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Comparison of post-urethroplasty complication rates in pediatric cases with Hypospadias using Vicryl or polydioxanone sutures

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Asian Journal of Urology 2022年第2期9卷 165-169页

作者： Mehdi Shirazi Abdolreza Haghpanah Anahita Dehghani Sezaneh Haghpanah Mehdi Ghahartars Mahdi Rahmanian Shiraz Nephro-urology Research Center Shiraz University of Medical SciencesShirazIran Hematology Research Center Shiraz University of Medical SciencesShirazIran Molecular Dermatology Research Center Shiraz University of Medical SciencesShirazIran Medical School MPH DepartmentShiraz University of Medical SciencesShirazIran

Objective:Hypospadias is a common congenital problem among male newborns.Both rapid absorbable sutures(polyglactin,Vicryl)and delayed absorbable sutures(polydioxanone,PDO)are used in Hypospadias repair based on the surgeon's preference.This study was conducted to compare post-urethroplasty complication rates in pediatric patients with Hypospadias using Vicryl or PDO sutures.Methods:This is a retrospective study which was designed and performed on 583 children aged 1-7 years old who had undergone Hypospadias repair from January 2012 to December 2018.Required data were obtained from the patients'medical records.Results:Overall,post-surgical complications were observed in 60(10.3%)patients comprising urethro-cutaneous fistula(n=39,6.7%),meatal stenosis(n=10,1.7%),urethral stricture(n=7,1.2%),and glans dehiscence(n=4,0.7%).The mean age of the children with complications was 3.0±1.3 years.According to Kaplan-Meier estimate,the interval between surgery and development of complications was significantly shorter in the Vicryl group(p=0.037).Overall,complications were more prevalent in Vicryl suture than PDO suture(15.1%vs.5.3%,pHypospadias(odds ratio[OR]:103.9,95%confidence interval[CI]:32.2-334.9,pHypospadias(OR:82.9,95%CI:25.9-264.6,pHypospadias due to its lower complication rate,especially in cases of proximal and mid-shaft Hypospadias which can get more complicated than the distal type.

关键词： Hypospadias Urinary fistula Polyglactin Polydioxanone

A novel onlay urethroplasty for Hypospadias with mild chordee after degloving:modified for complete removal of scar tissue underlying the urethral plate and for long-term outcomes

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Asian Journal of Andrology 2022年第6期24卷 639-642页

作者： Li-Qu Huang Zheng Ge Li-Xia Wang Xiao-Yu Li Yong-Ji Deng Yun-Fei Guo Geng Ma Department of Urology Children's Hospital of Nanjing Medical UniversityJiangsu Provincial Children's Medical CenterNanjing 210008China

Urethral plate(UP)-preserving urethroplasty is simple and has few complications,but it may affect the development of penis in the long term and lead to recurrent chordee.In this study,we used obliquely cut UP to repair Hypospadias with mild chordee after degloving(15°-30°)and compared the results with onlay urethroplasty to explore its rationality and feasibility.Between April 2018 and October 2020,108 Hypospadias patients underwent onlay urethroplasty or modified onlay urethroplasty.Clinical data were prospectively collected,and medium-term outcomes were assessed at follow-up.The complications were compared between the two groups.Forty-four patients underwent the modified onlay procedure(GroupⅠ),with follow-up time(mean±standard deviation[s.d.])of 23.2±4.5(range:17-31)months.Sixty-four patients underwent a standard onlay procedure(GroupⅡ),with follow-up time(mean±s.d.)of 39.7±3.9(range:32-46)months.There was no difference in age at surgery.The urethral defect length and operative time were longer in GroupⅠ.Six cases of fistula and one case each of stricture and diverticulum were reported in GroupⅠ.In GroupⅡ,11 cases of fistula and one case each of stricture and diverticulum were reported.The complication rates were 18.2%and 20.3%in GroupⅠand GroupⅡ,respectively(P>0.05).These medium-term follow-up results demonstrate that the modified onlay procedure(oblique cut UP urethroplasty)is a safe and feasible technique for Hypospadias with mild chordee after degloving.Compared with standard onlay urethroplasty,this modified procedure is conducive to the complete removal of scar tissue underlying the UP without increasing the risk of surgical complications.

