Recurrent Ventral Curvature with Long-Term Follow-up after Transverse Preputial Island Urethroplasty
Chaoxu Wang1, Weiping Zhang1, Hongcheng Song1
1Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China.
Insights
Recurrent ventral curvature (VC) affects over 30% of hypospadias patients after childhood surgery. Long-term follow-up into adulthood is recommended for better outcomes.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Hypospadias Research
Background:
- Transverse preputial island flap urethroplasty is a common procedure for hypospadias.
- Recurrent ventral curvature (VC) can occur after initial surgical repair.
- Long-term outcomes of VC repair in childhood require further investigation.
Purpose of the Study:
- To assess the long-term outcomes of recurrent ventral curvature (VC) after transverse preputial island flap urethroplasty.
- To identify factors associated with recurrent VC in patients who underwent hypospadias repair in early childhood.
Main Methods:
- Retrospective analysis of 43 patients who underwent transverse preputial island flap urethroplasty between 2000 and 2005.
- Assessment of recurrent VC after puberty.
- Analysis of age at surgery, hypospadias type, VC degree, and surgical procedures.
Main Results:
- Recurrent VC was identified in 32.5% of patients.
- Successful treatment rates varied: 50.0% with urethral plate transection and skin release, 28.6% with additional dorsal plication (DP).
- Recurrent VC was more frequent in patients with complications, particularly severe urethral strictures requiring open reconstruction.
Conclusions:
- A significant proportion (32.5%) of patients experienced recurrent VC after childhood hypospadias repair.
- Long-term follow-up of hypospadias patients into adolescence and adulthood is crucial.
- Further research may optimize surgical techniques to minimize recurrent VC.
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.
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