.: ORİJİNAL ARAŞTIRMA
Efficacy of Single-Stage Surgery (Island Tube Hypospadias Repair) in the Treatment of Proximal Hypospadias: A Comparative Retrospective Study
Proksimal Hipospadias Tedavisinde Tek Aşamalı Cerrahinin (Ada Tüp Hipospadias Onarımı) Etkinliği: Karşılaştırmalı Retrospektif Bir Çalışma
J Reconstr Urol. 2024;14(2):59-65
doi: 10.5336/urology.2024-104541
Makale Dili: EN
Tam Metin
Ücretsiz Erişim
ABSTRACT
Objective: The complexity of hypospadias surgery and the risk of complications increase as the location of the opening moves proximally. In some cases, single-session surgical techniques are sufficient, whereas in others, complementary surgical techniques performed at different times are required. In this study, we aimed to evaluate the efficacy of single-stage surgery [island tube hypospadias repair (ITHR)] in the treatment of proximal hypospadias through a comparative retrospective analysis. Material and Methods: The data of 139 patients who underwent surgery for proximal hypospadias between 2011-2020 in our pratice were analyzed retrospectively. A total of 76 patients underwent ITHR and 63 patients underwent two-stage hypospadias surgery (TSHS). All operated patients were followed up for 2 years to detect urethrocutaneous fistula, urethral stenosis, meatal stenosis, urethral diverticulum development, tissue dehiscence (wound dehiscence), residual chordee, and final cosmetic appearance. Results: The median (25.p-75.p) age and operative time of 76 patients who underwent ITHR were 3 (2-4) years and 179 (166.5-195) minutes. The median (25.p-75.p) ages and operative times of 63 patients who underwent TSHS were 4 (3-5) years and 220 (198-245) minutes. Although the median ages were similar, the operative time was longer in TSHS (p<0.05). Complications and final cosmetic appearance were similar in ITHR and TSHS cases (p>0.05). Conclusion: ITHR was found to be an effective technique in the treatment of proximal hypospadias, with complication rates similar to TSHS. The important advantages of ITHR are that it requires only one anesthesia, has shorter operation times, and relieves the burden on families.
Keywords: One-stage surgery; hypospadias; proximal; island tube; two-stage surgery
Objective: The complexity of hypospadias surgery and the risk of complications increase as the location of the opening moves proximally. In some cases, single-session surgical techniques are sufficient, whereas in others, complementary surgical techniques performed at different times are required. In this study, we aimed to evaluate the efficacy of single-stage surgery [island tube hypospadias repair (ITHR)] in the treatment of proximal hypospadias through a comparative retrospective analysis. Material and Methods: The data of 139 patients who underwent surgery for proximal hypospadias between 2011-2020 in our pratice were analyzed retrospectively. A total of 76 patients underwent ITHR and 63 patients underwent two-stage hypospadias surgery (TSHS). All operated patients were followed up for 2 years to detect urethrocutaneous fistula, urethral stenosis, meatal stenosis, urethral diverticulum development, tissue dehiscence (wound dehiscence), residual chordee, and final cosmetic appearance. Results: The median (25.p-75.p) age and operative time of 76 patients who underwent ITHR were 3 (2-4) years and 179 (166.5-195) minutes. The median (25.p-75.p) ages and operative times of 63 patients who underwent TSHS were 4 (3-5) years and 220 (198-245) minutes. Although the median ages were similar, the operative time was longer in TSHS (p<0.05). Complications and final cosmetic appearance were similar in ITHR and TSHS cases (p>0.05). Conclusion: ITHR was found to be an effective technique in the treatment of proximal hypospadias, with complication rates similar to TSHS. The important advantages of ITHR are that it requires only one anesthesia, has shorter operation times, and relieves the burden on families.
Keywords: One-stage surgery; hypospadias; proximal; island tube; two-stage surgery
ÖZET
Amaç: Hipospadias cerrahisinin karmaşıklığı ve komplikasyon riski açıklığın yeri, proksimale doğru ilerledikçe artmaktadır. Bazı durumlarda, tek seanslık cerrahi teknikler yeterli olurken bazı durumlarda ise farklı zamanlarda yapılan tamamlayıcı cerrahi tekniklere ihtiyaç duyulur. Bu çalışmada, proksimal hipospadias tedavisinde tek aşamalı cerrahinin [ada tüp hipospadias onarımı (island tube hypospadias repair ''ITHR'')] etkinliğini karşılaştırmalı retrospektif analizle değerlendirmeyi amaçladık. Gereç ve Yöntemler: Pratiğimizde 2011-2020 yılları arasında proksimal hipospadias nedeniyle ameliyat edilen 139 hastanın verileri, retrospektif olarak incelendi. Toplam 76 hastaya ITHR, 63 hastaya ise iki aşamalı hipospadias ameliyatı [two-stage hypospadias surgery (TSHS)] uygulandı. Ameliyat edilen tüm hastalar; üretrokutanöz fistül, üretral stenoz, mea stenozu, üretral divertikül gelişimi, doku ayrılması (yara açılması), rezidüel kordi ve son kozmetik görünüm açısından 2 yıl boyunca takip edildi. Bulgular: ITHR uygulanan 76 hastanın yaşları ve ameliyat süresi, median (25.p-75.p) olarak 3 (2-4) yıl ve 179 (166.5-195) dk idi. TSHS uygulanan 63 hastanın yaşları ve ameliyat süresi, median (25.p-75.p) olarak 4 (3-5) yıl ve 220 (198-245) dk'dır. Yaşların ortancaları benzer olmakla birlikte, TSHS'de ameliyat süresi daha uzundu (p<0,05). ITHR ve TSHS olgularında komplikasyonlar ve son kozmetik görünüm benzerdi (p>0,05). Sonuç: ITHR'nin proksimal hipospadias tedavisinde TSHS'ye benzer komplikasyon oranlarıyla etkili bir teknik olduğu ortaya konulmuştur. Tek anestezi gerektirmesi, ameliyat süresinin kısa olması ve ailelerin yükünü hafifletmesi ITHR'nin önemli avantajlarıdır.
