Objective To search for a new method to repair distal urethral stricture resulting from urethroplasty of hypospadias. Methods FromFebruary 2000 toMarch 2004, 16 patients with distal urethral stricture were treated by use of cutting stricture urethra and their distal urethra were reconstructed with phallic flap. Results All operations were successful without complication of flap necrosis. After 7 days of operation, the patients had free micturition and thick stream of urine. Eleven patients were followed 2 months to 4 years, the satisfactory result was obtained. Conclusion It is a simple and good method to reconstruct the distal urethra by superimposing the phallic flap on the cut stricture urethra after urethroplasty of hypospadias.
Twenty cases of hypospadiasundergone urethro-plasty with blad-der mucosa and correction of cordein one stage surgery are reported.Sixteen of 20 cases had satisfactoryresults .Two cases with structureof anastomosis have been improvedby urethral dilatation and the othertwo cases complicated with urethral-cutaneous fistula have gradually heal-ed with prolonged diversion of cysto- tomy. The indication and techniqueof this surgery are discussed indetail.
Objective To investigate the effect of scrotal septum vascular pedicle flap with two wing-l ike spl itthickness skin graft in reconstructing urethra in patients with hypospadias and in reducing the compl ications. Methods From January 2007 to March 2008, 30 cases of hypospadias were treated, with a median age of 10 years (2-20 years). There were 13 cases of proximal shaft type, 12 cases of penoscrotal type and 5 cases of scrotal type. There were 8 cases with operation history. The flap size ranged from 4.0 cm × 0.8 cm to 9.0 cm × 1.0 cm and 5 mm with two wing-l ike spl it-thickness skin graft.When the downward curvature corrected, length of the flap could be determined by the length of the urethra that neededto be reconstructed. Results All flaps survived. The incision healed by first intention in all patients except one whose incision healed after change dressing because of frequent erection. Incision at donor site healed well. Eighteen patients were followed up for 6-12 months, including 8 with second operation history. The reconstructed urethras were unobstructed and no urethrostenosis or urinary fistula happened. Conclusion This is an improved technique of the scrotal septum flap in urethra reconstruction. It takes advantages of both flap and spl it-thickness skin graft in reconstructing urethra and avoides the disadvantages of a single tissue. It is a good choice for treating hypospadias whose urinary meatus locates neighborly to penoscrotal junctional zone.
Objective To evaluate the effect of niti-alloy urethral stent on the prevention of urethrocutaneous fistula and urethral stricture in hypospadias repair. Methods From January 2001 to December 2004, niti-alloy urethral stents were applied to repair congenital hypospadias in 63 patients. Among 63 patients, 49( 19 cases of proximal hypospadias, 22 cases of penoscrotal hypospadias and 8 casesof perineoscrotal hypospadias) received one-stage surgical managements of urethral reconstruction, and 10 underwent postoperative fistular repairs and 4 received repeated urethral reconstruction because of urethral stricture after hypospadias repair. Results All patients gained healing by first intention without fistula or urethral stricture. The stents were left indwelling in the neourethra for 2 months to 3 months to prevent stricture. The longest indwelling period was about 1 year. No dysuria or other discomfort occurred during this period. Conclusion Niti-alloy urethral stent can effectively prevent the postoperative urethrocutaneous fistula and urethral stricture after hypospadias repair.
