| Peer-Reviewed

Paediatric Redo Urethroplasty for Hypospadias: A Comparative Evaluation

Received: 5 February 2020     Accepted: 9 April 2020     Published: 7 September 2020
Views:       Downloads:
Abstract

Introduction: The burden of a failed hypospadias repair can be devastating for a patient and his family. Urethrocutaneous fistula after hypospadias surgery is the most common complication and remains a frustrating problem that precludes the goal of hypospadias surgery leading to failure of primary surgery. Aim of the Study: The aim of this study was to assess the outcome of pediatric salvage urethroplasty for hypospadias and to compare among three procedures. Material & Methods: It was an interventional study which was carried out from July 2011 to June, 2016 in the Department of Paediatric Surgery, Rajshahi Medical College Hospital, Rajshahi, Bangladesh. The study was designed with randomized control trial. Simple Random sampling technique was followed to select groups for each sample by means of lottery. BM GRAFT (Buccal Mucosal Graft) was grouped as group A, DORSAL FLAP (Dorsal transposition flap) was grouped as group B, FLIP FLAP (Distally based flip-flap) was grouped as group C. The primary outcome measure was the evaluation of the recurrence of fistula among the surgical procedures. For a valid comparison of the outcomes of traditional and innovative surgical procedures patients were evaluated by objective scoring system. Informed consent was obtained from parents in the consent form. Collected data was arranged in systemic manner, presented in various tables and figures and statistical analysis was made to evaluate the objectives of this study with the help of SPSS. Results: The age range of the studied patients were started from 2 to 13 years and was divided into three age groups such as 2-5 years, 6-9 years and 10-13 years. Out of total 189 patient’s BM graft consisted 61 patients, Dorsal flap comprised 69 patients and Flip flap patient consisted 59 patients. The distribution patterns of prior types of surgeries were presented, which showed that among the preceding primary procedures Tubularized incised plate urethroplasty (TIP) demonstrated highest frequency. The differences of re-fistula rate in primary surgery were significantly less in Buccal Mucosal Graft group (group A) in comparison to Distally based flip-flap group (group C) and Dorsal transposition flap group (group B), at p<0.05. It was observed that the fistula recurrence frequency of secondary surgery was higher than primary surgery among the three tested redo urethroplasty groups. Duncan multiple range test (DMRT) revealed that refistula was higher at the sub- coronal area than other locations in case of flip-flap (46.66%) and BM groups (42.85%). Conclusion: Staged repair using buccal mucosa was a better option for urethral reconstruction in large (>4mm) or multiple -small (<4mm) fistulae, than dorsal transposition flap and flip flap procedures (group A> group B >group C).

Published in Advances in Surgical Sciences (Volume 8, Issue 2)
DOI 10.11648/j.ass.20200802.13
Page(s) 27-33
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Hypospadias Surgery, Urethrocutaneous Fistula, Surgical Procedure, Buccal Mucosal Graft, Dorsal Transposition Flap, Distally Based Flip-Flap

