Our Summary

Hypospadias surgery is a procedure to correct a birth defect in boys where the opening of the urethra (the tube through which urine exits the body) is on the underside, rather than at the end, of the penis. One of the main complications after this surgery is Glanular Dehiscence (GD), where the head of the penis doesn’t heal properly. This study reviewed 71 published articles related to GD and found that it occurred in 3.48% of the 8858 hypospadias surgeries they included in their analysis.

The researchers discovered that certain factors increased the chances of GD after surgery. The risk was higher for more complex cases of hypospadias (where the urethral opening is further up the shaft), surgeries that involved more than one stage, or redo surgeries. The size of the penis head and the width of the urethral plate (part of the urethra’s structure) were also significant. If the width of the penis head was less than 14 mm or the urethral plate was less than 7 mm, the risk of GD increased.

Additionally, the timing of the surgery also played a role. Surgeries performed before 6 months of age or after puberty had a higher risk of GD. The type of anesthesia used during surgery could also affect the rate of GD, with caudal block anesthesia increasing the risk.

In simple terms, GD is a potential complication after surgery to correct a penis birth defect, and this study identified several factors that can increase the risk of this happening. These include the complexity of the case, the size of the penis head and urethral plate, the timing of the surgery and the type of anesthesia used.

FAQs

  1. What is Glanular Dehiscence (GD) and how often does it occur after hypospadias surgery?
  2. What factors were found to increase the rate of GD after hypospadias surgery?
  3. What is the significance of glans width and urethral plate width in relation to the risk of GD post-hypospadias surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pediatric urologic reconstruction is to ensure that the surgery is performed by a highly experienced surgeon who specializes in pediatric urology. Additionally, it is important to follow all post-operative care instructions carefully to reduce the risk of complications such as glanular dehiscence. Regular follow-up appointments with the surgeon are also important to monitor healing and address any concerns promptly.

Suitable For

Patients who are typically recommended pediatric urologic reconstruction are those who have undergone hypospadias surgery and are at risk for glanular dehiscence. Factors that increase the risk of glanular dehiscence include proximal hypospadias, two-stage hypospadias repairs, re-do hypospadias repair, glans width <14 mm, urethral plate width <7 mm, hypospadias surgeries performed before 6 months of age and after puberty, and caudal block anesthesia. These patients may require further surgical intervention to address complications such as glanular dehiscence.

Timeline

  • Before pediatric urologic reconstruction:
  1. Patient is diagnosed with hypospadias, a congenital condition where the opening of the urethra is on the underside of the penis.
  2. Patient undergoes evaluation by a pediatric urologist to determine the severity of the hypospadias and the need for surgical intervention.
  3. Surgical repair is scheduled based on the type and severity of the hypospadias.
  4. Preoperative assessments and preparations are conducted, including discussions with the patient and family, physical exams, and possible imaging studies.
  • After pediatric urologic reconstruction:
  1. Surgery is performed to correct the hypospadias, which may involve repositioning the urethral opening, reconstructing the urethra, and reshaping the glans.
  2. Postoperative care includes monitoring for complications such as glanular dehiscence, infection, and urinary retention.
  3. Follow-up visits are scheduled to assess healing, monitor urinary function, and address any concerns or complications.
  4. Long-term outcomes are evaluated to determine the success of the reconstruction and any potential need for further interventions.

What to Ask Your Doctor

  1. What are the risk factors for glanular dehiscence after hypospadias surgery?
  2. How common is glanular dehiscence after pediatric urologic reconstruction?
  3. Are there specific surgical techniques that can help reduce the risk of glanular dehiscence?
  4. What are the potential complications associated with glanular dehiscence?
  5. How is glanular dehiscence typically treated?
  6. Are there any long-term implications or effects of glanular dehiscence?
  7. What is the success rate of treating glanular dehiscence?
  8. Is there anything that can be done to prevent glanular dehiscence in future surgeries?
  9. How closely should the patient or caregiver monitor the surgical site for signs of glanular dehiscence post-operatively?
  10. Are there any specific follow-up appointments or care instructions that should be followed after pediatric urologic reconstruction to reduce the risk of glanular dehiscence?

Reference

Authors: Karabulut R, Turkyilmaz Z, Atan A, Kaya C, Sonmez K. Journal: Actas Urol Esp (Engl Ed). 2022 Jan-Feb;46(1):4-15. doi: 10.1016/j.acuroe.2020.11.013. Epub 2021 Nov 24. PMID: 34838491