Abstract
Objective: There are only a few studies evaluating long-term consequences of cases with severe proximal hypospadias. In this study, we compared the first 5 years and second 5 years of 34 severe proximal hypospadias cases that were treated by a combination of a transverse island flap (Duckett) and ventral skin flap (Thiersch-Duplay) in order to reveal long-term complications.
Material and Methods: The 34 cases were operated between May 2000- May 2009 by combining the Duckett and Thiersch-Duplay techniques, for which the short-term results were previously published. These 34 cases were invited to evaluate long-term results. Then, short- and long-term results were compared in terms of urethral functions and complications.results: In the short term, a proximal anastomotic stricture was observed in 3 cases (8.8%). In the long-term, there was no new anastomotic stricture observed. In the first evaluation, a diverticulum was noted in 1 case (2.9%), however, in the second evaluation, one more diverticula was noted and the diverticulum rate increased to 5.8%. In the short-term evaluation, 7 cases (20.6%) were operated due to a fistula. In the long-term evaluation, a fistula was observed in 2 more cases and fistula recurrence was observed in 2 cases.Two patients (5.9%) were diagnosed with persistent chordee on long-term follow-up and 4 patients (11.8%) complained of short penile length. Erection and ejaculatory function was normal in 16 cases who reached adolescence. Reoperation was required in 13 patients (38.2%). A reoperation was required in 38.5% of the cases in the long term. 28 out of 34 patients had no symptoms during urination, while the other 6 cases urinated with difficulty and had a thin stream. Urinary tract infections were seen in two patients with diverticula while 32 patients had no urinary tract infection. conclusion: In the long-term evaluation, 61.8% of the cases did not show any complications. However, 38.2 % of the cases required reoperation. Various complications such as short penile length and chordee that were not seen in the short-term follow-up were noted in longterm follow-up. It is suggested that patients with severe proximal hypospadias should be followed up for cosmetic problems and potential penile curvature, diverticula and late fistula complications
Keywords: Proximal hypospadias, Long-term outcome
References
- Pierik FH, Burdorf A, Hijman JM, de Muinck Keizer-Schrama SM, Juttmann RE, Weber RF. A high hypospadias rate in the Netherlands. Hum Reprod 2002;17:1112-5.
- Lund L, Engebjerg MC, Pedersen L, Ehrenstein V, Norgaard M, Sorensen HT. Prevalence of hypospadias in Danish boys: a longitudinal study, 1977-2005. Eur Urol 2009;55:1022-6.
- Castagnetti M, El-Ghoneimi A. Surgical management of primary severe hypospadias in children: Systematic 20-year review. J Urol 2010;184:1469-75.
- Algen AB, Khawand N, Skoog ST, Belman AB. Acquired megalourethra: An uncommon complication of the transverse preputial island flap urethroplasty. J Urol 1987;137:710-2.
- Mieusset R, Soulie M. Hypospadias: Psychosocial, sexual and reproductive consequence in adult life. J Androl 2005;26:163-8.
- Singh JC, Jayanthi VR, Gopalakrishnan G. Effect of hypospadias on sexual function and reproduction. Indian J Urol 2008;24:249- 52.
- Ebert AK, Bals-Pratsch M, Seifert B, Reutter H, Rosch WH. Genital and reproductive function in males after functional reconstruction of the exstrophy-epispadias complex-long term results. Urology 2008;72:566-9.
- Tiryaki T. Combination of tubularized island flap and ventral skin flap techniques in single- stage correction of severe proximal hypospadias. Urologia Internationalis 2010;84:269-74.
- Ikoma F, Shima H, Yabumoto H. Classification of enlarged prostatic utricle in patients with hypospadias. Br J Urol 1985;57:334-7.
