Long-term results with a one-stage complex primary hypospadias repair strategy (the three-in-one technique)

Long-term results with a one-stage complex primary hypospadias repair strategy (the three-in-one technique)

Author Macedo, Antonio Autor UNIFESP Google Scholar
Liguori, Riberto Autor UNIFESP Google Scholar
Ottoni, Sergio L. Autor UNIFESP Google Scholar
Garrone, Gilmar Autor UNIFESP Google Scholar
Damazio, Eulalio Autor UNIFESP Google Scholar
Mattos, Ricardo M. Autor UNIFESP Google Scholar
Ortiz, Valdemar Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract Purpose: Complex primary hypospadias repair that warrants urethral plate division is treated mostly in two steps, not necessarily in two surgeries. Our aim was to review long-term results with a one-stage strategy based on reconstruction of the urethral plate with buccal mucosa graft and onlay transverse preputial flap anastomosis protected by a tunica vaginalis flap (the three-in-one concept).Material and methods: We were able to report on 35 patients operated for primary scrotal, penoscrotal and perineal hypospadias between March 2002 and June 2008. We reviewed all charts and had phone interviews with patients not seen for the last 24 months. We investigated parameters such as UTI occurrence, fistula, residual curvature, meatal stenosis, urethral diverticula, dehiscence, orchitis and parental perception.Results: Surgical complications occurred in 13 patients (37%): 4 meatal stenosis, 4 diverticula, 5 fistulae and 2 residual penile curvatures (total 42%). Meatal dilatation was successful in 2 cases, reflected in fistula resolution. the reoperation rate was 31.5% consisting mostly of simple procedures like fistula closure, meatotomy and penile curvature release, and complex diverticula repair in 4 cases. Parental perception was excellent for 57% (20 patients) and good or acceptable for the remaining. Mean follow-up was 4.6 years.Conclusions: the one-step strategy is associated with 68.5% success in a single operation, whereas 31.5% will need a second repair. We recognize that meatal problems are mostly associated with fistulae and diverticula; therefore, we recommend a final acceptable proximal glandar opening that will not compromise the neourethra. (C) 2011 Journal of Pediatric Urology Company. Published by Elsevier B.V. All rights reserved.
Keywords Hypospadia
Urethroplasty
Buccal mucosa
Language English
Date 2011-06-01
Published in Journal of Pediatric Urology. Oxford: Elsevier B.V., v. 7, n. 3, p. 299-304, 2011.
ISSN 1477-5131 (Sherpa/Romeo, impact factor)
Publisher Elsevier B.V.
Extent 299-304
Origin http://dx.doi.org/10.1016/j.jpurol.2011.02.024
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000292666200015
URI http://repositorio.unifesp.br/handle/11600/33718

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