Objective Anthropometric variants in prepubertal boys with hypospadias were assigned and assessed to illustrate anatomical malformation. Methods A total of 516 prepubertal (Tanner grade Ⅰ) boys with hypospadias who were admitted to three medical centers between March 2021 and December 2021 and met the selection criteria for primary surgery were selected. The age of the boys ranged from 10 to 111 months, with an average of 32.6 months. Hypospadias were classified according to the location of the urethral defect, 47 cases (9.11%) of the distal type (the urethral defect is in the coronal groove or beyond), 208 cases (40.31%) of the middle type (the urethral defect is in the penis body), and 261 cases (50.58%) of the proximal type (the urethral defect is at the junction or proximal side of the penis and scrotum). The following indexes were measured: penis length before and immediately after operation, reconstructed urethral length, and total urethral length. Morphological indicators of the glans area, including preoperative height and width of glans, AB, BC, AE, AD, effective AD, CC, BB, the urethral plate width of the coronal sulcus, and postoperative height and width of glans, AB, BE, and AD. In which point A is the distal endpoint of navicular groove, point B is the protuberance lateral to the navicular groove, point C is the ventrolateral protuberance of the glans corona, point D is the dorsal midline point of the glans corona, and point E is the ventral midline point of the coronal sulcus. The foreskin morphological indicators, including the foreskin width, inner foreskin length, and outer foreskin length. The scrotal morphological indicators, including the left, right, and front penile to scrotum distance. The anogenital distances, including anoscrotal distance 1 (ASD1), ASD2, anogenital distance 1 (AGD1), and AGD2. ResultsThe penis length of the distal, middle, and proximal types decreased successively before operation, the reconstructed urethral length increased successively and the total urethral length decreased successively, these differences were all significant (P<0.05). The height and width of the glans of the distal, middle, and proximal types significantly decreased successively (P<0.05), but the height/width of the glans was generally close; AB value, AD value, and effective AD value significantly decreased successively (P<0.05); there was no significant difference in BB value, urethral plate width of the coronary sulcus, and (AB+BC)/AD value between the groups (P>0.05). There was no significant difference in the width of glans between the groups after operation (P>0.05); AB value and AB/BE value increased successively, and AD value decreased successively, these differences were all significant (P<0.05). The inner foreskin length in the 3 groups significantly decreased successively (P<0.05), while the outer foreskin length had no significant difference (P>0.05). The left penile to scrotum distance of middle, distal, and proximal types significantly increased successively (P<0.05). ASD1, AGD1, and AGD2 significantly decreased from distal type to proximal type successively (P<0.05). The other indicators’ differences were significant only between some groups (P<0.05).Conclusion The anatomic abnormalities of hypospadias can be described by anthropometric indicators, which can be used as the basis for further standardized surgical guidance.
Objective To explore an effective method to repair penile-scrotal or perineal hypospadias in one stage with prepuce island flap.Methods Different prepuce island flaps were designed according to thedifferent pathological anatomy of the penile-scrotal or perineal hypospadias. The prepuce island flaps were thus translocated and sutured to form the urethra.Thirty-one cases of hypospadias (21 cases of peinil-scrotal type, 10 cases of perineal type) were repaired with prepuce island flap.The biggest length and the width of the prepuce island flapwere 7.5 cm and 1.5-1.8 cm respectively.Results All the cases resulted in a good contour of the penis and a normal anatomic position of urethral meatus without any redundancy or tortuosity.The urination was perfect and acceptable.Conclusion One stage repair of penilescrotal or perineal hypospadias with prepuce island flap can be considered as an acceptable effective surgical technique.
OBJECTIVE: To investigate the surgical approach to repair hypospadias. METHODS: From 1992 to 2000, 42 cases with hypospadias accepted secondary urethroplasty after primary operation, which included urethral burying in penile skin, bladder mucosa and scrotal septal vascular pedicled flap urethroplasty, trans-scrotal skin flap covering the wounds with normal meatus urinarius. RESULTS: Only one, out of 42 cases, had early complication of urinary fistula in 7 days after urethroplasty, which was cured by scrotal septal vascular pedicled flap urethroplasty 3 months later and had no further complication. The others were all succeeded once for all, the successful rate was 97.6%. CONCLUSION: The surgical method to repair hypospadias by urethral burying and transscrotal skin flap technique is safe, reliable and recommendable for clinical use.
Objective To investigate the safety, efficacy and morbidity of onestage urethroplasty by using bladder mucosa for treatment of hypospadias. Methods From August 1991 to August 2003, 38 cases of congenital hypospadias were given bladder mucosa flap procedure and one stage urethroplasty. Results Thirty-eight cases of hypospadias treated with one stageurethroplasty by using bladder mucosa were followed up 6 months-9 years afterthe procedure. The success rate of the operation was 95%. Three cases of urethral fistula after the procedure were surgically repaired again, 2 cases of urethral stricture recovered after distension. The complication markedly lessened, micturation became normal with the reconstructed meatussituated at the proper site on the glands. Conclusion one stage urethroplastyby using bladder mucosa for treatment of hypospadias is a simple, effective andsafe surgery.
