RESULTS OF TWO-STAGE VERSATILE ONE-STAGE SURGERY USING A FORESKIN PEDICLE FLAP IN TREATMENT OF POSTERIOR HYPOSPADIAS
Main Article Content
Abstract
Objective: To compare the results of two-stage and one-stage surgery using a vascularly pedicled foreskin flap for the treatment of posterior hypospadias.
Subjects and methods: A retrospective review of patient records of posterior hypospadias who underwent two-stage surgery (Group 2) and one-stage surgery (Group 1) using a vascularly pedicled foreskin flap, from May 2020 to December 2023.
Results: There were 76 patients with posterior hypospadias, including 38 patients in each surgical group. The mean age at surgery and the position of the urethral opening after straightening at the base of the penis and at the scrotum did not differ between the two groups; however, the mean length of the missing urethral segment in group 2 was 4.7 ± 0.9 cm, greater than that of group 1, 3.5 ± 0.5 cm, with p < 0.001. The mean time between two surgeries was 10.5 ± 3.2 months (6–20 months) in group 2. The complication rate in group 2 was statistically significantly lower than in group 1 (21.1% vs 42.1%; p = 0.04). Urethral fistula rates did not differ between the two groups, at 18.4% and 21.1%, respectively. In group 1, 15.8% of patients had urethral stricture and 7.9% had meatal stenosis, whereas these two complications were not observed in group 2.
Conclusion: Two-stage surgery had a lower complication rate than one-stage surgery using a pedicled foreskin flap to treat posterior hypospadias, with the complication rate approximately half that of one-stage surgery, a statistically significant difference. There were no complications of urethral stricture or meatal stenosis after two-stage surgery.
Keywords
Posterior hypospadias, one-stage surgery, two-stage surgery
Article Details
References
2. Wang CX, Zhang WP, and Song HC (2019). Complications of proximal hypospadias repair with transverse preputial island flap urethroplasty: a 15-year experience with long-term follow-up. Asian J Androl, 21(3): 300-303.
3. Wu Y, Guan Y, Wang X, Wang C et al (2023).Repair of proximal hypospadias with single-stage (Duckett's method) or Bracka two-stage: a retrospective comparative cohort study. Transl Pediatr, 12(3): 387-395.
4. Babu R and Chandrasekharam V.S (2021). Meta-analysis comparing the outcomes of single-stage (foreskin pedicled tube) versus two-stage (foreskin free graft & foreskin pedicled flap) repair for proximal hypospadias in the last decade. Journal of Pediatric Urology, 17(5): 681-689.
5. Castagnetti M and El-Ghoneimi A (2010). Surgical management of primary severe hypospadias in children: systematic 20-year review. J Urol, 184(4):1469-74.
6. Lê Nguyễn Yên, Ngô Xuân Thái, Lê Thanh Hùng và cộng sự (2019). Phẫu thuật điều trị miệng niệu đạo đóng thấp thể nặng bằng kỹ thuật Koyanagi cải biên: kinh nghiệm qua 30 trường hợp. Tạp chí Y học TP. Hồ Chí Minh, 23 (1): 204 - 209.
7. Wani SA, Baba AA, Mufti GN et al (2020). Bracka versus Byar's two-stage repair in proximal hypospadias associated with severe chordee: a randomized comparative study. Pediatr Surg Int, 36(8): 965-970.
8. Badawy H., Dawood W., Soliman A.S., et al (2020). Staged repair of proximal hypospadias: Reporting outcome of staged tubularized autograft repair (STAG). J Pediatr Surg, 5(12): 2710-2716
9. Al-Adl A.M, Abdel A.M., El-Karamany T.M et al (2020). Two-stage repair of proximal hypospadias with moderate to severe chordee using inner preputial skin graft: prospective evaluation of functional and cosmetic outcomes. World J Urol, 38(11): 2873-2879.
10. Phạm Ngọc Thạch và Lê Hữu Đăng (2022). Khảo sát biến chứng điều trị lỗ tiểu thấp thể sau bằng phẫu thuật hai thì tại Bệnh viện Nhi Đồng 2. Tạp Chí Y Học Lâm Sàng,81: 77–82.