Short-term effectiveness of hypospadias repair with free inner prepuce tube_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; Urethroplasty; Free skin graft

DOI：

10.7507/1002-1892.20160176

Video：

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Objective To explore the short-term effectiveness of hypospadias repairs with free inner prepuce tube. Methods Forty-two males with hypospadias were repaired with free inner prepuce tube between May and October 2015. The age ranged from 1 year and 1 month to 28 years and 2 months with a median of 2 years and 9 months. Initial operation for hypospadias was performed in 41 cases and re-operation in 1 case of chordee after 16 months of hypospadias repair. There were 36 cases of hypospadias (6 cases of proximal penile type, 1 case of penile scrotal type, 26 cases of scrotal type, and 3 cases of perineal type) and 6 cases of typeⅣchordee according to Donnahoo classification criteria. Results The length of reconstructed urethra was 2.0-5.5 cm (mean, 3.6 cm). The patients were followed up 6-10 months (mean, 8 months). Urinary fistulae was noted in 10 patients, which healed spontaneously in 5 cases within 3 months after surgery, and was cured after repair in 5 cases. Urethral stenosis occurred in 4 cases (2 external orifice stricture and 2 distal urethral stricture) and urethral incision was performed. Wound infection was noted in 3 cases, 2 of them needed further surgery for a permanent fistula. Skin ischemic necrosis was found in 3 cases, 1 of them had infection and fistula, and needed further surgical repair. Diverticulum of scrotum developed in 1 case. Ten patients need re-operation, and the success rate was 76.2% (32/42). At 3 months after surgery, the HOSE score ranged from 11 to 16 (mean, 14.7). The maximum urinary flow rate was 1.9-28.4 mL/s (mean, 10.5 mL/s) in 22 cases of outpatient at 3 months after surgery. Conclusion Free inner prepuce tube can survive and play a role of normal neourethra. The short-term effectiveness has shown a relatively high complication rate and suggests this procedure should be carefully applied.

Citation： TANGYunman, WANGXuejun, MAOYu, CHENShaoji, LIUMao, CHENYuejiao. Short-term effectiveness of hypospadias repair with free inner prepuce tube. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(7): 866-870. doi: 10.7507/1002-1892.20160176 Copy

1.	Snodgrass W, Macedo A, Hoebeke P, et al. Hypospadias dilemmas: a round table. J Pediatr Urol, 2011, 7(2): 145-157.
2.	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.
3.	Tang YM, Chen SJ, Huang LG, et al. Chordee without hypospadias: report of 79 Chinese prepubertal patients. J Andorl, 2007, 28(4): 630-633.
4.	Singh S, Rawat J, Kureel SN, et al. Chordee without hypospadias: operative classification and its management. Urol Ann, 2013, 5(2): 93-98.
5.	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.
6.	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.e1-7.
7.	Springer A, Krois W, Horcher E. Trends in hypospadias surgery: results of a wouldwide survey. Eur Urol, 2011, 60(6): 1184-1189.
8.	Subramaniam R, Spinoit AF, Hoebeke P. Hypospadias repair: an overview of the actual techniques. Semin Plast Surg, 2011, 25(3): 206-212.
9.	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.
10.	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.
11.	徐哲, 谢家伦, 刘文旭, 等.游离包皮在尿道下裂尿道成形术中的应用.中华泌尿外科杂志, 2006, 27(11): 785-787.
12.	隆电熙, 王德娟, 黄文涛, 等.游离包皮内板一期尿道成形术治疗儿童尿道下裂.局解手术学杂志, 2013, 22(4): 396-399.
13.	王胜义, 陈勇, 麦继昌.游离包皮内板治疗不伴尿道下裂的阴茎下弯畸形.临床医学, 2013, 33(5): 42-44.
14.	Powell CR, McAleer I, Alagiri M, et al. Comparison of flaps versus grafts in proximal hypospadias surgery. J Urol, 2000, 163(4): 1286-1289.
15.	Bertozzi M, Yildiz A, Kamal B, et al. Multicentric experience on double dartos flap protection in tubularized incised plate urethroplasty for distal and midpenile hypospadias. Pediatr Surg Int, 2011, 27(12): 1331-1336.
16.	Hayashi Y, Kojima Y, Nakane A, et al. A strategy for repairing moderately severe hypospadias using onlay urethroplasty versus onlay-tube-onlay urethroplasty. Urology, 2003, 61(5): 1019-1022.
17.	Fine R, Reda EF, Zelkovic P, et al. Tunneled buccal mucosa tube grafts for repair of proximal hypospadias. J Urol, 2015, 193(5 Suppl): 1813-1817.
18.	Barbagli G, Kulkarini SB, Fossati N, et al. Long-term followup and deterioration rate of anterior substitution urethroplasty. J Urol, 2014, 192(3): 808-813.

1. Snodgrass W, Macedo A, Hoebeke P, et al. Hypospadias dilemmas: a round table. J Pediatr Urol, 2011, 7(2): 145-157.
2. 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.
3. Tang YM, Chen SJ, Huang LG, et al. Chordee without hypospadias: report of 79 Chinese prepubertal patients. J Andorl, 2007, 28(4): 630-633.
4. Singh S, Rawat J, Kureel SN, et al. Chordee without hypospadias: operative classification and its management. Urol Ann, 2013, 5(2): 93-98.
5. 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.
6. 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.e1-7.
7. Springer A, Krois W, Horcher E. Trends in hypospadias surgery: results of a wouldwide survey. Eur Urol, 2011, 60(6): 1184-1189.
8. Subramaniam R, Spinoit AF, Hoebeke P. Hypospadias repair: an overview of the actual techniques. Semin Plast Surg, 2011, 25(3): 206-212.
9. 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.
10. 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.
11. 徐哲, 谢家伦, 刘文旭, 等.游离包皮在尿道下裂尿道成形术中的应用.中华泌尿外科杂志, 2006, 27(11): 785-787.
12. 隆电熙, 王德娟, 黄文涛, 等.游离包皮内板一期尿道成形术治疗儿童尿道下裂.局解手术学杂志, 2013, 22(4): 396-399.
13. 王胜义, 陈勇, 麦继昌.游离包皮内板治疗不伴尿道下裂的阴茎下弯畸形.临床医学, 2013, 33(5): 42-44.
14. Powell CR, McAleer I, Alagiri M, et al. Comparison of flaps versus grafts in proximal hypospadias surgery. J Urol, 2000, 163(4): 1286-1289.
15. Bertozzi M, Yildiz A, Kamal B, et al. Multicentric experience on double dartos flap protection in tubularized incised plate urethroplasty for distal and midpenile hypospadias. Pediatr Surg Int, 2011, 27(12): 1331-1336.
16. Hayashi Y, Kojima Y, Nakane A, et al. A strategy for repairing moderately severe hypospadias using onlay urethroplasty versus onlay-tube-onlay urethroplasty. Urology, 2003, 61(5): 1019-1022.
17. Fine R, Reda EF, Zelkovic P, et al. Tunneled buccal mucosa tube grafts for repair of proximal hypospadias. J Urol, 2015, 193(5 Suppl): 1813-1817.
18. Barbagli G, Kulkarini SB, Fossati N, et al. Long-term followup and deterioration rate of anterior substitution urethroplasty. J Urol, 2014, 192(3): 808-813.

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