References
[1] Barbagli, G., Perovic, S., Djinovic, R., Sansalone, S., Lazzeri, M. (2010) Retrospective descriptive analysis of 1,176 patients with failed hypospadias repair. Journal of Urology. 183 (1), pp. 207–211.
[2] Bhat, A., and Mandal, AK. (2008) Acute postoperative complications of hypospadias repair. Indian Journal of Urology. 24 (2), pp. 241–248.
[3] Shehata, SM., Elian, AA., Soliman SM., Hassan, HS. (2007) Re-Operative Repair of Mid Penile Hypospadias: Experience in 34 Cases. Annals of Pediatric Surgery. 3 (3), pp. 155-162.
[4] Secrest, CL., Jordan, GH., Winslow, BH., Horton, CE., McCraw, J., Gilbert, DA., Devine, CJ Jr. (1993) Repair of the complications of hypospadias surger. The Journal of Urology. 150 (5), pp. 1415-1418.
[5] Barbagli, G., Angelis, MD., Palminteri, E., Lazzeri, M. (2006) Reconstructive Urology -Failed Hypospadias Repair Presenting in Adults. European urology [online]. 49 (5), pp. 887–895. Available from: DOI: 10.1016/j.eururo.2006.01.027 [12 may 2014].
[6] Barbagl, i G., Palminteri, E., Guazzoni, G., Montors, i F., Turini, D., Lazzeri, M. (2005) Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: are results affected by the surgical technique? Journal of Urology [online]. 174 (3), pp. 955-958. Available from DOI: 10.1097/01.ju.0000169422.46721.d7 [20 October 2014].
[7] Zhang, X., Li, LC., Zhou, SW., Zhou, XC., Yang, WM. (1995) Experience with Repair of Hypospadias Using Bladder Mucosa in Adolescents and Adults. The Journal of Urology [online]. 153 (4), pp. 1117-1119. Available from. https://doi.org/10.1016/S0022-5347(01)67526-8 [Accessed 1st March 2016].
[8] Springer, A. (2014) Assessment of Outcome in Hypospadias Surgery – A Review. Frontiers in Pediatrics [online]. 2 (2), pp. 2-19. Available from DOI: 10.3389/fped.2014.00002. [20 ‎May ‎‎2016].
[9] Shahid, SMA., Nowshad, MA., Mostaque, A., Islam, SS. (2010) Outcome of urethral reconstruction in destile penile hypospadias by Tubularized Incised Plate urethroplasty: as a versatile technique. The Journal of Teachers Association, RMC, Rajshahi. 23 (1), pp. 26-32.
[10] Shahid, SMA., Mostafiz, R. (2011) Tubularized Incised Plate hypospadias repair: a multicenter experience. KhazaYunus Ali Medical College Journal. 1 (2), pp. 65-67.
[11] Yassin, T., Bahaaeldin, KH., Husein, A., Minawi, HE. (2011) Assessment and management of urethrocutaneous fistula developing after hypospadias repair. Annals of Pediatric Surgery [online]. 7 (2), pp.88–93. Availaible from DOI: 10.1097/01.XPS.0000397066.98404.82 [24 April ‎‎2017].
[12] Dubey, D., Vijjan, V., Kapoor, R., Srivastava, A., Mandhani, A., Anant Kumar, A., Ansari, MS. (2007) Dorsal Onlay Buccal Mucosa Versus Penile Skin Flap Urethroplasty for Anterior Urethral Strictures: Results From a Randomized Prospective Trial. The Journal of Urology. 178, pp. 2466-2469, Available from DOI: 10.1016/j.juro.2007.08.010 [28 November ‎2011].
[13] Retik AB., Keating, M., Mandell J. (1988) Complications of Hypospadias repair. The Urologic Clinics of North America. 15 (2), pp. 223-36.
[14] American Academy of Pediatrics, (1996) Timing of Elective Surgery on the Genitalia of Male Children with Particular reference to the risks, benefits, and psychological effects of Surgery and Anesthesia. Pediatrics [online]. 97 (4), pp. 590-595. Available from: http://pediatrics.aappublications.org/content/97/4/590 [Accessed 20 ‎May ‎‎2017].
