Related Experiment Videos
A new technique for skin closure in hypospadias: ipsilateral penoscrotal approximation for closure
K Nonomura1, T Koyanagi, N Sakakibara
1Department of Urology, Hokkaido University School of Medicine, Sapporo, Japan.
Insights
The novel ipsilateral penoscrotal approximation for closure (IPSAC) procedure offers a tension-relieving skin closure for hypospadias repair. This technique shows promise in improving outcomes, particularly for complex cases with scrotal deformities.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Reconstructive Surgery
Background:
- Hypospadias repair remains a challenge, especially in cases with proximal penile curvature or significant skin deficiency.
- Existing techniques may lead to complications such as meatal regression and urethrocutaneous fistulas.
- Scrotal deformities can complicate hypospadias repair, impacting functional and cosmetic outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of the ipsilateral penoscrotal approximation for closure (IPSAC) technique in hypospadias repair.
- To assess the functional and cosmetic results of IPSAC in patients with distal and proximal hypospadias.
- To identify the advantages of IPSAC in providing tension-relieving closure and correcting scrotal deformities.
Main Methods:
- A cohort of 16 patients (ages 2-45) with hypospadias underwent surgical repair using the IPSAC technique.
- The study included both one-stage and multi-staged repair approaches.
- Functional and cosmetic outcomes were assessed post-operatively.
Main Results:
- Complete functional success was achieved in all 6 patients with distal hypospadias.
- Functional success was observed in 7 out of 10 patients with proximal hypospadias.
- Complications included meatal regression and urethrocutaneous fistula in one-stage repairs, and one fistula in a multi-staged repair. Two cases had cosmetic thickening at the penile base.
Conclusions:
- The IPSAC procedure provides effective tension-relieving skin closure in hypospadias repair.
- IPSAC demonstrates significant functional success, particularly in distal hypospadias, and offers benefits for proximal cases.
- The technique effectively corrects scrotal deformities, enhancing outcomes in both one-stage and multi-staged repairs, especially in cases with penile skin deficiency.
Abstract:
Sixteen patients, between 2 and 45 years old, with hypospadias underwent repair with our new skin closure procedure called ipsilateral penoscrotal approximation for closure (IPSAC). Complete functional success was obtained in all 6 patients with distal hypospadias and in 7 of 10 patients with proximal hypospadias. Meatal regression and urethrocutaneous fistula were complications in one-stage repair. Another urethrocutaneous fistula resulted from fifth-stage repair in the case of an adult hypospadias cripple. Cosmetically, there were two cases with unsightly thickening of the base of the penis in this early series. It was found that this IPSAC procedure had two major advantages: it provided (1) a tension-relieving skin closure, and (2) correction of scrotal deformity, especially in one-stage repair with the parameatal flap and in multi-staged repair with absolute penile skin deficiency.