Anahtar Kelimeler: Tek aşamalı cerrahi; hipospadias; proksimal; ada tüpü; iki aşamalı cerrahi
Amaç: Hipospadias cerrahisinin karmaşıklığı ve komplikasyon riski açıklığın yeri, proksimale doğru ilerledikçe artmaktadır. Bazı durumlarda, tek seanslık cerrahi teknikler yeterli olurken bazı durumlarda ise farklı zamanlarda yapılan tamamlayıcı cerrahi tekniklere ihtiyaç duyulur. Bu çalışmada, proksimal hipospadias tedavisinde tek aşamalı cerrahinin [ada tüp hipospadias onarımı (island tube hypospadias repair ''ITHR'')] etkinliğini karşılaştırmalı retrospektif analizle değerlendirmeyi amaçladık. Gereç ve Yöntemler: Pratiğimizde 2011-2020 yılları arasında proksimal hipospadias nedeniyle ameliyat edilen 139 hastanın verileri, retrospektif olarak incelendi. Toplam 76 hastaya ITHR, 63 hastaya ise iki aşamalı hipospadias ameliyatı [two-stage hypospadias surgery (TSHS)] uygulandı. Ameliyat edilen tüm hastalar; üretrokutanöz fistül, üretral stenoz, mea stenozu, üretral divertikül gelişimi, doku ayrılması (yara açılması), rezidüel kordi ve son kozmetik görünüm açısından 2 yıl boyunca takip edildi. Bulgular: ITHR uygulanan 76 hastanın yaşları ve ameliyat süresi, median (25.p-75.p) olarak 3 (2-4) yıl ve 179 (166.5-195) dk idi. TSHS uygulanan 63 hastanın yaşları ve ameliyat süresi, median (25.p-75.p) olarak 4 (3-5) yıl ve 220 (198-245) dk'dır. Yaşların ortancaları benzer olmakla birlikte, TSHS'de ameliyat süresi daha uzundu (p<0,05). ITHR ve TSHS olgularında komplikasyonlar ve son kozmetik görünüm benzerdi (p>0,05). Sonuç: ITHR'nin proksimal hipospadias tedavisinde TSHS'ye benzer komplikasyon oranlarıyla etkili bir teknik olduğu ortaya konulmuştur. Tek anestezi gerektirmesi, ameliyat süresinin kısa olması ve ailelerin yükünü hafifletmesi ITHR'nin önemli avantajlarıdır.
Anahtar Kelimeler: Tek aşamalı cerrahi; hipospadias; proksimal; ada tüpü; iki aşamalı cerrahi
REFERANSLAR:
- Long CJ, Canning DA. Proximal hypospadias: we aren't always keeping our promises. F1000Res. 2016;5:F1000. [Crossref] [PubMed] [PMC]
- Acimi S. What is the pathogenesis of proximal hypospadias? Turk J Urol. 2018;44(4):357-61. [Crossref] [PubMed] [PMC]
- Retik AB, Bauer SB, Mandell J, Peters CA, Colodny A, Atala A. Management of severe hypospadias with a 2-stage repair. J Urol. 1994;152(2 Pt 2):749-51. [Crossref] [PubMed]
- Gershbaum MD, Stock JA, Hanna MK. A case for 2-stage repair of perineoscrotal hypospadias with severe chordee. J Urol. 2002;168(4 Pt 2):1727-8;discussion 1729. [Crossref] [PubMed]
- Badawy H, Fahmy A. Single- vs. multi-stage repair of proximal hypospadias: The dilemma continues. Arab J Urol. 2013;11(2):174-81. [Crossref] [PubMed] [PMC]
- DeFoor W, Wacksman J. Results of single staged hypospadias surgery to repair penoscrotal hypospadias with bifid scrotum or penoscrotal transposition. J Urol. 2003;170(4 Pt 2):1585-8; discussion 1588. [Crossref] [PubMed]
- Cousin I, Basmaison C, Cousin E, Lebonvallet N, Germouty I, Leven C, et al. Complication rates of proximal hypospadias: meta-analyses of four surgical repairs. J Pediatr Urol. 2022;18(5):587-97. [Crossref] [PubMed]
- Uygur MC, Unal D, Tan MO, Germiyanoğlu C, Erol D. Factors affecting outcome of one-stage anterior hypospadias repair: analysis of 422 cases. Pediatr Surg Int. 2002;18(2-3):142-6. [Crossref] [PubMed]
- Abu-Arafeh W, Chertin B, Zilberman M, Farkas A. One-stage repair of hypospadias-experience with 856 cases. Eur Urol. 1998;34(4):365-7. [Crossref] [PubMed]
- Ghali AMA, El-Malik EMA, Al-Malki T, İbrahim AH. One stage hypospadias repair. Experience with 544 cases. Eur Urol. 1999;36(5):346-442. [Crossref]
