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Hypospadias

Chapter

Abstract

Primary goals in hypospadias repair:
  1. 1.

    Restore normal penile function

     
  2. 2.

    Restore normal genital appearance

     

Normal function includes forceful, straight urination without spraying or dribbling, straight erection, and normal ejaculation.

Normal genital appearance includes the following:
  • A vertical slit urethral meatus correctly positioned within the glans.

  • Circumcision or foreskin reconstruction.

  • A symmetric scrotum without transposition, midline cleft, or encroachment onto the penile shaft.

A secondary aim is to complete repair in as few stages with as few complications as possible.

Summary of evidence for these goals:
  • Uroflowometry consistently demonstrates decreased Q max in patients after repair compared to nomograms. No study reports uroflows comparing patients and controls.

  • Adults repaired as children more often complain of obstructive voiding, spraying, and/or deviated stream than controls.

  • Ventral penile curvature (VC) occurs in approximately 10 % of distal and over 50 % of proximal hypospadias. Short-term studies indicate that dorsal plication and ventral lengthening used according to extent of curvature reliably achieve straightening.

  • Studies of dorsal plication done in adults with congenital curvature report persistence in <10 %.

  • The few surveys of adults operated as children find similar prevalences of penile curvature in patients and controls.

  • Ejaculation is more often reported by patients to have weak force with need to milk semen than controls.

  • Objective assessment of postoperative penile appearance indicates that tubularized incised plate (TIP) operation creates a more normal meatus and glans than flap procedures (Mathieu and onlay preputial flap). One study reported that parents of hypospadias patients scored outcomes after distal and proximal TIP similarly to parents of normal boys after circumcision.

  • Questionnaires of adults operated in childhood, sometimes by techniques no longer in use, find patients have less satisfaction with genital appearance than controls.

  • Distal hypospadias repair has short-term complication rates <10 %.

  • A reduction in proximal TIP complications from 53 to 13 % was reported in one study after a series of technical modifications.

  • Onlay and tubularized preputial flap proximal hypospadias repairs have complications of approximately 15–45 %.

  • There are few reported data for complications after various staged repairs.

  • Multiple logistic regression analyses find proximal meatal location and reoperation to be independent risk factors for complications, whereas suture materials and methods (interrupted vs. continuous) and stent or not (distal repair) did not impact outcomes.

  • Age at surgery >4 years was an independent risk factor in one study, but age was not a factor in two other analyses.

  • Most urethroplasty complications are diagnosed within 1 year of repair. Two studies of patients dismissed from childhood follow-up reported that 8 and 17 % had a complication when evaluated again as teens or adults.

Keywords

Urethral Stricture Hypospadias Repair Urethral Plate Meatal Location Meatal Stenosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Pediatric UrologyUniversity of Texas Southwestern Medical Center and Children’s Medical Center DallasDallasUSA

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