with distal hypospadias and controls. CONCLUSION: In general, hypospadias is not associated with differences in performance on cognitive tests that typically yield sex differences or with altered gender role behavior in childhood. Further studies on cognitive abilities in boys and men with proximal hypospadias are warranted.


Assuntos
Comportamento/fisiologia , Cognição/fisiologia , Identidade de Gênero , Hipospadia/psicologia , Adulto , Estudos de Casos e Controles , Criança , Estudos Transversais , Feminino , Seguimentos , Humanos , Hipospadia/fisiopatologia , Hipospadia/cirurgia , Masculino , Autorrelato , Caracteres Sexuais , Adulto Jovem
15.
Pediatr Surg Int ; 35(5): 611-617, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30762107

RESUMO

INTRODUCTION: To review the surgical treatment of hypospadias (HP) associated with disorders of sex development (DSD). PATIENTS AND METHODS: HP cases were assessed for DSD by gross examination for atypical external genitalia, and assessment of hormone levels and karyotype. There were 58 HP cases with concomitant DSD treated between 1999 and 2017. DSD classification, type of HP, sex assignment, hormonal abnormality, surgical strategy, and post-urethroplasty complications (post-UPC) were reviewed. RESULTS: DSD were sex chromosome abnormalities (n = 4), 46,XY (n = 51), 46,XX (n = 1), and 47,XY + 21 (n = 2). HP was perineal: (n = 26), scrotal: (n = 16), penoscrotal: (n = 15), and midshaft: (n = 1); repair was primary (n = 6) or staged (n = 52). Mean age at final urethroplasty (UP) was 4.12 ± 0.21 years; all cases had soft tissue interposition at UP. At mean follow-up 5.16 ± 0.56 years after final UP, observed post-UPC (n = 8; 13.8%) were urethral stenosis (n = 3), urethral diverticulum (n = 2), urethrocutaneous fistula (n = 2), and curvature (n = 1). Mean onset of post-UPC was 1.24 ± 0.77 years (range 0.1-6.3). The second half of our cases (n = 29; treated 2015 ~) had significantly less post-UPC (0/29; 0%) than the first half (8/29; 27.6%) (p = 0.0075). CONCLUSIONS: Although UP for HP + DSD was formidably challenging, we achieved a significant decrease in post-UPC through a combination of surgical techniques and experience.


Assuntos
Transtornos do Desenvolvimento Sexual/complicações , Transtornos do Desenvolvimento Sexual/cirurgia , Hipospadia/complicações , Hipospadia/cirurgia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Períneo/cirurgia , Estudos Retrospectivos , Escroto/cirurgia , Resultado do Tratamento , Uretra/cirurgia
17.
J Int Med Res ; 47(4): 1620-1627, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30747026

RESUMO

OBJECTIVE: Transverse island pedicle flap (TIPF) plus transected urethral plate-preserving urethroplasty is increasingly used for treatment of severe hypospadias. We aimed to reduce the occurrence of urethral strictures in patients undergoing such procedures. METHODS: Sixty-five patients with severe hypospadias were enrolled. Thirty-two patients underwent onlay-tube-onlay urethroplasty (Group A), and 33 patients underwent modified Duplay urethroplasty (Group B). Postoperative complications were recorded, including fistulas, urethral strictures, and diverticula. RESULTS: Three patients (9.4%) in Group A and 10 patients (30.3%) in group B had urethrocutaneous fistulas. Three patients (9.4%) in Group A and 0 patients (0%) in Group B had urethral strictures. No patient in the two groups had symptoms of diverticulum or penile chordee. The results of uroflowmetry were better in Group B than Group A, when comparing uroflow patterns. CONCLUSIONS: TIPF plus transected urethral plate-preserving urethroplasty can lower the occurrence of stricture, which is a challenging complication. The occurrence of stricture was lower in patients who underwent modified Duplay urethroplasty, and neourethral function and quality were better in these patient. Thus, this modified procedure can be used for treatment of severe hypospadias.


Assuntos
Hipospadia/cirurgia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos/métodos , Uretra/cirurgia , Estreitamento Uretral/prevenção & controle , Pré-Escolar , Seguimentos , Humanos , Hipospadia/diagnóstico , Masculino , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/classificação , Estudos Retrospectivos
18.
J Urol ; 202(3): 617-622, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30747872

