Hernández-Aguilar G, Landa-Juárez S, Miguel-Gómez RD, Andraca Dumit R, Meneses Juárez JH

Language: Spanish
References: 16
Page: 22-26
PDF size: 390.96 Kb.

ABSTRACT

Introduction: Recurrent hypospadias is one of the most important surgical challenges waiting to be resolved. The objective of the present work is to report on the results of two-stage urethroplasty to correct secondary hypospadias.
Materials and methods: Patients presenting with recurrent or secondary hypospadias underwent urethral reconstruction.
Results: Sixteen patients presenting with recurrent hypospadias were operated on using tubularized island flaps taken from the residual prepuce in two-stage interventions with time between stages. Complications were fistulas, meatal stenosis and anastomosis contracture.
Discussion: The main problems in secondary hypospadias treatment are residual chordee and poor quality of scarred tissue. Two-stage repair with a delay between stages involves 4 basic principles: to improve vascularity, time of delay, circular catheter and to avoid urinary flow during the first stage. These principles promote adequate cicatrization with a minimal retraction of the neourethra, reduced complications and easy reproducibility.

REFERENCES

1. Elbakry A. Complications of the preputial island flap-tube urethroplasty. BJU Int 1999;84(1):89-94.

2. Snodgrass W, Lorenzo A. Tubularized incised-plate urethroplasty for hipospadias reoperation. BJU Int 2002;89(1):98-100.

3. Landa JS, Hernández AG, Ruedas DA. Uretroplastia con injerto de mucosa bucal. Bol Col Mex Urol 1994;11(3):196-200.

4. Barbagli G, Plaminteri E, Rizzo M. Dorsal onlay graft urethroplasty using penile

5. skin or buccal mucosa in adult bulbourethral stricture. J Urol 1998;160(4):1307-9.

6. Hernández AG, Landa JS, Zaldívar CJ. Uretroplastía en dos tiempos con injerto de mucosa bucal en hipospadias multioperados. Rev Mex Cir Ped 2002;9(3);149-52.

7. Hernández AG, Landa JS, Pimentel AA. Efectos del ácido hialurónico sobre el mecanismo de la cicatrización en la anastomosis de uretra. Bol Col Mex Urol 2002;17(1):26-31.

8. Snodgrass W, Mitchell ME. New concepts regarding chordee and the urethral in hipospadias surgery. AUA Update (Series 27)1999;18:210-5.

9. Nesbit RM. Congenital curvature of the phallus: report of three cases with description of corrective operation. J Urol 1965;93:230-2.

10. Dean GE, Bruno DK, Zaontz RM. Chordee repair utilizing a novel technique ensuring neurovascular bundle preservation. Tech Urol 2000;6(1):5-8.

11. Converse JM. Principles and procedures in correction, reconstruction and transportation. Plast Reconstr Surg 1997;7:3909-21.

12. Soutis M, Papandreou E, Mavridis G. Multiple failed urethroplasties: definitive repair with the Duckett Island-flap technique. J Ped Surg 2003;38(11):1633-6.

13. Duckett JW, Jr. Transverse preputial island flap technique for repair of severe hypospadias. Urol Clin North Am 1980;7(2):423-30.

14. Snodgrass W. Tubularized, incised plate urethroplasty for distal hypospadias. J Urol 1994;151(2):464-5.

15. Shanberg AM, Sanderson K, Duel B. Re-operative hipospadias repair using the Snodgrass incised plate urethroplasty. BJU Int 2001;87(6):544-7.

16. Hernández AG, Landa JS, Navarro PG. Utilidad del tejido fibrograso escrotal en la prevención de las fístulas uretrocutáneas en pacientes con hipospadias graves. Rev Mex Cir Ped 1997;14:139-41.