Topography in hypospadias repair

• 16 Apr 2021 02:00:08 PM
• |Pediatic Urology

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  Amilal Bhat

  16 Apr 2021 02:33:42 PM

  
  

  
  

  
  

  

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  Amilal Bhat

  16 Apr 2021 02:35:44 PM

  Picture 

  

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  Amilal Bhat

  16 Apr 2021 03:13:25 PM

  Original article PDF

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  Amilal Bhat

  17 Apr 2021 09:18:46 AM

  
  

  Topographic Labeling of Glans Penis and Corpus Spongiosum When Planning Surgery for Distal Hypospadia.

  Author Seleim H  in Devepress Open access  Journal

  Comments :

  Eyes don’t see if brain does not know holds true in hypospadias. Every details is available on the hypospadias penis. Authors have depicted the same the article with surface marking of the land marks. The same has been presented my presentation webinars of Paediatric urology on spongioplasty and chordee and are under  publication.  The  land marks are not only for the meatus and spongiosum but also the bifurcation of midline raphae, prominence  of spongiosal pillars but also the dorsal Bulls eye midline skin colour. All these land marks depicts the embryological events .

  Authors have touched the theory of the development of distal urethra showing it as a tubularization rather than invagination.  The whole gist of the repair is spongioplasty only.  Based on it he has done spongioplasty only with the concept of epithelization of the ventral deficit urethral plate.

  He neither incised the urethral not raised the glanular wings and glanuloplasty. And did not interposing healthy tissue cover. Author have not mobilized the spongiosum before spongioplasty.

   In my opinion the dorsal epithelization after incising the urethral plate is better than the ventral epithelization of spongiosal plate. Spongioplasty without mobilization of spongiosum is likely to under tension and have the chances of dehiscence.  Again the delayed epithelization or non-epithelization of spongiosal plate may lead to fistula . Approximated margins epithelize better.

  As far for interposing heathy interposing heathy tissue author don’t mobilize the dorsal dartos but in my opinion using the ventral dartos with the skin. The ventral dartos is equally good and we had been using the same since vey long and published in Journal of paediatric urology.( Bhat et al JPU PDF attached ).

  Amilal Bhat

  Bhat hyppospadias and reconstructive Urology hospital and research center.

   

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  Amilal Bhat

  17 Apr 2021 09:23:20 AM

  Figure 1 Showing the site of Dorsal hood and bifurcation of median raphae Depicting the embryological event .ie severity of hypospadias .

  Figure 2 Showing the surface markings of meatus , glanular wings and spongiosum.

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  Amilal Bhat

  17 Apr 2021 09:26:12 AM

  Comparison of variables affecting the surgical outcomes of tubularized incised plate urethroplasty in adult and pediatric hypospadias

  A. Bhat, M. Bhat, V. Kumar, R. Kumar, R. Mittal, G. Saksena

  http://dx.doi.org/10.1016/j.jpurol.2015.09.005

  Journal of Pediatric Urology (2016) 12, 108.e1e108.e7

  Summary Introduction

  The American Academy of Pediatrics recommends operating on hypospadias between the ages of 6e12 months. Since most births in developed countries are conducted in a hospital, parents are likely to be well informed and counseled about the hypospadias. However, significant numbers of births in developing countries are still conducted at home, with illiter- acy, poverty and ignorance often leading to late presentation at the hospital. Reported hypospadias- repair complication rates are higher in adults compared with those having surgery in childhood. The present study’s objective was to evaluate the factors affecting surgical outcome in hypospadias patients undergoing tubularized and tubularized incised plate urethroplasty (TIPU) in adulthood compared with childhood.

  Materials and methods

  A prospective study of 60 adult patients >16 years, and 60 pediatric patients <5 years who underwent TIPU for primary hypospadias between May 2008 and May 2012. Patients were operated on by a single surgeon, under similar circumstances, and were pre-operatively examined to assess meatal location, chordee, and torsion; they were also examined intra-operatively for quality of spongio- sum and urethral plate width. The outcomes were assessed by patient/parents for satisfaction regarding cosmesis, urinary stream and complications.

  Results

  The age of the patients varied from 16 to 27 years, with a mean of 20.8 years in adults, and 6 months to 5 years, with a mean of 2.1 years, in children. The type of hypospadias, degree of curvature, quality of spongiosum and urethral plate width were compa- rable in both groups, but complication rates were higher in adults (16.7%) than in the pediatric (6.7%) group (Figure 1AeD). Meatal stenosis responded well to dilatation, but fistulae required revision surgery and had a cure rate of 100%. The median follow-up was 37 months in adults, and 39 months in children.

  Discussion

  The higher complication rates in adults may be due to more frequent erections; increased susceptibility to infection along with relatively reduced vascu- larity lead to poor wound healing and increased complication rates. The limitation of the study was the small number of patients with mid and proximal hypospadias having lesser incidences in comparison with distal hypospadias. Adequate number of pa- tients in these subgroups could have further strengthened the statistical correlation. Secondly, there was no objective criterion like uroflowmetry to assess urinary stream.

  Conclusions

  Complication rates were higher in adults undergoing TIPU compared with pediatric patients, which was also statistically significant in distal hypospadias. The important factors in surgical outcome were: severity of hypospadias, degree of curvature, quality of spongiosum, and urethral plate width. 

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  Amilal Bhat

  17 Apr 2021 09:35:52 AM

  Ventral dartos cover 

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  Amilal Bhat

  17 Apr 2021 09:35:55 AM

  Ventral dartos cover 

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  Amilal Bhat

  17 Apr 2021 09:59:58 AM

  Picture 

  

  Tariq Abbas

  19 Aug 2021 01:23:45 AM

  Although different surgical procedures have been performed over the previous decades, lots of knowledge is lacking in hypospadiology. However, strong efforts are recently pushing towards objective classification, algorithm-based management and standardization. This article talking about the details of topographical landmarks is a real example on this pathway. One of the most important steps in the repair is to objectively categorize the different variables of the anatomical phenotypes of this anomaly from which Urethral plate is considered of high importance. (1) We have developed the plate objective scoring tool (POST) as a reproducible, and potentially objective approach to categorize Urethral plate quality. (2) Every effort should be paid to standardize other variable like measurement of penile curvature and extent of urethral hypoplasia in order to achieve a consistent plan and reliable communication. 

  
  

  References

  (1) Abbas TO, Braga LH, Spinoit AF, Salle JP. Urethral plate quality assessment and its impact on hypospadias repair outcomes: A systematic review and quality assessment. J Pediatr Urol. 2021 Jun;17(3):316-325. doi: 10.1016/j.jpurol.2021.02.017. Epub 2021 Feb 23. PMID: 33846072.

  (2) Abbas TO, Vallasciani S, Elawad A, Elifranji M, Leslie B, Elkadhi A, Pippi Salle JL. Plate Objective Scoring Tool (POST); An objective methodology for the assessment of urethral plate in distal hypospadias. J Pediatr Urol. 2020 Oct;16(5):675-682. doi: 10.1016/j.jpurol.2020.07.043. Epub 2020 Aug 5. PMID: 32830060.