RESUMO

PURPOSE: Increased complications following failed hypospadias repairs suggest that impaired wound healing is a contributing factor. We used perioperative hyperbaric oxygen therapy to promote wound healing determined by graft take in staged tubularized autograft reoperations using oral graft. MATERIALS AND METHODS: Hyperbaric oxygen therapy was recommended for patients with 3 or more failed hypospadias repairs, comprising 20 preoperative and 10 postoperative sessions. All patients underwent reoperative staged tubularized autograft repair using oral mucosa. Graft lengths and widths were measured at grafting and again at the second stage, from which graft area was calculated. The primary outcomes were percent graft contracture and graft failure, defined as contracture 50% or greater. Patients who received hyperbaric oxygen therapy were compared to other patients who underwent reoperative staged tubularized autograft who did not receive therapy. RESULTS: Among 57 patients 32 received hyperbaric oxygen therapy and 25 did not as they had fewer than 3 prior repairs, or were not able to receive treatment due to insurance issues or lack of local availability. Grafts were healthier in those receiving hyperbaric oxygen therapy, with significantly less percent area contracture (9% vs 26%, p=0.04) and graft failure (6% vs 28%, p=0.03) compared to those not receiving therapy, although treated patients had significantly more prior failed hypospadias repairs. CONCLUSIONS: Hyperbaric oxygen therapy improved graft take in hypospadias reoperations. This observation also calls attention to wound healing as another variable to consider in hypospadias surgery.


Assuntos
Contratura/prevenção & controle , Oxigenação Hiperbárica , Hipospadia/cirurgia , Mucosa Bucal/transplante , Autoenxertos , Contratura/fisiopatologia , Sobrevivência de Enxerto/fisiologia , Humanos , Masculino , Reoperação , Transplante Autólogo/métodos , Cicatrização/fisiologia
19.
Urol Int ; 102(3): 336-340, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30731455

RESUMO

PURPOSE: We present our experience of stented and unstented distal hypospadias repaired by tubularized incised plate urethroplasty (TIPU). PATIENTS AND METHODS: Data of 84 patients who were operated by TIPU method in 2 hospitals were retrospectively analyzed, and they were invited to be included in the study. Sixty-six patients agreed to participate in the study and were divided into 2 groups. Group 1 consisted of 38 boys operated in Sütçü Imam University Hospital on using a stent between 2015 and 2017. Group 2 consisted of 28 boys operated in Private Hospital of Megapark on without a stent between 2016 and 2017. The hypospadias objective scoring evaluation (HOSE) scale was used to compare the groups. RESULTS: The median age was 2.81 years in group 1 and 1.95 years in group 2 (p = 0.243). The mean follow-up duration was 25.74 ± 4.62 and 24.5 ± 4.19 months in groups 1 and 2 respectively (p = 0.268). The HOSE scores were similar in both groups with comparable results (p = 0.622). CONCLUSIONS: No difference was observed between the groups in this study, regarding functional and cosmetic outcomes according to the HOSE score. However, the results should be supported by prospective studies with a sufficient number of patients.


Assuntos
Hipospadia/cirurgia , Stents , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Masculino , Pênis/cirurgia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Resultado do Tratamento , Uretra/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/instrumentação
20.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(2): 223-226, 2019 02 15.
Artigo em Chinês | MEDLINE | ID: mdl-30739420

RESUMO

Objective: To discuss the reoperation methods of urethral stricture after urethroplasty of hypospadias and their effectiveness. Methods: Between September 2010 and April 2018, 169 patients with urethral stricture after urethroplasty of hypospadias, who underwent ineffective conservative treatments first, were accepted. The age ranged from 1 year and 7 months to 41years with a median age of 5 years and 8 months. The stricture located at the external urethral orifice in 80 cases, internal anastomosis connection in 87 cases, and constructed urethra in 2 cases. The symptoms of urethral stricture occurred at 2 weeks to 52 months after urethroplasty, with a median time of 4.5 months. The patients with external urethral orifice stenosis were treated with urethral meatus augmentation (74 cases) and urethral advancement (6 cases). The patients with internal anastomosis connection stenosis were treated with internal urethrotomy with urethroscopy (10 cases), urethrotomy and one-stage urethroplasty (26 cases), and urethrostomy (51 cases) including 43 cases of two-stage urethroplasty. The patients with constructed urethral stricture were treated with urethrolysis. Results: One hundred and fifty-four patients were followed up 6-86 months with an average of 47 months. The stenosis was relieved in 137 cases, and re-stenosis in 12 cases, urethral fistula in 4 cases, all of which were treated successfully. In addition, 1 case with mild urethral diverticulum did not need to be treated. Conclusion: If it is ineffective for the conservative treatment of urethral stricture after urethroplasty of hypospadias, appropriate surgical treatments could be selected according to the location and length of the stricture, local tissue conditions, complications, and so on.


Assuntos
Hipospadia , Estreitamento Uretral , Procedimentos Cirúrgicos Urológicos Masculinos , Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Hipospadia/cirurgia , Lactente , Masculino , Reoperação , Resultado do Tratamento , Uretra , Adulto Jovem
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