The ratio of COL2A1:COL1A1 in dartos tissue patients with hypospadias. The inelasticity of dartos tissue and the regulation of collagen expression are significant factors in the pathophysiology of chordee associated with hypospadias. While the COL2A1:COL1A1 ratio is recognised as a measure of cell differentiation, there is yet to be a study specifically examining this ratio in hypospadias . The aim of this study was to determine the COL2A1:COL1A1 ratio. We collected 55 samples of dartos tissue, comprising 35 from patients with hypospadias procured from urethroplasty procedures and 20 from patients with phimosis collected during circumcision without any lichen cases at our institution. The gene expression levels of COL1A1 and COL2A1 in the dartos tissue were analyzed using reverse
Effect of Intravenous Paracetamol on Postoperative Recovery in Children Undergoing Hypospadias Repair under General Anaesthesia with Caudal Block: A Randomised Controlled Trial. To explore the impact of perioperative intravenous (IV) paracetamol, administered with caudal ropivacaine on the quality of postoperative recovery in children undergoing hypospadias repair. Double-blinded randomised controlled trial. Place and Duration of the Study: The operating room, post-anaesthesia care unit (PACU), and paediatric surgical ward at the Aga Khan University Hospital, from 31st January 2019 to 1st May 2022. Children aged 3-10 years undergoing hypospadias repair were randomly divided into two groups. Group P was administered IV paracetamol 15 mg/kg an hour before the completion of the repair procedure
"Surgical outcomes following caudal versus pudendal analgesia in hypospadias repair: a prospective randomized blinded pilot study". Caudal analgesia (CA) is a widely used method to tackle pain after hypospadias repair. Complications related to temporary penile engorgement has made people concerned about CA and switch to pudendal analgesia (PA). In this prospective randomized blinded study we compared CA and PA among children undergoing hypospadias repair. We hypothesized that pudendal analgesia would be equally effective as caudal analgesia, with no altered risk of surgical complications. All children undergoing single-stage distal hypospadias repair were randomized into CA or PA groups. In both groups, analgesia was provided under ultrasound guidance with 0.2% ropivacaine and 1 mcg/kg
Clinical characteristics, complications and satisfaction of megameatus intact prepuce (MIP) hypospadias variant: a 15 year retrospective study. To analyze the clinical characteristics, complications and patients satisfaction of MIP hypospadias variant. A retrospective analysis was performed for 31 patients with MIP admitted to our hospital from January 2008 to February 2023. All enrolled post-operative complications; however, none required reoperation. The only risk factors for complications were the meatus position and whether urethroplasty was performed.Only the occurrence of complications may affect patients satisfaction. MIP hypospadias variants can exhibit severe ventral curvature. Surgery can achieve good results with a low incidence of complications. A satisfactory skin
Performance of ultrasound in detecting fetal hypospadias during pregnancy: a pooled analysis. Opinions regarding the role and value of ultrasound in the diagnosis of prenatal hypospadias are diverse. Although hypospadias is not a fatal malformation, a higher degree of severity exerts a significant impact on children's physiology and psychology. On the other hand, hypospadias may be accompanied by accompanying anomalies, syndromic conditions, and fetal growth restriction (FGR). This study aimed to systematically assess the value of ultrasound in the prenatal diagnosis of hypospadias. In the systematic review and meta-analysis, we searched PubMed, Web of Science, Scopus, Embase, and China National Knowledge Infrastructure (CNKI) databases until June 30, 2024. The key terms included: hypospadias
Microscopic and molecular analysis of the Urethral Plate: A Step Towards Improved Hypospadias Surgery Outcomes. To investigate the microscopic and molecular structure of the urethral plate in hypospadias patients compared to normal urethral tissue, focusing on epithelial characteristics, cytokeratin expression, vascular patterns, and extracellular matrix components, including elastin fibers. We analyzed 8 full-thickness mid urethral plate samples from pediatric hypospadias patients using immunohistochemistry to evaluate epithelial structure, cytokeratin expression (PanCK, CK7, CK10, CK13, CK14), vascular patterns (vWF, CD31), and extracellular matrix components (elastin). Control tissues included fetal urethras and penile urethras from gender confirmation surgery. The hypospadias urethral plate
Chordee and hooded prepuce with no hypospadias; outcome of urethral preservation surgery with spongioplasty. Deficient ventral prepuce is a rare anomaly of prepuce with normally situated meatus. It is usually associated with this or hypoplastic urethra. A retrospective study included all infants diagnosed with a ventrally hooded prepuce. A penile degloving was the first step. Then reinforcement , repairing the injury, reinforcing the dartos pedicle flap, and spongioplasty are suitable options. It is possible to preserve the urethra in patients having chordee without hypospadias. Utmost care should be taken to avoid urethral injuries which are common because shaft skin is stuck to the urethral skin. Urethral injuries can be repaired primarily; however, there is a high incidence of fistula.
