Recurrent Ventral Curvature with Long-Term Follow-up after Transverse Preputial Island UrethroplastyFunding This study was funded by the Beijing Municipal Administration of Hospitals “Dengfeng” Talent Training Plan (DFL20151102), Beijing Municipal Administration of Hospitals “Yangfan Plan”: Pediatric Urology (ZYLX201709), and Capital Development Fund of Health (2014-2-2093).
06 January 2019
21 March 2019
12 May 2019 (eFirst)
Objective This study was aimed to assess the long-term outcomes of recurrent ventral curvature (VC) repaired in early childhood after transverse preputial island flap urethroplasty.
Materials and Methods A total of 378 patients underwent transverse preputial island flap urethroplasty between January 2000 and January 2005 at our hospital. Of these patients, 43 were invited for assessment of VC after puberty. The age at surgery, types of hypospadias, degrees of recurrent VC, and surgical procedures were analyzed.
Results The study included 43 patients with a mean age of 15.9 years (range, 12.3–17.9). The average age at the time of primary surgery was 1.9 years (range, 1.2–3.6). Of 43 patients, recurrent VC was identified in 14 (32.5%). In total, 8 out of 16 patients (50.0%) were successfully treated by urethral plate transection with skin release during the primary surgery, and 6 out of 27 patients (28.6%) underwent additional dorsal plication (DP; p = 0.093). Severe recurrent VC was observed in four, moderate curvature was observed in four, and mild curvature was observed in six cases. Recurrent VC was present more often in patients with complications (34.6 vs. 24.1%, p = 0.331), especially in severe urethral strictures that required open surgical reconstruction (p = 0.039).
Conclusion Although the patients in our study represent only a small portion of the overall hypospadias population, it is notable that 32.5% of these patients showed recurrent VC, including 28.6% of patients with transection plus DP. We suggest long-term follow-up of hypospadias at least during adolescence or even into adulthood.
- 1 Baskin LS. Hypospadias and urethral development. J Urol 2000; 163 (03) 951-956
- 2 Devine Jr. CJ, Blackley SK, Horton CE, Gilbert DA. The surgical treatment of chordee without hypospadias in men. J Urol 1991; 146 (02) 325-329
- 3 Baskin LS, Duckett JW, Ueoka K, Seibold J, Snyder III HM. Changing concepts of hypospadias curvature lead to more onlay island flap procedures. J Urol 1994; 151 (01) 191-196
- 4 Spinoit AF, Van Praet C, Groen LA, Van Laecke E, Praet M, Hoebeke P. Congenital penile pathology is associated with abnormal development of the dartos muscle: a prospective study of primary penile surgery at a tertiary referral center. J Urol 2015; 193 (05) 1620-1624
- 5 Mettauer JP. Practical observations in those malformations of the male urethra and penis, termed hypospadias and epispadias, with an anomalous case. Am J Med Sci 1842; 4: 43-58
- 6 Baskin LS, Duckett JW. Dorsal tunica albuginea plication for hypospadias curvature. J Urol 1994; 151 (06) 1668-1671
- 7 Bhat A. Extended urethral mobilization in incised plate urethroplasty for severe hypospadias: a variation in technique to improve chordee correction. J Urol 2007; 178 (3, Pt. 1): 1031-1035
- 8 Kajbafzadeh AM, Arshadi H, Payabvash S, Salmasi AH, Najjaran-Tousi V, Sahebpor AR. Proximal hypospadias with severe chordee: single stage repair using corporeal tunica vaginalis free graft. J Urol 2007; 178 (3, Pt. 1): 1036-1042
- 9 Snodgrass W, Prieto J. Straightening ventral curvature while preserving the urethral plate in proximal hypospadias repair. J Urol 2009; 182 (4, Suppl.): 1720-1725
- 10 Duckett Jr JW. Transverse preputial island flap technique for repair of severe hypospadias. Urol Clin North Am 1980; 7 (02) 423-430
- 11 Long CJ, Canning DA. Hypospadias: are we as good as we think when we correct proximal hypospadias?. J Pediatr Urol 2016; 12 (04) 196.e1-196.e5
- 12 Barbagli G, De Angelis M, Palminteri E, Lazzeri M. Failed hypospadias repair presenting in adults. Eur Urol 2006; 49 (05) 887-894
- 13 Ekmark AN, Svensson H, Arnbjörnsson E, Hansson E. Postpubertal examination after hypospadias repair is necessary to evaluate the success of the primary reconstruction. Eur J Pediatr Surg 2013; 23 (04) 304-311
- 14 Stecker Jr. JF, Horton CE, Devine Jr. CJ, McCraw JB. Hypospadias cripples. Urol Clin North Am 1981; 8 (03) 539-544
- 15 Golomb D, Sivan B, Livne PM. , et al. Long-term results of ventral penile curvature repair in childhood. Urology 2018; 112: 161-163
- 16 Braga LH, Lorenzo AJ, Bägli DJ. , et al. Ventral penile lengthening versus dorsal plication for severe ventral curvature in children with proximal hypospadias. J Urol 2008; 180 (4, Suppl.): 1743-1747
- 17 Long CJ, Chu DI, Tenney RW. , et al. Intermediate-term followup of proximal hypospadias repair reveals high complication rate. J Urol 2017; 197 (3, Pt. 2): 852-858
- 18 Snodgrass W, Bush N. Surgery for primary proximal hypospadias with ventral curvature >30°. Current Urology Reports 2015; 16 (10) 69
- 19 Hollowell JG, Keating MA, Snyder III HM, Duckett JW. Preservation of the urethral plate in hypospadias repair: extended applications and further experience with the onlay island flap urethroplasty. J Urol 1990; 143 (01) 98-100
- 20 Hatzimouratidis K, Eardley I, Giuliano F. , et al; European Association of Urology. EAU guidelines on penile curvature. Eur Urol 2012; 62 (03) 543-552
- 21 Mureau MA, Slijper FM, Slob AK, Verhulst FC. Psychosocial functioning of children, adolescents, and adults following hypospadias surgery: a comparative study. J Pediatr Psychol 1997; 22 (03) 371-387
- 22 Rynja SP, de Jong TP, Bosch JL, de Kort LM. Functional, cosmetic and psychosexual results in adult men who underwent hypospadias correction in childhood. J Pediatr Urol 2011; 7 (05) 504-515