关键词： complications Hypospadias penile curvature urethral plate

Spongiosum-combined glanuloplasty reduces glans complications after proximal Hypospadias repair

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Asian Journal of Andrology 2021年第5期23卷 532-536页

作者： Yi-Qing Lyu Lin Yu Hua Xie Yi-Chen Huang Xiao-Xi Li Li Sun Yan Liang Fang Chen Department of Urology Shanghai Children's HospitalShanghai Jiao Tong UniversityShanghai 200040China

We aim to design a new glanuloplasty procedure combined with spongiosum to reduce the incidence of glans dehiscence and coronal fistula after proximal Hypospadias repair.Patients who underwent urethroplasty by dorsal preputial island flap for proximal Hypospadias between January 2014 and December 2016 were reviewed in this retrospective cohort study.Those who underwent spongiosum-combined glanuloplasty comprised the new-maneuver group,whereas those who underwent conventional glanuloplasty comprised the control group.The incidence of complications was then compared.In the new-maneuver group,dysplastic corpus spongiosum alongside lateral Buck's fascia(0.3-0.4 cm wide)on both sides of the urethral plate was separated from the proximal normal spongy tissue,joining into the glans wings to increase tissue volume and covering the neourethra in the glans penis.In the control group,the neourethra was covered with superficial fascia under the coronal sulcus.As a result,the new-maneuver and control groups comprised 47 and 28 patients,respectively.In the new-maneuver group,no glans dehiscence was detected;however,two(4.3%)patients had coronal fistula,two(4.3%)had urethral stricture,and four(8.5%)had diverticulum.In the control group,two(7.1%)patients had glans dehiscence,eight(28.6%)had coronal fistula,four(14.3%)had urethral stricture,one(3.6%)had diverticulum,and one(3.6%)had penile curvature recurrence.The new-maneuver group had less incidences of coronal fistula(P<0.001),glans dehiscence(P=0.033),and urethral stricture(P=0.008)but had a higher incidence of diverticulum than the control group(P=0.040).It clearly demonstrates that spongiosum-combined glanuloplasty can significantly reduce the incidences of coronal fistula and glans dehisce.

关键词： glans dehiscence glanuloplasty Hypospadias urinary fistula

Analysis of the social and clinical factors affecting the age of children when receiving surgery for Hypospadias:a retrospective study of 1611 cases in a single center

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Asian Journal of Andrology 2021年第5期23卷 527-531页

作者： Zhi-Cheng Zhang Xing Liu Hong-Song Chen Yan Shi Tao Lin Da-Wei He Guang-Hui Wei Ye-Tao Luo Department of Urology Chongqing Medical University Affiliated Children's HospitalChongqing 400010China Ministry of Education Key Laboratory of Child Development and Disorders Chongqing 400010China National Clinical Research Center for Child Health and Disorders Chongqing 400010China China International Science and Technology Cooperation Base of Child Development and Critical Disorders Chongqing 400010China Children's Hospital of Chongqing Medical University Chongqing 400010China Chongqing Key Laboratory of Pediatrics Chongqing 400010China

We aimed to explore the associations between the age at which children undergo surgery for Hypospadias and a range of social and clinical factors in a single center.Our aim was to promote the early surgical treatment of children with Hypospadias.For a 6-year period,social and clinical data were collected from all children undergoing surgery to repair Hypospadias in Children’s Hospital of Chongqing Medical University(Chongqing,China),located in southwest of China.We analyzed the correlations between age at surgery and a range of social and clinical factors.A total of 1611 eligible cases were recruited,with a mean age of 54.3 months and a median age of 42 months:234 cases(14.5%)were classified into a“timely operation”group,419(26.0%)cases into a“subtimely operation”group,and 958(59.5%)cases into a“delayed operation”group.According to multivariate regression analyses,the higher the regional economic level,the closer the urethral opening to the perineum,and the higher the educational level of the guardians was,the younger the children were when they underwent the initial surgery for Hypospadias;this was also the case for families without other children.Our subgroup analysis showed that the primary educational level of the guardians was a risk factor for subtimely surgery in their children(odds ratio[OR]=1.52,95%confidence interval[CI]:1.08-2.15,PHypospadias]=2.07,95%CI:1.42-3.03;0R_(2)[vs posterior Hypospadias]=2.63,95%CI:1.75-3.95;P<0.01)were all risk factors for delayed surgery in children.

关键词： age children Hypospadias surgery

Complications of proximal Hypospadias repair with transverse preputial island flap urethroplasty: a 15-year experience with long-term follow-up

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Asian Journal of Andrology 2019年第3期21卷 300-303页

作者： Chao-Xu Wang Wei-Ping Zhang Hong-Cheng Song Department of Urology Beijing Children's Hospital Affiliated to Capital Medical University Beijing 100045 China

There is still debate regarding the optimal surgical approach for proximal Hypospadias. This retrospective study aims to evaluate the long-term outcomes using transverse preputial island flap urethroplasty. A total of 320 patients were included, with a mean follow-up of 40.2 months (range: 1–156 months). Complications were encountered in 125 patients (39.1%), including fistulas in 53 (16.6%), urethral strictures in 31 (9.7%), and diverticula in 41 (12.8%). The mean timing of presentation with a complication was 15.8 months (median: 1.7, range: 1–145), of which 79.2% were early complications and 20.8% were late complications. In all, 20.8% of the patients with complications presented after ≥1 year, and 12.8% presented after ≥5 years. Univariate analysis revealed that age at the time of surgery, flap length, and location of the urethral meatus were not correlated with complications. A stricture was present in 31.7%(13/41) of those with diverticula (P Hypospadias are diagnosed within 1 year postoperatively, while fistulas and urinary strictures generally occur within 2 months and diverticula tend to be present by 1 year.