Objective To investigate the local ization and expression characteristics of androgen receptor (AR) in genital tissue of patients with congenital hypospadias and simple chordee. Methods Between August 2005 and Janury 2007, dorsal prepuce, ventral perimeatal skin, and urethral plate were harvested from 25 patients with congenital hypospadias (aged from 1 year and 11 months to 19 years with an average of 3 years and 7 months) and 4 patients with simple chordee (aged from 3 years and 6 months to 16 years with an average of 7 years and 1 month). Prepuce by circumcision from 18 patients was used as control. The expression intensity and distribution of AR were assessed with mmunohistochemistry. Results AR was expressed in prepuce tissues from congentital hypospadias, simple chordee, and control. The AR positive cell rates were 62.94% ± 5.40% and 62.87% ± 5.33% in dorsal and ventral prepuce of control patients respectively, and were 59.00% ± 3.75%, 58.46% ± 4.14%, and 52.30% ± 3.53% in dorsal prepuce, ventral perimeatal skin, and urethral plate of patients with congenital hypospadias respectively. AR positive cell rate was significantly lower in patients with congenital hypospadias than in control patients (P lt; 0.05), and in urethral plate than in dorsal prepuce and ventral perimeatal skin of patients with congenital hypospadias (P lt; 0.05), and no significant difference was detected between dorsal and ventral specimens (P gt; 0.05). Stratified analysis showed a similar expression mode in severe hypospadias group and severe chordee group (P lt; 0.05). In mild to moderate hypospadias group and mild to moderate chordee group, no significant difference was shown when dorsal and ventral skin specimens were compared to that in normal control (P gt; 0.05), with AR expression diminished in urethral plate (P lt; 0.05), and AR decrease was relative to severity of chordee (P lt; 0.05). The AR positive cell rates were 59.69% ± 2.73%, 55.71% ± 1.67%,and 51.92% ± 1.87% in dorsal, ventral skin, and urethral late of patients with chordee respectively. Reducing tendency of AR expression was observed. Conclusion AR expression decreases in penile skin of patients with congenital hypospadias and simple chordee, especially in urethral plate.
Objective To investigate the application of cavernosum reduction technology in glanuloplasty during the repair of moderate-severe hypospadias and evaluate the effectiveness. Methods The clinical data of 192 patients with moderate-severe hypospadias between November 2015 and May 2017 were retrospectively analyzed. Among them, 103 patients were treated with the cavernosum reduction technology in glanuloplasty during the repair (observation group), 88 patients were treated with repair and glanuloplasty without the cavernosum reduction technology (control group). There was no significant difference in maximum transverse diameter of glans and the height of glans between 2 groups (t=1.652, P=0.152; t=1.653, P=0.077). The length of reconstructed urethra, complications (e.g. glans dehiscence and fistula), and the maximum flow rate at 3 months after operation in 2 groups were recorded. Results The length of reconstructed urethra were (35.51±7.79) mm in observation group and (32.17±6.37) mm in control group. In observation group, the meatus location after the correction of chordee was proximal in 24 cases and scrotum-perineum in 79 cases. In control group, the meatus location after the correction of chordee was proximal in 21 cases and scrotum-perineum in 67 cases. There was no significant difference in the meatus location between 2 groups (χ2=0.008, P=0.920). All patients were followed up 6-12 months after operation (mean, 9 months). There were 3 cases of urethral fistula, 2 cases of glans dehiscence, and 3 cases of urethral orifice stricture in observation group, with the incidence of complications of 7.8%. There were 7 cases of urethral fistula, 3 cases of glans dehiscence, and 4 cases of urethral orifice stricture in control group, with the incidence of complications of 15.9%. There was a significant difference in the incidence of complications between 2 groups (χ2=4.027, P=0.040). The appearance of the penis was satisfactory, and the urethral orifice was fissured, which was close to the appearance of the normal urethral orifice. At 3 months after operation, the maximal flow rates were (6.23 ± 0.54) mL/s in observation group and (5.44±0.92) mL/s in control group. There was significant difference in the maximum flow rate between 2 groups (t=1.653, P=0.000). Conclusion Cavernosum reduction technology being applied in the repair of moderate-severe hypospadias can reduce the probability of glans dehiscence, urethral fistula, urethrostenosis, and other postoperative complications, and improve the success and satisfaction of surgery.