Our Summary

This research paper discusses a surgical procedure known as preputial reconstruction (PR), which is a technique used during hypospadias repair. Hypospadias is a birth defect in boys where the opening of the urethra is on the underside of the penis, rather than at the tip. The reconstructive procedure involves recreating the foreskin or the ‘prepuce’.

The study suggests that PR can be performed on most patients with a common type of hypospadias, except those with severely asymmetrical foreskins or a significant lack of skin on the underside of the penis. The research found that PR didn’t seem to increase complications related to the urethra reconstruction, and when combined with another technique known as ’tubularisation of the urethral plate urethroplasty’, it offered the best chances of success.

However, there are some complications specific to PR, occurring in about 8% of patients. These complications include partial or complete separation of the foreskin and secondary phimosis, a condition where the foreskin cannot be fully retracted. To prevent these issues, the study suggests that the reconstructed foreskin should be easily retractable at the end of the surgery.

The research also notes that the appearance of the reconstructed foreskin may not be completely normal, but argues that this abnormality might be less significant to the patient and his parents than the complete absence of a foreskin.

Based on the findings of the study, the authors propose an algorithm or a systematic set of guidelines for PR in patients with this type of hypospadias. They recommend offering PR to most patients, but note that some adjustments to the surgical technique may be necessary. They emphasize that the retractability of the reconstructed foreskin at the end of the surgery is crucial for the procedure’s success.

FAQs

  1. What is the importance of preputial reconstruction (PR) in hypospadias repair?
  2. Are there complications specific to preputial reconstruction during hypospadias repair?
  3. What modifications might be needed for the technique of hypospadias repair when preputial reconstruction is involved?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hypospadias repair and preputial reconstruction is to ensure that the reconstructed prepuce is easily retractable at the end of surgery. This can help prevent complications such as secondary phimosis and improve the overall success of the procedure. It is also important for patients and their parents to understand that while the reconstructed prepuce may not be fully normal cosmetically, it can still provide important benefits compared to the complete absence of the prepuce.

Suitable For

Patients with distal hypospadias are typically recommended for preputial reconstruction (PR) during hypospadias repair. PR can be important for patients requiring hypospadias repair and their parents, and it can be performed in almost all patients with distal hypospadias. Patients with the most asymmetrical prepuces or severe ventral skin deficiency may not be suitable candidates for PR. Combination of PR with tubularisation of the urethral plate urethroplasty seems to offer the best chance of success. Specific complications related to PR occur in around 8% of patients and include partial or complete dehiscence of the prepuce and secondary phimosis. To prevent complications, the reconstructed prepuce should be easily retractile at the end of surgery. Cosmetic outcomes of reconstructed prepuces may not be fully normal, but the potential benefits may outweigh the abnormality for the patient and their family. An algorithm for PR in patients with distal hypospadias is proposed based on the evidence summarized.

Timeline

  • Prior to hypospadias repair: The patient and their parents may be informed about the condition and potential treatment options. The patient may undergo evaluations and assessments to determine the severity of the hypospadias and whether preputial reconstruction is necessary.

  • During hypospadias repair: The surgical procedure may involve both urethroplasty and preputial reconstruction, depending on the specific case. The surgeon will work to correct the abnormal positioning of the urethral opening and reconstruct the prepuce if needed.

  • After hypospadias repair: The patient will undergo a recovery period, during which they will need to follow post-operative instructions to promote healing and prevent complications. Follow-up appointments will be scheduled to monitor the surgical site and ensure proper healing. The patient and their family may also receive counseling and support to address any concerns or questions about the procedure and its outcomes.

What to Ask Your Doctor

  1. Can preputial reconstruction be performed during hypospadias repair in my case?
  2. Are there any specific risks or complications associated with preputial reconstruction that I should be aware of?
  3. How does preputial reconstruction combine with the other steps of hypospadias repair?
  4. What are the potential benefits of preputial reconstruction for me as a patient and for my family?
  5. Are there any modifications or technical considerations that may be necessary for preputial reconstruction in my specific situation?
  6. What is the success rate of preputial reconstruction in patients with distal hypospadias?
  7. How will the reconstructed prepuce appear cosmetically compared to a normal prepuce?
  8. How can I ensure proper care and maintenance of the reconstructed prepuce post-surgery to prevent complications such as secondary phimosis?
  9. Are there any alternative options to preputial reconstruction that I should consider?
  10. What is the recommended follow-up care after undergoing preputial reconstruction during hypospadias repair?

Reference

Authors: Castagnetti M, Bagnara V, Rigamonti W, Cimador M, Esposito C. Journal: J Pediatr Urol. 2017 Feb;13(1):102-109. doi: 10.1016/j.jpurol.2016.07.018. Epub 2016 Sep 22. PMID: 27773620