关键词： diverticulum fistula follow-up Hypospadias late complications urethral stricture

Timing of pubertal development in boys born with cryptorchidism and Hypospadias:a nation wide cohort study

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Asian Journal of Andrology 2019年第6期21卷 551-556页

作者： Linn Hakonsen Arendt Andreas Ernst Lea Lykke Braskhoj Lauridsen Nis Brix Jorn Olsen Cecilia Host Ramlau-Hansen Department of Public Health Section for EpidemiologyAarhus UniversityAarhus 8000Denmark Perinatal Epidemiology Research Unit Department of Paediatric and Adolesce nt Medici neAarhus Un iversity HospitalAarhus 8000Den mark Department of Clin ical Epidemiology Aarhus University HospitalAarhus 8000Denmark.

Pubertal development may be altered in boys with cryptorchidism and Hypospadias,but existing kno wledge is inc on siste nt.Therefore,we investigated the association between cryptorchidism and Hypospadias and pubertal development in a large cohort study.Boys in the Puberty Cohort,a cohort nested within the Danish National Birth Cohort,were in eluded in this study.Information on cryptorchidism and Hypospadias was retrieved from the Danish National Patient Register.From 11 years until 18 years or full pubertal developme nt,info rmatio n on physical markers of pubertal developme nt was provided biannu ally,in eluding Tanner stages,axillary hair,acne,voice break,and first ejaculation.In multivariate regression models for interval censored data,the mean(95%confidence intervals[Cis])d iff ere nces in months in obtaining the pubertal markers between boys with and without the anomalies were estimated.Among 7698 boys,196(2.5%)had cryptorchidism and 60(0.8%)had Hypospadias.Boys with Hypospadias experienced first ejaculation and voice break 7.7(95%Cl:2.5-13.0)months and 4.5(95%Cl:0.3-8.7)months later than boys without Hypospadias?The age at attaining the Tanner stages for gonadal and pubic hair growth was also higher,though not statistically significant.Pubertal development seemed unaffected in boys with mild as well as severe cryptorchidism?In conclusion,Hypospadias may be associated with delayed pubertal development,but pubertal development seems unaffected by cryptorchidism.The relation between Hypospadias and later pubertal development may be due to the underlying shared in utero risk or genetic factors.

关键词： congenital abnormalities cryptorchidism Hypospadias prenatal exposure delayed effects puberty Tanner stages

One-stage dorsal lingual mucosal graft urethroplasty for the treatment of failed Hypospadias repair

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Asian Journal of Andrology 2016年第3期18卷 467-470,I0011页

作者： Hong-Bin Li Yue-Min Xu Qiang Fu Ying-Long Sa Jiong Zhang Hong Xie Department of Urology Shanghai Jiao Tong University Affiliated Sixth People's Hospital and Shanghai Eastern Institute for Urologic Repair and Reconstruction ShanghaiChina.

The aim of this study was to retrospectively investigate the outcomes of patients who underwent one-stage onlay or inlay urethroplasty using a lingual mucosal graft （LMG） after failed Hypospadias repairs. Inclusion criteria included a history of failed Hypospadias repair, insufficiency of the local skin that made a reoperation with skin flaps difficult, and necessity of an oral mucosal graft urethroplasty. Patients were excluded if they had undergone a failed Hypospadias repair using the foreskin or a multistage repair urethroplasty. Between January 2008 and December 2012, 110 patients with failed Hypospadias repairs were treated in our center. Of these patients, 56 underwent a one-stage onlay or inlay urethroplasty using LMG. The median age was 21.8 years （range： 4-45 years）. Of the 56 patients, one-stage onlay LMG urethroplasty was performed in 42 patients （group 1）, and a modified Snodgrass technique using one-stage inlay LMG urethroplasty was performed in 14 （group 2）. The median LMG urethroplasty length was 5.6 ± 1.6 cm （range： 4-13 cm）. The mean follow-up was 34.7 months （range： 10-58 months）, and complications developed in 12 of 56 patients （21.4%）, including urethrocutaneous fistulas in 7 （6 in group 1, 1 in group 2） and neourethral strictures in 5 （4 in group 1, 1 in group 2）. The total success rate was 78.6%. Our survey suggests that one-stage onlay or inlay urethroplasty with LMG may be an effective option to treat the patients with less available skin after failed Hypospadias repairs; LMG harvesting is easy and safe, irrespective of the patient＇s age.

