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Hypospadias Repair (hypospadias + repair)

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Medical Sciences100%

Selected Abstracts

Hypospadias repair: an overview

INTERNATIONAL JOURNAL OF UROLOGICAL NURSING, Issue 1 2010
Michael Pfeil
Hypospadias is a birth defect in boys where the meatus is not placed at the tip of the glans of the penis. This article reviews the rapidly developing international literature surrounding hypospadias and hypospadias repairs paying specific attention to important aspects of nursing care, including preparing for surgery, use of dressings, stents and catheters as well as medication. It concludes by considering the long-term impact of hypospadias and its surgical correction on the patient's life. Hypospadias is treated surgically, normally during the second 6 months of the boy's life. Hospitalization periods vary from day case surgery to several days. The success of the hypospadias repair can be measured according to functional results and cosmetic appearance of the penis. The post-operative use of dressings as well as urinary catheters or stents is common but not uniform. Complication rates for hypospadias surgery vary from below 10% in boys with distal hypospadias to above 50% in children with a proximal meatus. The most common complications are urethral fistulas, strictures and stenoses. The continuing efforts by paediatric urologists focus on further optimizing the cosmetic and functional results. [source]

Current concepts in hypospadias surgery

INTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2008
Yutaro Hayashi
Abstract: Anatomical anomalies in hypospadias are an abnormal ventral opening of the urethral meatus, abnormal ventral curvature of the penis and abnormal distribution of the foreskin around the glans with a ventrally deficient hooded foreskin. The techniques of hypospadias surgery continue to evolve. The current standard of care for hypospadias repair includes not only a functional penis adequate for sexual intercourse and urethral reconstruction offering the ability to stand to urinate, but also a satisfactory cosmetic result. Tubularized incised plate repair has been the mainstay for distal hypospadias. In cases of proximal hypospadias, one-stage repairs such as the Duckett repair or the Koyanagi repair have been well established, while two-stage repairs remain important alternatives. Whether dorsal plication or ventral lengthening should be used to correct penile curvature is still controversial, and long-term results are required. Efforts have been made in this decade to improve cosmetic appearance, constructing a slit-like meatus or performing foreskin reconstruction, and to prevent onerous complications. [source]

Prepuce-Sparing hypospadias repair with tubularized incised plate urethroplasty

INTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2008
Kenji Shimada
Objectives: Modifications in surgical methods of hypospadias repair have been influenced by social considerations. Most Japanese parents wish their children to retain their foreskin during hypospadias repair. We report on short-term results of foreskin reconstruction associated with hypospadias repair. Methods: Of 44 tubularized incised plate urethroplasty-patients, 42 (95%) underwent foreskin reconstruction at the time of urethroplasty during the last 2 years. After the urethroplasty was completed, the foreskin was re-approximated in three layers. Results: Complications related to urethroplasty consisted of fistula in two patients with penoscrotal hypospadia, and mild stenosis of the glandular urethra in one patient. Complications related to foreskin reconstruction included dehiscence of the ventral foreskin in two patients. In all cases parents were well satisfied with the reconstructed prepuce. Conclusions: Pre-operative information about preputial reconstruction should be given to parents if they would prefer their son to be uncircumcised. [source]

Use of bladder mucosal graft for urethral reconstruction

INTERNATIONAL JOURNAL OF UROLOGY, Issue 10 2000
ar Özgök
Background: The ideal tissue for complex urethral reconstruction has yet to be determined, especially in patients with deficient preputium. The use of bladder mucosa as a free graft could be an alternative in these problem cases. Methods: Bladder mucosa graft urethroplasty was performed on 14 patients with penoscrotal or scrotal hypospadias. The mean age of the patients was 18.7 (range 14,23) years. Ten cases were subjected to primary urethral reconstruction while four cases had previous hypospadias repair. Results: Complete urethral replacement by the bladder mucosa tube was performed in six patients. Meatal problems occurred in two (33.33%) patients and proximal fistula formed in one (16.67%) patient. A bladder mucosa graft was combined with preputial or tunica vaginalis grafts distally in eight cases, and one patient in the tunica vaginalis group developed fistula at the anastomosis of the bladder mucosa and tunica vaginalis grafts. The overall complication rate was 28.6%. Conclusions: Our initial results showed that bladder mucosa grafts can be used successfully for urethral reconstruction especially when combined with preputial or tunica vaginalis grafts distally. [source]

The addition of fentanyl to 1.5 mg/ml ropivacaine has no advantage for paediatric epidural analgesia

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2009
J. E. CHO
Background: Epidural opioids are frequently combined with local anaesthetics for an additive antinociceptive effect. We investigated the efficacy of epidural fentanyl to 1.25 or 1.5 mg/ml ropivacaine for post-operative epidural analgesia in children. Methods: One hundred and eight children undergoing hypospadias repair were randomized to receive 1.25 mg/ml ropivacaine (R1.25 group), 1.25 mg/ml ropivacaine with 0.2 mcg/kg/h of fentanyl (R1.25F group), 1.5 mg/ml ropivacaine (R1.5 group) or 1.5 mg/ml ropivacaine with 0.2 mcg/kg/h of fentanyl (R1.5F group) for post-operative epidural analgesia. The epidural catheter was threaded caudally through the L4-5 interspace. The face, legs, activity, cry, consolability (FLACC) score was assessed at every hour and at FLACC score >4, an epidural bolus of 0.5 ml/kg of ropivacaine 1.5 mg/ml was given as the rescue analgesia. The incidence of side effects such as hypoxia, sedation, pruritus, nausea and/or vomiting was recorded. Results: The need for rescue analgesia was higher in the R1.25 group compared with that in the other three groups (all P<0.05). The incidence of side effects was higher in the R1.5F group compared with that in the R1.25 and R1.5 groups (both P=0.010). Conclusion: The addition of 0.2 mcg/kg/h fentanyl to 1.5 mg/ml ropivacaine increased the incidence of side effects without improvement of analgesia in infants and children undergoing hypospadias repair. The use of plain 1.25 mg/ml ropivacaine increased the need for rescue analgesia and this could be compensated by addition of fentanyl. [source]

Nonsurgical factors in the success of hypospadias repair

BJU INTERNATIONAL, Issue 1 2005
Christopher R.J. Woodhouse
First page of article [source]

Tubularized incised-plate urethroplasty for proximal hypospadias

BJU INTERNATIONAL, Issue 1 2002
W.T. Snodgrass
Objective To report the experience of one surgeon using tubularized incised-plate (TIP) urethroplasty to repair proximal hypospadias in a consecutive series of boys. Patients and methods The records of 33 consecutive patients with midshaft to scrotal hypospadias undergoing TIP repair by one surgeon were reviewed. Dorsal plication was used as necessary for penile straightening, to preserve the urethral plate. Standard TIP urethroplasty was undertaken, and the follow-up included the selective use of neourethral calibration and urethroscopy. Results Plication was necessary in 18 (55%) patients. The incised plate had a supple appearance in all but two boys. The mean (range) follow-up was 9 (1,48) months and included calibration in 16 (48%) and urethroscopy in 13 (39%) patients. Complications were noted in 11 (33%) boys, of whom seven (21%) developed small fistulae. The two patients in whom the incised plate appeared unhealthy had dehiscence of the repair and contracture of the neourethra with recurrent penile curvature, respectively. There was one meatal stenosis and one short neourethral stricture. Conclusions TIP urethroplasty can be used to repair proximal hypospadias in the absence of severe penile curvature, and if the incised urethral plate has a supple appearance. As with distal hypospadias repair, the procedure creates a normal-appearing penis with a slit-like meatus. [source]