Our Summary

This research paper discusses a study that was conducted to compare the outcomes of three different surgical methods used to correct hypospadias (a condition where the opening of the urethra is on the underside of the penis, rather than at the tip). The study reviewed the medical data of 39 patients who underwent such surgery between 2010 and 2019.

Three different surgical techniques were evaluated: a ventral preputial onlay flap, a preputial tubular flap, and a full thickness skin tubular graft. The researchers looked at several factors including age, number and type of previous repairs, catheter time, curvature of the penis, length of the urethral defect, operation time, complications, and results after surgery.

The patients’ average age at the time of operation was around 5 years. Most had undergone at least one previous repair. The success rate of the procedures was approximately 80%. However, several complications were noted, including wound infections, glans dehiscences (openings in the head of the penis), fistulas (abnormal connections between the urethra and skin), meatal stenoses (narrowing of the urethral opening), and urethral diverticulas (outpouchings of the urethra).

The research found that complications, need for a urinary catheter, and need for further surgery were more common in the group that received the skin tubular graft. However, this finding was not statistically significant, meaning it could have occurred by chance.

In conclusion, the researchers recommend using the patient’s own preputial tissue (foreskin) for repeat hypospadias surgery. If this is not available, other tissues such as oral or buccal mucosa (the lining of the mouth or cheek) should be used instead of skin grafts.

FAQs

  1. What are the three surgical techniques evaluated in the study for hypospadias repair?
  2. What were the common complications noted following hypospadias repair surgery?
  3. What type of tissue do the researchers recommend using for repeat hypospadias surgery?

Doctor’s Tip

A doctor may advise a patient undergoing hypospadias repair to discuss with their surgeon the use of their own preputial tissue for the procedure, as it may lead to better outcomes and a lower risk of complications compared to using skin grafts. Additionally, patients should be aware of the potential complications associated with the surgery and follow post-operative care instructions closely to ensure a successful recovery.

Suitable For

Overall, patients who are typically recommended hypospadias repair are those who have a urethral opening located on the underside of the penis, rather than at the tip. These patients may have undergone previous repair surgeries and are experiencing complications such as urinary issues, curvature of the penis, or other functional problems.

It is important for patients to undergo a thorough evaluation by a urologist or pediatric surgeon to determine the most appropriate surgical technique for their specific case. Factors such as age, previous surgeries, length of the urethral defect, and overall health will all play a role in determining the best course of treatment.

In the study mentioned above, using the patient’s own preputial tissue for the repair was found to have a higher success rate and fewer complications compared to using skin grafts. Therefore, this approach may be recommended for patients undergoing repeat hypospadias surgery.

Ultimately, the decision to undergo hypospadias repair surgery should be made in consultation with a medical professional who can provide individualized recommendations based on the patient’s unique circumstances.

Timeline

Before hypospadias repair:

  • Patient is diagnosed with hypospadias, a condition where the opening of the urethra is on the underside of the penis
  • Patient undergoes evaluation by a urologist to determine the severity of the condition
  • Patient and family discuss treatment options with the urologist
  • Surgery is scheduled and pre-operative instructions are given to the patient and family

After hypospadias repair:

  • Patient undergoes surgery using one of the three evaluated techniques (ventral preputial onlay flap, preputial tubular flap, or full thickness skin tubular graft)
  • Patient recovers in the hospital for a few days post-surgery
  • Patient may experience pain, swelling, and discomfort in the days following surgery
  • Patient may need to wear a catheter for a period of time to aid in healing
  • Patient attends follow-up appointments with the urologist to monitor healing and address any complications
  • Patient may require additional surgeries to address complications such as fistulas, meatal stenoses, or urethral diverticulas
  • Patient ultimately achieves successful repair of hypospadias, with the best outcomes seen in those who received their own preputial tissue for surgery

What to Ask Your Doctor

Some questions a patient should ask their doctor about hypospadias repair include:

  1. What surgical technique do you recommend for my specific case of hypospadias?
  2. What are the potential risks and complications associated with the surgery?
  3. How long will the recovery process take, and what can I expect during this time?
  4. Will I require a urinary catheter after the surgery, and if so, for how long?
  5. What are the chances of needing additional surgeries in the future?
  6. How will the surgery impact the appearance and function of my penis?
  7. What kind of follow-up care will be needed after the surgery?
  8. Are there any specific lifestyle changes or restrictions I should be aware of post-surgery?
  9. What is the success rate of this surgical technique, and what are the factors that could affect the outcome in my case?
  10. Are there alternative treatment options available for hypospadias repair that I should consider?

Reference

Authors: Turkyilmaz Z, Karabulut R, Atan A, Sonmez K. Journal: Urol Int. 2020;104(5-6):391-395. doi: 10.1159/000504947. Epub 2020 Feb 5. PMID: 32023621