Two-stage repair of proximal hypospadias with moderate to severe chordee using inner preputial skin graft: prospective e
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ORIGINAL ARTICLE
Two‑stage repair of proximal hypospadias with moderate to severe chordee using inner preputial skin graft: prospective evaluation of functional and cosmetic outcomes Ahmed M. Al‑Adl1 · Ashraf M. Abdel Aal1 · Tarek M. El‑Karamany1 · Yasser A. Noureldin1 Received: 21 July 2019 / Accepted: 2 January 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective To critically evaluate inner preputial graft (IPG) used in staged proximal hypospadias with severe chordee regarding cosmetic and functional outcomes. Patients and methods In this prospective study, patients with primary proximal hypospadias with moderate to severe chordee (> 30°) after penile degloving were considered candidates for staged repair between June 2011 to July 2017. After transection of the urethral plate (UP) and penile straightening, the bare shaft was covered with IPG. Tubularization of the graft was done as a second stage. Cosmetic and functional outcomes were assessed using HOSE score and uroflowmetry (UF). Additionally, factors influencing success were analyzed. Results In all, 38 consecutive cases were included. Native meatus was at proximal penile in 17, penoscrotal in 11, scrotal in 7, and perineal in 3 cases. Median age was 26 and 32 months at the first stage and the second stage, respectively. Preoperative testosterone was given for ten patients with a small penis and/or severe curvature. The mean follow-up was 18 ± 8.2, median 15 months. Grafts took well in all cases after the first stage except one. Cosmetic success achieved in 33 (86.8%). A total of ten complications occurred in six cases. Unplanned intervention was needed in 5/38 cases. Functionally, UF study revealed normal flow in 7/23 (30.4%), equivocal in 11/23(47.8%), and obstructed flow in 5/23(21.7%). Conclusion Inner preputial graft use in proximal hypospadias with moderate to severe chordee seems to have a good technical outcome and functionally mimic the normal urethral function and could be considered an ideal option for substitution urethroplasty. Keywords Hypospadias · Proximal · Severe chordee · Graft · Outcome
Introduction Proximal hypospadias with chordee typically requires multiple reconstructive surgeries that constitute a challenging issue especially when the urethral plate (UP) needs to be excised [1]. In cases with severe penile curvature, a small glans, and ventral scarring, the two-stage repair was considered a versatile technique representing an unswerving Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-020-03075-5) contains supplementary material, which is available to authorized users. * Ahmed M. Al‑Adl [email protected] 1
Department of Urology, Faculty of Medicine, Benha University, Farid Nada St., Benha 13512, Qalubeya, Egypt
solution when a full circumference urethroplasty is required or when the UP is of dubious quality that is preferred by most surgeons for correction of proximal hypospadias [2–4]. In this prospective study, we critica
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