关键词： failed repair Hypospadias lingual mucosa graft urethroplasty

Association between diacylglycerol kinase kappa variants and Hypospadias susceptibility in a Han Chinese population

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Asian Journal of Andrology 2018年第1期20卷 85-89页

作者： Hua Xie Xiao-Ling Lin Song Zhang Ling Yu Xiao-Xi Li Yi-Chen Huang Yi-Qing Lyu Hai-Tao Chen Jianfeng Xu Fang Chen Department of Urology Shanghai Children's Hospital Shanghai Jiao Tong University Shanghai 200062 China Fudan Institute of Urology Huashan Hospital Fudan University Shanghai 200040 China State Key Laboratory of Genetic Engineering School of Life Sciences Fudan University Shanghai 200433 China Center for Genomic Translational Medicine and Prevention School of Public Health Fudan University Shanghai 200433 China Program for Personalized Cancer Care NorthShore University HealthSystem Evanston IL 60201 USA

Previous genome-wide association studies have identified variants in the diacylglycerol kinase kappa （DGKtO gene associated with Hypospadias in populations of European descent. However, no variants of DGKKwere confirmed to be associated with Hypospadias in a recent Han Chinese study population, likely due to the limited number of single-nucleotide polymorphisms （SNPs） included in the analysis. In this study, we aimed to address the inconsistent results and evaluate the association between DGKK and Hypospadias in the Han Chinese population through a more comprehensive analysis of DGKK variants. We conducted association analyses for 17 SNPs in or downstream of DGKKwith Hypospadias among 322 cases （58 mild, 113 moderate, 128 severe, and 23 unknown） and 1008 controls. Five SNPs （rs2211122, rs4554617, rs7058226, rs7063116, and rs5915254） in DGKK were significantly associated with Hypospadias （P 〈 0.05）, with odds ratios （ORs） of 1.64-1.76. When only mild and moderate cases were compared to controls, 10 SNPs in DGKKwere significant （P〈 0.05）, with ORs of 1.56-2.13. No significant SNP was observed when only severe cases were compared to controls. This study successfully implicated DGKK variants in Hypospadias risk among a Han Chinese population, especially for mild/moderate cases. Severe forms of hyposDadias are likely due to other genetic factors.

关键词： association study diacylglycerol kinase kappa Hypospadias polymorphisms

Genotype-phenotype correlations,surgical selections,and postoperative complications of 5α-reductase 2 deficiency in 69 children with Hypospadias

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Asian Journal of Andrology 2023年第6期25卷 731-736页

作者： Xu Wen Li-Jun Fan Wei-Ping Zhang Xin Ni Chun-Xiu Gong Department of Urology Beijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijing 100045China Department of Endocrinology GeneticsMetabolismBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijing 100045China Beijing Key Laboratory for Genetics of Birth Defects MetabolismBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijing 100045China Department of Otolaryngology Head and Neck Surgery Beijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijing 100045China

5α-reductase 2 deficiency prevents testosterone from being converted to dihydrotestosterone,which causes abnormal urogenital sinus development.The aim of this study was to analyze the relationship between genotype–phenotype,surgical selections,and postoperative complications of 5α-reductase 2-deficient patients with Hypospadias.We retrospectively evaluated the medical records of patients who were diagnosed with 5α-reductase 2 deficiency after genetic testing in the Department of Endocrinology and underwent initial Hypospadias surgery in the Department of Urology in Beijing Children’s Hospital,Capital Medical University(Beijing,China),from April 2007 to December 2021.A total of 69 patients were included in this study;the mean age at surgery was 34.1 months,and the average follow-up time was 54.1 months.Sixty children were treated with preoperative hormone stimulation(PHS)to promote penile growth.The average penis length and glans width were increased by 1.46 cm and 0.62 cm,respectively.The most frequent mutations were p.R227Q(39.1%,54/138),p.Q6^(*)(15.2%,21/138),p.G203S(12.3%,17/138),and p.R246Q(11.6%,16/138).In 64 patients who were followed up,43 had a one-stage operation and 21 had a staged operation,and there were significant differences in external masculinization score(EMS)(P=0.008)and the average number of operation required to cure(PHypospadias.One-stage surgery can be selected if conditions permit.The growth and development of children are acceptable in the long term,but penis growth remains unsatisfactory.Longterm complications of Hypospadias should be considered during puberty.

关键词： 5α-reductase 2 deficiency disorders of sex development Hypospadias