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Severe hypospadias: long term follow-up with 3 different surgical techniques

D. Gorduza, E. de Mattos et Silva, CL. Gay, M. Catti, AF. Valmalle, D. Demede, F. Hameury, PY. Mure, P. Mouriquand

Pediatric Surgery Department, Hôpital Femme Mère Enfants HFME, Lyon, France

 

ABSTRACT

Objective: To compare the number of long-term postoperative complications in children with severe hypospadias (proximal division of the corpus spongiosum) for 3 different surgical urethroplasty techniques (Onlay, buccal mucosa graft and Koyanagy).

Material and methods: Between 1997 and 2007, 184 cases of severe hypospadias were operated in our Department by the same operator (PM): Onlay urethroplasty (group A: 133 cases), buccal mucosa graft (group B: 25 cases) and Koyanagy urethroplasty (group C: 26 cases). In 74 cases a preoperative androgenic stimulation was performed (37 in group A, 11 in group B and 26 in group C). A complementary corporeoplasty was needed in 18 cases.

Results: with a mean follow-up of 24 months, there were 68 cases noted to have complications: 38 cases in group A (28.5%), 14 cases in group B (56%) and 16 cases in group C (61.5%). Among these complications: 33 fistulas (15% in group A, 32% in group B and 19.2% in group C), 31 dehiscences of the urethra (11.3%, 20% and 42.3% respectively), 16 stenosis. The final result was functionally and cosmetically satisfying in 160 cases (94.7%, 80% and 53.8% respectively). The patients that underwent preoperative androgenic treatment presented more complications than the children not having received this treatment (Onlay 40.5% vs. 23.9%, buccal 70% vs. 43.7%).

Discussion: The surgical technique used for severe hypospadias depends on the aspect of the urethral plaque: if this and also the prepuce are of good quality, our first choice is Onlay urethroplasty. If the prepuce is no longer available, buccal mucosa graft urethroplasty is chosen. In case of marked hypoplasia of the ventral aspect of the penis, the Koyanagi technique is preferred. In our series, we found a very small percentage of necessary corporeoplasties. An important increase in the rate of postoperative complications was found in patients having undergone hormonal stimulation before the intervention, especially when this treatment was administered less than 3 months before the intervention.

 

Key words: severe hypospadias, long-term complications, Onlay urethroplasty, Koyanagy urethroplasty