- Snodgrass W, Koyle M, Manzoni G, Hurwitz R, Caldamone A, Ehrlich R. Tubularized incised plate hypospadias repair: results of a multicenter experience. J Urol. 1996;156(2 Pt 2):839-41. [Crossref] [PubMed]
- Baskin LS, Duckett JW, Ueoka K, Seibold J, Snyder HM 3rd. Changing concepts of hypospadias curvature lead to more onlay island flap procedures. J Urol. 1994;151(1):191-6. [Crossref] [PubMed]
- Wang YS, Song HC, Liu P, Fang YW, Zhang WP. Comparison of outcomes in three surgical techniques for proximal hypospadias: staged transverse preputial island flap urethroplasty versus single-stage repairs. Asian J Androl. 2023;25(5):616-20. [Crossref] [PubMed] [PMC]
- Bhat A, Single M, Bhat M, Sabharwal K, Upadhay R, Kumar V. Incised plate uretroplasty in perinéal and périnéo-scrotal hypospadias. Afr J Urol. 2015;21(2):105-10.. [Crossref]
- Shahin M, Abdalrazek M, Abdelmaboud M, Elsayaad IM, Mahmoud MA, Mousa MA, et al. Evaluation of double-faced tubularized preputial flap versus duckett's procedure for repair of penoscrotal hypospadias with significant penile curvature: a comparative study. Adv Urol. 2022;2022:6996933. [Crossref] [PubMed] [PMC]
- Eassa W, Jednak R, Capolicchio JP, Brzezinski A, El-Sherbiny M. Risk factors for re-operation following tubularized incised plate urethroplasty: a comprehensive analysis. Urology. 2011;77(3):716-20. [Crossref] [PubMed]
- Geng H, Cheng S, Yang X, Huang Y. The effect of the duckett procedure on the outcome and prognosis of children with suburethral cleft. Contrast Media Mol Imaging. 2022;2022:7444104. [Crossref] [PubMed] [PMC]
- Wu Y, Guan Y, Wang X, Wang C, Ma X, Guan H. Repair of proximal hypospadias with single-stage (Duckett's method) or Bracka two-stage: a retrospective comparative cohort study. Transl Pediatr. 2023;12(3):387-95. [Crossref] [PubMed] [PMC]
- Emir H, Jayanthi VR, Nitahara K, Danismend N, Koff SA. Modification of the Koyanagi technique for the single stage repair of proximal hypospadias. J Urol. 2000;164(3 Pt 2):973-5; discussion 976. [Crossref] [PubMed]
- Cui X, He Y, Huang W, Chen L, Wang Y, Zhou C. Clinical efficacy of transverse preputial island flap urethroplasty for single-stage correction of proximal hypospadias: a single-centre experience in Chinese patients. BMC Urol. 2020;20(1):118. [Crossref] [PubMed] [PMC]
- Joseph VT. One-stage surgical correction of proximal hypospadias. Ann Acad Med Singap. 2003;32(1):106-11. [Crossref] [PubMed]
- Rynja SP, de Jong TPVM, Bosch JLHR, de Kort LMO. Proximal hypospadias treated with a transverse preputial island tube: long-term functional, sexual, and cosmetic outcomes. BJU Int. 2018;122(3):463-71. [Crossref] [PubMed]
- Aslam R, Campbell K, Wharton S, Bracka A. Medium to long term results following single stage Snodgrass hypospadias repair. J Plast Reconstr Aesthet Surg. 2013;66(11):1591-5. [Crossref] [PubMed]
- Patel RP, Shukla AR, Snyder HM 3rd. The island tube and island onlay hypospadias repairs offer excellent long-term outcomes: a 14-year followup. J Urol. 2004;172(4 Pt 2):1717-9 [Crossref]
- Hadidi AT. Lateral-based flap: a single stage urethral reconstruction for proximal hypospadias. J Pediatr Surg. 2009;44(4):797-801. [Crossref] [PubMed]
- Rigamonti W, Castagnetti M. Onlay on albuginea: modified onlay preputial island flap urethroplasty for single-stage repair of primary severe hypospadias requiring urethral plate division. Urology. 2011;77(6):1498-502. [Crossref] [PubMed]
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