[15] Castagnetti, M., El-Ghoneimi, A. (2010) Surgical management of primary severe hypospadias in children: systematic 20-year review. Journal Urology [online]. 184 (4), pp. 1469–1474. Available from DOI: 10.1038/nrurol.2013.164 [20 March ‎ ‎2015].
[16] Jones, BC., O’Brien, M., Chase, J., Southwell, BR., Hutson, JM. (2009) Early Hypospadias Surgery May Lead to a Better Long-Term Psychosexual Outcome. The Journal of Urology [online].182, pp. 1744-1750. Available from DOI: 10.1016/j.juro.2009.02.089 [20 December 2015].
[17] Weber, DM., Schonbucher, VB., Gobet, R., Gerber, A., Landolt, MA. (2009) Is there an ideal age for hypospadias repair? A pilot study. Journal of Pediatric Urology [online]. 5, pp. 345-350. Available from: DOI: 10.1016 /j.jpurol. 2008.12.008 [11 ‎May ‎‎2014].
[18] Barbagli, G., Sansalone, S., Djinovic, R., Lazzeri, M. (2012) Surgical Repair of Late Complications in Patients Having Undergone Primary Hypospadias Repair during Childhood: A New Perspective. Advances in Urology [online]. Volume no [n.k.], (Article ID 705212), p. 5. Available from DOI: 10.1155/2012/705212 [24 March 2017].
[19] Kessler, TM., Schreiter, FM., Kralidis, G., Heitz, M., Olianas, R., Fisch, M. (2003) Long-term results of surgery for urethral stricture: a statistical analysis. The Journal of Urology. 170 (3), p. 840-844.
[20] Elsaket, H., Habib, EM. (2009) Systematic Approach for the Management of Urethrocutaneous Fistulae after Hypospadias Repair. Egyptian journal of Plastic. Reconstrive Surgery. 33 (2), pp. 285-290.
[21] Karabulut, A., Sunay, M., Erdem, K., Emir, L., Erol, D. (2008) Retrospective analysis of the results obtained by using Mathieu and TIP urethroplasty techniques in recurrent hypospadias repairs. Journal of Pediatric Urology [online]. 4 (5), pp. 359–363. Available from: https://doi.org/10.1016/j.jpurol.2008.02.007 [21 December 2015].
[22] VanderWerff, JFA. (1999) Operative Strategies in Hypospadias –to divert or not to divert. In: The assessment of hypospadias. Rotterdam: Erasmus University Press, pp. 55-62.
[23] Shapiro, SR. (1999) Fistula Repair. In: Ehrlich, RM., Alter, GJ. (eds.) Reconstructive and Plastic Surgery of the External Genitalia; Adult and Pediatric. Philadelphia: WB Saunders Company, pp. 132-136.
[24] Redman, JF. (1993) Results of undiverted simple closure of 51 urethrocutaneous fistulas in boys. Urology [online]. 41 (4), pp. 369-371. Available from: https://doi.org/10.1016/0090-4295(93)90599-6 [Accessed19 May 2014].
[25] Eardley, I., Whitaker, RH. (1992) Surgery for Hypospadias Fistula. British Journal of Urology International [online]. 69 (3), pp. 306–310. Available from DOI: 10.1111/j.1464-410X.1992.tb15534.x [12 April 2014].
[26] Latifoglu, O., Yavuzer, R., Unal, S., Cavuşoğlu, T., Atabay, K. (2000) Surgical treatment of urethral fistulas following hypospadias repair. Annals of Plastic Surgery. 44 (4), pp. 381-386.
[27] Holland, AJA., Smith, GHH., Ross, FI., Cass, DT. (2001). HOSE; an objective scoring system for evaluating the results of hypospadias surgery. British Journal of Urology international. 88, pp. 255-258.
Cite This Article
  • APA Style