Utility of Preoperative Antimicrobial Prophylaxis in Hypospadias Repair: Results From NSQIP-Pediatrics. Literature supporting antimicrobial prophylaxis for hypospadias repairs is lacking, with largest studies including several hundred subjects. We sought to evaluate the association of a single dose of preoperative antibiotics in hypospadias repairs on postoperative outcomes using National Surgical Quality Improvement Program Pediatrics (NSQIP-P). The 2021-2022 NSQIP-P database was used to categorize hypospadias repairs into 3 groups - (1) 1-stage distal hypospadias repairs, (2) 1-stage proximal hypospadias repairs and second/third stage urethroplasties, and (3) repair of hypospadias complications. Patients with missing data regarding preoperative antibiotic prophylaxis administration were
Unilateral SLAM: A simple novel technique to correct complications of hypospadias. To evaluate Unilateral SLAM as a simple and effective option for repairing hypospadias complications. Between December 2018 and December 2023, 66 patients were treated at our center, with a minimum follow-up of 12 months. Cases included meatal retraction (n=4), distal fistula (n=11), and glandular dehiscence (n=44 ). Additionally, the technique was utilized during the second stage repair of proximal hypospadias in 7 cases. The inclusion criteria included patients with recurrent hypospadias or complicated hypospadias in which the morphology of the meatus, though coronal position, yet its edge is contiuous to one side with the glans giving and L-Shape or crescentic shaped meatus. This was observed in cases with partial
Effect of hydromorphone combined with ropivacaine caudal block on immune function after hypospadias surgery in children. This study aimed to evaluate the effects of caudal block anesthesia with hydromorphone-ropivacaine compared to ropivacaine alone on postoperative immune function and pain management in children undergoing hypospadias surgery. A total of 100 pediatric patients were randomly pressure, or oxygen saturation between the groups at any time point (p > 0.05). No significant differences were observed between the two groups in terms of postoperative adverse reactions (all p > 0.05). Caudal block anesthesia with hydromorphone-ropivacaine offers enhanced postoperative pain relief and a lesser impact on immune function compared to ropivacaine alone in children undergoing hypospadias
Widening of narrow urethral plates with lateral skin in TIP hypospadias repair: single center series. To compare the outcomes of hypospadias repair using tubularized incised plate (TIP) urethroplasty and modified TIP with lateral skin to widen the urethral plate (WTIP). Data were obtained from pre-pubertal boys who underwent primary hypospadias repair between May 2018 and July 2023. The cases of postoperative complications (17.6% vs. 21.6%, P = 0.550) were not statistically different between the TIP and WTIP groups. In addition, both groups did not differ significantly in postoperative uroflowmetry assessment. The described technique helps to create an adequately caliber aesthetic neomeatus and facilitates tubularization, especially in hypospadias with a narrow urethral plate. Our data suggest
Intravenous dexamethasone does not prolong the duration of pudendal nerve block in infants and children undergoing hypospadias surgery: A randomized clinical trial. The administration of intravenous dexamethasone increases the duration of neuraxial block and improves the quality of analgesia. However, little is known about these effects of dexamethasone on peripheral nerve blocks in children . In this study, we aimed to investigate the benefit of intravenous dexamethasone for enhancing the effect of pudendal block on postoperative analgesia in children who underwent hypospadias surgery. In total, 46 children aged 6-36 months who underwent hypospadias surgery were randomly allocated to either a control group (normal saline, group C) or dexamethasone group (0.5 mg/kg, group D). Pudendal block
Evaluation of Tubularized Incised Plate Urethroplasty with Spongioplasty-Dartosoraphy Reinforcement in Pediatric Hypospadias: A Randomized Controlled Study. The original description of tubularized incised plate urethroplasty (TIPU) was provided by Snodgrass in 1994. The results were significantly improved by several modifications. To decrease the incidence of complications, interposing in group A than in group B. Also, the difference in the mean Hypospadias Objective Scoring Evaluation between the two groups was statistically significant. TIPU with spongioplasty-dartosoraphy reinforcement is an effective modification of conventional TIPU. This modification appears to reduce the rate of complications and yield better cosmetic outcomes.
