Duckett URETHROPLASTY-URETHROTOMY FOR STAGED HYPOSPADIAS REPAIR_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 TANGYunman , WANGXuejun , MAOYu , CHENShaoji , LIUMao , CHENYuejiao

Department of Pediatric Surgery of Children's Medical Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu Sichuan, 610072, P. R. China;

Corresponding author：

TANGYunman, Email: tangyunman@126.com

Keywords：

Hypospadias; Staged repair; Pedicle flap urethroplasty

DOI：

10.7507/1002-1892.20160120

Video：

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Objective To explore the surgical outcome of Duckett urethroplasty-urethrotomy for staged hypospadias repair. Methods Fifty-three patients with hypospadias were treated by 2 stages between August 2013 and September 2014. The age ranged from 10 months to 24 years and 3 months (median, 1 year and 10 months). There were 5 cases of proximal penile type, 2 cases of penoscrotal type, 36 cases of scrotal type, and 10 cases of perineal type. Urethroplasty was performed with tubed transverse preputial island flap only in 27 cases or combined with urethral plate in the other 26 cases, thus a urethrocutaneous fistula was intentionally created; stage II fistula repair was carried out at 1 year after stage I repair. Results The length of the new urethra ranged from 2 to 8 cm with an average of 3.6 cm. The patients were followed up 5-17 months with an average of 8 months after stage II repair. After stage I repair, urethral fistula was noted at other site in 3 cases, skin necrosis in 1 case, glandular stricture in 2 cases, cicatric curvature in 1 case, and position and morphology of urethral orifice not ideal in 4 cases. After stage II repair, urethral fistula was noted in 2 cases, mild urethral diverticulum in 2 cases, and stricture at temporary repair site in 1 case. HOSE score was 12-16 at 3 months after stage II repair (mean, 14.5). At 3-14 months after stage II repair, the maximum flow rate ranged from 3.9 to 22.7 mL/s with an average of 8.6 mL/s. Conclusion Duckett urethroplasty-urethrotomy can be used as staged repair for primary treatment of hypospadias because of high safety, low complication incidence, and satisfactory appearance.

Citation： TANGYunman, WANGXuejun, MAOYu, CHENShaoji, LIUMao, CHENYuejiao. Duckett URETHROPLASTY-URETHROTOMY FOR STAGED HYPOSPADIAS REPAIR. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(5): 594-598. doi: 10.7507/1002-1892.20160120 Copy

1.	Duckett JW Jr. Transverse preputial island flap technique for repair of severe hypospdias. Urol Clin North Am, 1980, 7(2):423-430.
2.	Snodgrass W. Tubularize, incised plate urethroplasty for distal hypospadias. J Urol, 1994, 151(2):464-465.
3.	Koyanagi T, Nonomura K, Yamashita T, et al. One-stage repair of hypospadias:is there no simple method universally applicable to all types of hypospadias? J Urol, 1994, 152(4):1232-1237.
4.	Pippi Salle JL, Sayed S, Salle A, et al. Proximal hypospadias:A persistent challenge. Single institution outcome analysis of three surgical techniques over a 10-year period. J Pediatr Urol, 2016, 12(1):28.e1-28.e7.
5.	Springer A, Krois W, Horcher E. Trends in hypospadias surgery:results of a worldwide survey. Eur Urol, 2011, 60(6):1184-1189.
6.	Springer A, Subramaniam R. Split dorsal dartos flap transposed ventrally as a bed for preputial skin graft in primary staged hypospadias repair. Urology, 2012, 79(4):939-942.
7.	唐耘熳, 陈绍基, 毛宇, 等. 尿道板重建卷管尿道成形术在复杂尿道下裂矫治中的应用. 中华小儿外科杂志, 2015, 36(3):182-186.
8.	陈嘉波, 徐浩伦, 杨体泉, 等. 分期Duckett尿道成形术的临床应用. 中华小儿外科杂志, 2015, 36(3):174-177.
9.	Zhao M, Li Y, Tang Y, et al. Two-stage repair with buccal mucosa for severe and complicated hypospadias in adults. Int J Urol, 2011, 18(2):155-161.
10.	Snodgrass W, Macedo A, Hoebeke P, et al. Hypospadias dilemmas:a round table. J Pediatr Urol, 2011, 7(2):145-157.
11.	Holland AJ, Smith GH, Ross FI, et al. HOSE:an objective scoring system for evaluating the results of hypospadias surgery. BJU Int, 2001, 88(3):255-258.
12.	Donnahoo KK, Cain MP, Pope JC, et al. Etiology, management and surgical complications of congenital chordee without hypospadias. J Urol, 1998, 160(3 Pt 2):1120-1122.
13.	Tang YM, Chen SJ, Huang LG, et al. Chordee without hypospadias:report of 79 Chinese prepubertal patients. J Andorl, 2007, 28(4):630-633.
14.	Radojicic ZI, Perovic SV. Classification of prepuce in hypodpadias according to morphological abnormalities and their impact on hypospadias repair. J Urol, 2004, 172(1):301-304.
15.	Yucel S, Guntekin E, Kukul E, et al. Comparison of hypospadiac and normal preputial vascular anatomy. J Urol, 2004, 172(5 Pt 1):1973-1976.
16.	Manzoni G, Bracka A, Palminteri E, et al. Hypospadias surgery:when, what and by whom. BJU Int, 2004, 94(8):1188-1195.
17.	Price RD, Lambe GF, Jones RP. Two-stage hypospadias repair:audit in a district general hospital. Br J Plast Surg, 2003, 56(8):752-758.
18.	唐耘熳. 尿道下裂分期手术矫治. 现代泌尿外科杂志, 2012, 17(2):115-117.