    Shah Md. Ahsan Shahid, Md. Nawshad Ali, Khondokar Seheli Nasrin Lina, Md. Kamruzzaman, Md. Humayun Reza. (2020). Paediatric Redo Urethroplasty for Hypospadias: A Comparative Evaluation. Advances in Surgical Sciences, 8(2), 27-33. https://doi.org/10.11648/j.ass.20200802.13

    Copy | Download

    ACS Style

    Shah Md. Ahsan Shahid; Md. Nawshad Ali; Khondokar Seheli Nasrin Lina; Md. Kamruzzaman; Md. Humayun Reza. Paediatric Redo Urethroplasty for Hypospadias: A Comparative Evaluation. Adv. Surg. Sci. 2020, 8(2), 27-33. doi: 10.11648/j.ass.20200802.13

    Copy | Download

    AMA Style

    Shah Md. Ahsan Shahid, Md. Nawshad Ali, Khondokar Seheli Nasrin Lina, Md. Kamruzzaman, Md. Humayun Reza. Paediatric Redo Urethroplasty for Hypospadias: A Comparative Evaluation. Adv Surg Sci. 2020;8(2):27-33. doi: 10.11648/j.ass.20200802.13

    Copy | Download

  • @article{10.11648/j.ass.20200802.13,
      author = {Shah Md. Ahsan Shahid and Md. Nawshad Ali and Khondokar Seheli Nasrin Lina and Md. Kamruzzaman and Md. Humayun Reza},
      title = {Paediatric Redo Urethroplasty for Hypospadias: A Comparative Evaluation},
      journal = {Advances in Surgical Sciences},
      volume = {8},
      number = {2},
      pages = {27-33},
      doi = {10.11648/j.ass.20200802.13},
      url = {https://doi.org/10.11648/j.ass.20200802.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ass.20200802.13},
      abstract = {Introduction: The burden of a failed hypospadias repair can be devastating for a patient and his family. Urethrocutaneous fistula after hypospadias surgery is the most common complication and remains a frustrating problem that precludes the goal of hypospadias surgery leading to failure of primary surgery. Aim of the Study: The aim of this study was to assess the outcome of pediatric salvage urethroplasty for hypospadias and to compare among three procedures. Material & Methods: It was an interventional study which was carried out from July 2011 to June, 2016 in the Department of Paediatric Surgery, Rajshahi Medical College Hospital, Rajshahi, Bangladesh. The study was designed with randomized control trial. Simple Random sampling technique was followed to select groups for each sample by means of lottery. BM GRAFT (Buccal Mucosal Graft) was grouped as group A, DORSAL FLAP (Dorsal transposition flap) was grouped as group B, FLIP FLAP (Distally based flip-flap) was grouped as group C. The primary outcome measure was the evaluation of the recurrence of fistula among the surgical procedures. For a valid comparison of the outcomes of traditional and innovative surgical procedures patients were evaluated by objective scoring system. Informed consent was obtained from parents in the consent form. Collected data was arranged in systemic manner, presented in various tables and figures and statistical analysis was made to evaluate the objectives of this study with the help of SPSS. Results: The age range of the studied patients were started from 2 to 13 years and was divided into three age groups such as 2-5 years, 6-9 years and 10-13 years. Out of total 189 patient’s BM graft consisted 61 patients, Dorsal flap comprised 69 patients and Flip flap patient consisted 59 patients. The distribution patterns of prior types of surgeries were presented, which showed that among the preceding primary procedures Tubularized incised plate urethroplasty (TIP) demonstrated highest frequency. The differences of re-fistula rate in primary surgery were significantly less in Buccal Mucosal Graft group (group A) in comparison to Distally based flip-flap group (group C) and Dorsal transposition flap group (group B), at p4mm) or multiple -small ( group B >group C).},
     year = {2020}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Paediatric Redo Urethroplasty for Hypospadias: A Comparative Evaluation
    AU  - Shah Md. Ahsan Shahid
    AU  - Md. Nawshad Ali
    AU  - Khondokar Seheli Nasrin Lina
    AU  - Md. Kamruzzaman
    AU  - Md. Humayun Reza
    Y1  - 2020/09/07
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ass.20200802.13
    DO  - 10.11648/j.ass.20200802.13
    T2  - Advances in Surgical Sciences
    JF  - Advances in Surgical Sciences
    JO  - Advances in Surgical Sciences
    SP  - 27
    EP  - 33
    PB  - Science Publishing Group
    SN  - 2376-6182
    UR  - https://doi.org/10.11648/j.ass.20200802.13
    AB  - Introduction: The burden of a failed hypospadias repair can be devastating for a patient and his family. Urethrocutaneous fistula after hypospadias surgery is the most common complication and remains a frustrating problem that precludes the goal of hypospadias surgery leading to failure of primary surgery. Aim of the Study: The aim of this study was to assess the outcome of pediatric salvage urethroplasty for hypospadias and to compare among three procedures. Material & Methods: It was an interventional study which was carried out from July 2011 to June, 2016 in the Department of Paediatric Surgery, Rajshahi Medical College Hospital, Rajshahi, Bangladesh. The study was designed with randomized control trial. Simple Random sampling technique was followed to select groups for each sample by means of lottery. BM GRAFT (Buccal Mucosal Graft) was grouped as group A, DORSAL FLAP (Dorsal transposition flap) was grouped as group B, FLIP FLAP (Distally based flip-flap) was grouped as group C. The primary outcome measure was the evaluation of the recurrence of fistula among the surgical procedures. For a valid comparison of the outcomes of traditional and innovative surgical procedures patients were evaluated by objective scoring system. Informed consent was obtained from parents in the consent form. Collected data was arranged in systemic manner, presented in various tables and figures and statistical analysis was made to evaluate the objectives of this study with the help of SPSS. Results: The age range of the studied patients were started from 2 to 13 years and was divided into three age groups such as 2-5 years, 6-9 years and 10-13 years. Out of total 189 patient’s BM graft consisted 61 patients, Dorsal flap comprised 69 patients and Flip flap patient consisted 59 patients. The distribution patterns of prior types of surgeries were presented, which showed that among the preceding primary procedures Tubularized incised plate urethroplasty (TIP) demonstrated highest frequency. The differences of re-fistula rate in primary surgery were significantly less in Buccal Mucosal Graft group (group A) in comparison to Distally based flip-flap group (group C) and Dorsal transposition flap group (group B), at p4mm) or multiple -small ( group B >group C).
    VL  - 8
    IS  - 2
    ER  - 

    Copy | Download

Author Information
  • Department of Pediatric Surgery, Rajshahi Medical College, Rajshahi, Bangladesh

  • Department of Pediatric Surgery, Rajshahi Medical College, Rajshahi, Bangladesh

  • Department of Gynaecology and Obstetrics, Rajshahi Medical College, Rajshahi, Bangladesh

  • Department of Surgery, 250 Bed District Sadar Hospital, Feni, Bangladesh

  • Department of Orthopaedic Surgery, Shaheed M. Monsur Ali Medical College, Sirajganj, Bangladesh

  • Sections