The long-term consequences of the hypospadias salvage repair issue. To present the long-term results of redo-hypospadias at our tertiary referral center following a failed prior repair. One hundred sixty-four individuals with a history of unsuccessful repairs qualified for our retrospective cohort study. Our inclusion criteria were as follows: pre-operative data that was accessible, redo -hypospadias that was successfully repaired, and at least three years of follow-up at the last hospital visit. The mean patient age was 91.3 ± 21.1 months. The mean follow-up after successful repair was 41.3 ± 3.1 months. Ninety-two (group A) had one prior repair, and 72 (group B) had 2 or 3 repairs. Group A underwent six primary techniques: 32 underwent Onlay Island Flap (OIF), 10 underwent Mathieu, 12
Scrotal flaps for skin deficit correction after failed hypospadias repair. To analyze the effectiveness of scrotal flaps' use for skin deficit correction in re-operative cases to improve hypospadias' treatment results in children. In the Urology Department of the Russian Children's Clinical Hospital (from 2013 to 2019) 46 patients were treated with hypospadias who underwent 3 to 7 failed repairs before being admitted to the clinic. Patients were divided into two groups: Group I - 24 patients with ventral skin deficit and proximal hypospadias; Group II - 22 patients with circumferential skin deficit and mid-shaft hypospadias. Scrotal flaps were used in both groups to cover the skin defect. The results were analyzed in short- and long-term follow-up of 2-8 years. Cosmetic results according
The application of the modified Snodgrass technique in hypospadias surgery. We aimed to explore the effectiveness of the modified tubularized incised plate urethroplasty (Snodgrass Technique) in hypospadias surgery. A study was conducted on 50 pediatric patients with hypospadias treated in our hospital from May 2020 to May 2023. The patients were divided into two groups based on the condition of their urethral plate; 22 patients were included in the study group and 28 patients were included in the control group. The control group underwent the traditional Snodgrass technique, while the study group received the modified Snodgrass technique. The two groups were compared in terms of treatment efficacy, preoperative and postoperative 6-month Hypospadias Objective Scoring Evaluation (HOSE) scores, surgical
3 M antimicrobial incise drape combined with MEBO in wound recovery of postoperative hypospadias surgery. To evaluate the efficacy of different dressing methods in wound healing and the postoperative outcome in children who underwent hypospadias repair. Altogether 109 children with distal hypospadias who underwent urethroplasty were recruited from our hospital between January 2021 and March 2023 , and dressing falling off, a lower pain degree during dressing removal, and a better overall comfort level than those of the control group. This method is cost-effective and clinically safe, which contributes to the postoperative recovery of children with hypospadias and is thus worth promoting and applying.
Evaluation of USG-guided novel sacral erector spinae block for postoperative analgesia in pediatric patients undergoing hypospadias repair: A randomized controlled trial. Erector spinae plane block (ESPB) has been found to be simple, safe, and effective at thoracic and lumbar levels. There is no randomized controlled trial evaluating its effectiveness at sacral level. The present study was conducted to evaluate its effectiveness at sacral level for postoperative analgesia in pediatric patients undergoing hypospadias repair. Forty children of 2-7 years with ASA grade I or II were included. They were randomly allocated to one of the two groups of 20 patients each. After induction of general anesthesia, patients of group I were given ultrasound-guided sacral ESPB with 1 ml/kg of 0.25
Reducing fistula rate in hypospadias repair: A comparative study between standard tubularized incised plate repair and incorporation of a layer of spongiosum tissue. The most prevalent complication in hypospadias repair is fistula formation. Adhering to the principle of providing urethroplasty coverage to mitigate fistula occurrence, we implemented a modification by integrating a spongiosum layer between the urethroplasty and the dartos flap. Our hypothesis posited that this approach would result in a reduced fistula formation rate. This study is a comparative analysis involving patients under 18 years of age who underwent primary hypospadias repair. The cases were allocated into two groups. In the study group, in addition to performing tubularized incised plate (TIP) repair
The Efficacy of Active Fistulation in Duckett Procedure for Proximal Hypospadias in Children. To explore the efficacy of active fistulation in the treatment of proximal hypospadias in children by comparing one-stage and two-stage Duckett procedure. A total of sixty-seven children who were diagnosed with proximal hypospadias and underwent Duckett operation at our hospital between January 2013 : In the treatment of proximal hypospadias in children, The active fistulation within the two-stage Duckett procedure significantly reduces the rate of stage 1 postoperative complications and improves parental satisfaction. The active fistulation may offer a more promising option for the treatment of proximal hypospadias in children.