Use of the penis’s own tissue for urethral reconstruction in the treatment of complications developing following hypospadias repair

Year 2020, Volume: 37 Issue: 2, 41 - 45, 06.04.2020

Mahmut Ulubay

Abstract

The aim of the present study is to evaluate the results of the surgical technique applied in patients who have previously undergone several operations and who develop persistent distal hypospadias. A novel surgical technique was applied to 13 cases of persistent distal hypospadias presenting between November 2012 and January 2019. The mean age of these patients was 12.7 years (the youngest four and the oldest 21). In methodological terms, fistula formation was pre- vented by contracting the suture line inside the glans by means of sutures to an incision made between the glans apex and meatus. Thirteen patients underwent surgery, two of which involved complications developing in our clinic. The oth- er 11 had been referred to our clinic from other centers. The common feature of the complications was that they were at the distal hypospadias level. Two patients had undergone two operations, and 11 more than two. Following our therapeutic technique, complete dehiscence was achieved in one patient (7%), external meatal stenosis was present in one (7%), and preoperatively existing urethral stenosis persisted in two cases. Positive results can be achieved in suit- able cases of persistent distal hypospadias using the recommended technique.

Keywords

Hypospadias surgery, Dehiscence, Repair, Fistula, Stenosis

References

• Barbagli, G., Balò, S., Sansalone, S., Lazzeri, M., 2016. One-stage and two-stage penile buccal mucosa urethroplasty. Afr. J. Urol. 22, 11-17.
• Beuke, M., Fisch, M., 2007. Salvage strategies after complications of hypospadias repair. Urologe A. 46, 1670-1675.
• Borer, J.G, Retik, A.B. 2007, Hypospadias. In: Campbell-Walsh Urology. 9th edn, Saunders, Philadelphia, pp. 3703-3710.
• Brock, J.W., 1994. Autologous buccal mucosal graft for urethral reconstruction. J. Urol. 44, 753.
• Ducket, J.W., Coplen, D., Ewalt, D., 1995. Buccal mucosal urethral replacement. J. Urol. 153, 1660.
• Garat, M.J., Villavicencio, H., 1991. Posterior urethroplasty with tubularized bladder mucosal graft. J. Urol. 146, 1615.
• Hendren, W.H., Crooks, K.K., 1980. The bed free skin graft for construction of male urethra. J. Urol. 123, 858.
• Hübner, W., Rurka, I., Poıpaczy, P., 1991. Autologous everted yein graft for repairing long-section urethral defects. Urol. Res. 19, 131.
• Kinkead, T.M., Borzi, P.A., Duffy, P.G., Ransley, P.G., 1994. Long-term follow up of bladder mucosa graft for male urethral reconstruction. J. Urol. 151, 1056-1058.
• Li, L.C., Zhang, X., Zhou, S.W., Yang, W.M., Zhang, Y.S., 1995. Experience with repair of hypospadias using bladder mucosa in adolescents and adults. J. Urol. 153, 1117-1119.
• Mousavi, S.A., 2008. Use of tubularized incised plate urethroplasty for secondary hypospadias repair or repair in circumcised patients. Int. Braz. J. Urol. 34, 609-614.
• Mousavi, S.A., Aarabi, M., 2014. Tubularized incised plate urethroplasty for hypospadias reoperation: a review and meta-analysis. Int. Braz. J. Urol. 40, 588-595.
• Myers, J.B., McAninch, J.W., Erickson, B.A., Breyer, B.N., 2012. Treatment of adults with complications from previous hypospadias surgery. J. Urol. 188, 459-463.
• Olsen, L., Bowald, S., Busch, C., 1992. Urethral reconstruction with a new synthetic absorbable device. J. Urol. Neph. 26, 323.
• Romagnoli, G., De Luca, M., Faranda, F., 1990. Treatment of posterior hypospadias by the autologous graft of cultured urethral epithelium. New Eng. J. Med. 323, 527.
• Saleh, A.M., 2007. Tubularized incised plate urethroplasty (tip) after failed hypospadias repair. Ann. Pediatr. Surg. 3, 41-43.
• Snodgrass, W., 1994. Tubularized, incised plate urethroplasty for distal hypospadias. J. Urol. 151, 464-465.
• Snodgrass, W.T., Lorenzo, A., 2002. Tubularized incised-plate urethroplasty for hypospadias reoperation. BJU Int. 89, 98-100.