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[Hypospadias. Review of a caseload and of the various techniques used--279 cases]
M J Leal1, C P Monteiro, J Barbosa
1Cirurgia Pediátrica, Hospital de Santa Maria, Lisboa.
Insights
This review of 279 hypospadias cases shows a trend towards single-stage surgical procedures. These techniques offer benefits like fewer interventions and shorter hospital stays for pediatric patients.
Area of Science:
- Pediatric Surgery
- Urology
- Congenital Abnormalities
Context:
- Hypospadias is a common congenital condition affecting the urethral opening.
- Treatment strategies have evolved over time, with a focus on improving outcomes for affected children.
- This study reviews surgical interventions for hypospadias in a pediatric population.
Purpose:
- To classify hypospadias based on chordee and meatal position.
- To analyze surgical procedures and outcomes over time.
- To evaluate the trend towards single-stage repair for hypospadias.
Summary:
- A review of 279 pediatric hypospadias cases analyzed surgical techniques including meatotomy, MAGPI, Denis Browne Crawford (DBC), Van Der Meulen, and Duckett procedures.
- Glanular hypospadias (144 cases) were managed with meatotomy/meatoplasty or MAGPI.
- Distal penile hypospadias (87 cases) utilized DBC or Van Der Meulen procedures.
- Penile/perineal hypospadias with chordee (48 cases) involved chordee release followed by DBC or Duckett procedures.
- The study highlights a shift towards single-stage procedures (MAGPI, Van Der Meulen, Duckett) for hypospadias repair.
Impact:
- Single-stage procedures demonstrate potential advantages, including reduced mean interventions per patient (M I/P) and shorter hospitalization.
- Earlier repair completion in life may lead to reduced emotional distress for pediatric patients.
- The analysis balances the benefits of single-stage repairs against aesthetic outcomes and complication rates.
Abstract:
A review was made of 279 children with Hypospadias treated in Pediatric Surgery Department. Hypospadias was classified in accordance with existence of chordee and position of urethral meatus. Indications and the results are discussed according to Hypospadias type and surgical procedure performed over the years. Glanular Hypospadias (144 cases) were treated as follows: 117 by meatotomy or advancement meatoplasty and postectomy with 1.09 mean interventions per patient (M I/P). 24 by MAGPI procedure with 1,12 M I/P and 3 by other procedures. Distal penil Hypospadias without chordee (87 cases), 23 were treated by Denis Browne Crawford (DBC) procedure with 2,82 M I/P, 62 by Van Der Meulen procedure with 1,48 M I/P and 2 by other procedures. Hypospadias with chordee, penile and perineal (48 cases) 35 had chordee release followed by DBC procedure with 4,0 M I/P, 7 by Duckett procedure with 2,0 M I/P and 6 by other procedures. The present tendency towards the use of single stage procedures, namely MAGPI, Van Der Meulen and Duckett is analysed. Its advantages for patients and institutions--lower M I/P, decrease of hospitalization period, repair completed earlier in life and reduced emotional damage--are balanced with aesthetical results and frequency of complications.