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Background:
Surgical correction of proximal hypospadias is challenging. The complication rate of proximal hypospadias is still high, and the debate over its optimal treatment is ongoing. Duckett's method is a classic non-staging operation, and two-stage Bracka repair is an attractive alternative procedure. Herein, we retrospectively analyzed the e...
Context in source publication
Context 1
... average age of the patients at surgery was 21.78 months (10-56 months) in the Bracka group and 22.23 months (9-76 months) in the Duckett group, and the mean follow-up durations were 30 months (24-64 months) and 38.8 months (35-70 months), respectively. Patient characteristics are presented in Table 1. There was no significant difference between the two groups in terms of age and type of hypospadias. ...Citations
... 5 However, several study found that staged uretroplasty with or without grafting gave higher success rate compared to single staged procedure. 6,7 In the recent past, the role of tissue sealants has been taken into consideration. 8 Sealants are agents that can prevent the leakage of fluids by providing a physical barrier, which also aids in hemostasis. ...
... The intervention included tissue sealants usage. 6. The comparison was made with patients without tissue sealant (Control). ...
Background Hypospadias was ranked second after undescended testis as the most prevalent congenital abnormality in newborn males. Hypospadias can be successfully repaired through multiple surgeries in the majority of children. Postoperative complications were not rarely seen after surgeries, such as urethrocutaneous fistula (UCF), meatal stenosis, and glans breakdown. Tissue sealant application in hypospadias repair serves as additional suture line coverage and reduces the post surgery complications. However, the effects of sealants usage during urethroplasty are still uncertain. This review aimed to know the effects of tissue sealant usage on patients with hypospadias who undergo urethroplasty. Methods The study was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Literature was searched on PubMed, Embase, and Scopus following PRISMA guidelines. The search was conducted on October 12th, 2021, using the search term (“glue” OR “sealants” OR “tissue glue” OR “tissue sealant” OR “tissue adhesive”) AND (“hypospadias” OR “urethrocutaneous fistula” OR “urethral repair” OR “urethroplasty” OR “hypospadiology”). Result Systematic searching from all databases resulted in 160 potential articles. After a full-text review, eight articles were included in this study. Urethrocytaneous fistula complication was reported in all studies. The occurrence of complication reported by all studies was urethrocutaneous fistula. Several studies also reported tissue edema and flap-related complications. Tissue sealant had no significant effect in reducing meatal stenosis. Conclusions This systematic review revealed additional benefits from several types of tissue sealant in hypospadias repair surgery. Fibrin sealant application over the urethroplasty suture line in hypospadias repair offers a water-proof coverage and may enhance the outcome from the surgery.
... Common stage methods include Byars: A Byars' ap was created and transferred to the ventral aspect of the penis to create a new UP [21] . Bracka: A free skin ap, which was designed on the inner layer of the preputial hood, and the size was decided by the length of the urethra defect and the width of the glans [21,25] . Staged Duckett: A urethral tube was formed by a transverse preputial island ap that was dissociated from the dorsal prepuce and the inner and outer plates. ...
Aim
To compare and analyze the clinical efficacy of modified Koyanagi and staged Duckett for proximal hypospadias.
Method
The clinical and prognostic data of children were treated and underwent surgery (modified Koyanagi or stage Duckett) in the Department of Urology, Kunming Children's Hospital from January 2020 to January 2023 were retrospectively analyzed. According to different surgical methods, the subjects were divided into the modified Koyanagi group and the staged Duckett group. Patients in both groups were followed up for more than 6 months after surgery. The success rate and complications of postoperative surgery in both groups were analyzed.
Result
A total of 63 patients were included in this study, 34 in the modified Koyanagi group and 29 in the staged Duckett group. A total of 14 patients in the modified Koyanagi group experienced postoperative complications, the success rate of the surgery was 58.82%, and 5 among them experienced more than two kinds of complications. A total of 5 children in the staging Duckett group experienced postoperative complications, and the success rate of the operation was 82.75%. There were significant differences in the incidence of overall complications and fistula between the two surgical methods (P = 0.028).
Objectives
To evaluate the risk factors for postoperative complications in adolescents who undergo primary hypospadias repair and determine the time required for complication detection.
Methods
Our study included patients classified as Tanner stages three to five who underwent primary hypospadias repairs at our hospital from January 2015 to August 2022. The patients' baseline information, clinical characteristics, postoperative complications, and time to complication detection were collected. Cox regression analysis, ROC curves, Kaplan–Meier survival analyses, and the Mann–Whitney U test were used.
Results
The study comprised 143 patients, with a median age of 12.58 years. Postoperative complications were experienced by 66 patients. The length of the urethral defect was identified as an independent risk factor for postoperative complications. The ROC curve analysis identified 3 cm as the optimal cutoff value for the length of the urethral defect. The median time to complication detection was 30.5 days (IQR 23 to 209.25). 89.4% of the complications were identified within the first year. Patients with a urethral defect of <3 cm experienced a significantly longer time for the detection of urethral fistula compared to those with a urethral defect of ≥3 cm ( p = 0.047).
Conclusions
Our data indicate that adolescents with a urethral defect ≥3 cm have a higher risk of postoperative complications. Although most complications were identified within the first year, conducting long‐term follow‐ups for adolescents is recommended to identify potential subsequent complications that may arise from persistent urethral alterations.