1. Duckett JW Jr. Transverse preputial island flap technique for repair of severe hypospdias. Urol Clin North Am, 1980, 7(2):423-430.
2. Snodgrass W. Tubularize, incised plate urethroplasty for distal hypospadias. J Urol, 1994, 151(2):464-465.
3. Koyanagi T, Nonomura K, Yamashita T, et al. One-stage repair of hypospadias:is there no simple method universally applicable to all types of hypospadias? J Urol, 1994, 152(4):1232-1237.
4. Pippi Salle JL, Sayed S, Salle A, et al. Proximal hypospadias:A persistent challenge. Single institution outcome analysis of three surgical techniques over a 10-year period. J Pediatr Urol, 2016, 12(1):28.e1-28.e7.
5. Springer A, Krois W, Horcher E. Trends in hypospadias surgery:results of a worldwide survey. Eur Urol, 2011, 60(6):1184-1189.
6. Springer A, Subramaniam R. Split dorsal dartos flap transposed ventrally as a bed for preputial skin graft in primary staged hypospadias repair. Urology, 2012, 79(4):939-942.
7. 唐耘熳, 陈绍基, 毛宇, 等. 尿道板重建卷管尿道成形术在复杂尿道下裂矫治中的应用. 中华小儿外科杂志, 2015, 36(3):182-186.
8. 陈嘉波, 徐浩伦, 杨体泉, 等. 分期Duckett尿道成形术的临床应用. 中华小儿外科杂志, 2015, 36(3):174-177.
9. Zhao M, Li Y, Tang Y, et al. Two-stage repair with buccal mucosa for severe and complicated hypospadias in adults. Int J Urol, 2011, 18(2):155-161.
10. Snodgrass W, Macedo A, Hoebeke P, et al. Hypospadias dilemmas:a round table. J Pediatr Urol, 2011, 7(2):145-157.
11. Holland AJ, Smith GH, Ross FI, et al. HOSE:an objective scoring system for evaluating the results of hypospadias surgery. BJU Int, 2001, 88(3):255-258.
12. Donnahoo KK, Cain MP, Pope JC, et al. Etiology, management and surgical complications of congenital chordee without hypospadias. J Urol, 1998, 160(3 Pt 2):1120-1122.
13. Tang YM, Chen SJ, Huang LG, et al. Chordee without hypospadias:report of 79 Chinese prepubertal patients. J Andorl, 2007, 28(4):630-633.
14. Radojicic ZI, Perovic SV. Classification of prepuce in hypodpadias according to morphological abnormalities and their impact on hypospadias repair. J Urol, 2004, 172(1):301-304.
15. Yucel S, Guntekin E, Kukul E, et al. Comparison of hypospadiac and normal preputial vascular anatomy. J Urol, 2004, 172(5 Pt 1):1973-1976.
16. Manzoni G, Bracka A, Palminteri E, et al. Hypospadias surgery:when, what and by whom. BJU Int, 2004, 94(8):1188-1195.
17. Price RD, Lambe GF, Jones RP. Two-stage hypospadias repair:audit in a district general hospital. Br J Plast Surg, 2003, 56(8):752-758.
18. 唐耘熳. 尿道下裂分期手术矫治. 现代泌尿外科杂志, 2012, 17(2):115-117.

Chinese Journal of Reparative and Reconstructive Surgery

Duckett URETHROPLASTY-URETHROTOMY FOR STAGED HYPOSPADIAS REPAIR

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