Complications following Staged Hypospadias Repair Using Transposed Preputial Skin Flaps

Irina Stanasel, Hoang Kim Le, Aylin Bilgutay, David R. Roth, Edmond T. Gonzales, Nicolette Janzen, Chester J. Koh, Patricio Gargollo, Abhishek Seth

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Purpose Proximal hypospadias repair using a staged approach is a complex reconstructive operation with the potential for significant complications requiring repeat surgery. We report outcomes of staged hypospadias repair using transposed preputial skin flaps and factors predictive of postoperative complications. Materials and Methods We retrospectively analyzed patients who underwent staged proximal hypospadias repair using transposed preputial skin flaps between 2002 and 2013. Patient demographics, operative details, complications, reoperations and factors predictive of complications were reviewed. Results A total of 56 patients were identified with a mean age of 14.1 months (median 14.3) at first stage. Mean followup was 38.6 months (median 34.1). Complications requiring additional unplanned operation(s) were observed in 38 patients (68%), including fistulas in 32 (57%), diverticula in 8 (14%), meatal stenosis in 5 (9%), urethral stricture in 8 (14%) and glans dehiscence in 3 (5%). In addition, redo first stage repair was performed in 4 patients (7%). Since some patients had more than 1 complication, the total number of complications is greater than the number of patients undergoing a redo operation. On univariate analyses the use of small intestinal submucosa was significantly associated with an increased risk of fistula (91% vs 49%, p = 0.02) and urethral diverticulum (64% vs 24%, p = 0.04). Incision of the tunica albuginea of the corpora was associated with an increased likelihood of fistula (77% vs 44%, p = 0.03). Finally, patients with glans dehiscence were significantly younger at first stage (5.8 vs 14.8 months, p = 0.01). Conclusions The reoperation rate for complications in children undergoing staged hypospadias repair using transposed preputial skin flaps is higher than previously reported.

Original languageEnglish (US)
Pages (from-to)512-516
Number of pages5
JournalJournal of Urology
Volume194
Issue number2
DOIs
StatePublished - Jan 1 2015

Fingerprint

Hypospadias
Skin
Reoperation
Fistula
Diverticulum
Urethral Stricture
Pathologic Constriction
Demography

Keywords

  • hypospadias
  • postoperative complications
  • surgical flaps
  • treatment outcome

ASJC Scopus subject areas

  • Urology

Cite this

Stanasel, I., Le, H. K., Bilgutay, A., Roth, D. R., Gonzales, E. T., Janzen, N., ... Seth, A. (2015). Complications following Staged Hypospadias Repair Using Transposed Preputial Skin Flaps. Journal of Urology, 194(2), 512-516. https://doi.org/10.1016/j.juro.2015.02.044

Complications following Staged Hypospadias Repair Using Transposed Preputial Skin Flaps. / Stanasel, Irina; Le, Hoang Kim; Bilgutay, Aylin; Roth, David R.; Gonzales, Edmond T.; Janzen, Nicolette; Koh, Chester J.; Gargollo, Patricio; Seth, Abhishek.

In: Journal of Urology, Vol. 194, No. 2, 01.01.2015, p. 512-516.

Research output: Contribution to journalArticle

Stanasel, I, Le, HK, Bilgutay, A, Roth, DR, Gonzales, ET, Janzen, N, Koh, CJ, Gargollo, P & Seth, A 2015, 'Complications following Staged Hypospadias Repair Using Transposed Preputial Skin Flaps', Journal of Urology, vol. 194, no. 2, pp. 512-516. https://doi.org/10.1016/j.juro.2015.02.044
Stanasel, Irina ; Le, Hoang Kim ; Bilgutay, Aylin ; Roth, David R. ; Gonzales, Edmond T. ; Janzen, Nicolette ; Koh, Chester J. ; Gargollo, Patricio ; Seth, Abhishek. / Complications following Staged Hypospadias Repair Using Transposed Preputial Skin Flaps. In: Journal of Urology. 2015 ; Vol. 194, No. 2. pp. 512-516.
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abstract = "Purpose Proximal hypospadias repair using a staged approach is a complex reconstructive operation with the potential for significant complications requiring repeat surgery. We report outcomes of staged hypospadias repair using transposed preputial skin flaps and factors predictive of postoperative complications. Materials and Methods We retrospectively analyzed patients who underwent staged proximal hypospadias repair using transposed preputial skin flaps between 2002 and 2013. Patient demographics, operative details, complications, reoperations and factors predictive of complications were reviewed. Results A total of 56 patients were identified with a mean age of 14.1 months (median 14.3) at first stage. Mean followup was 38.6 months (median 34.1). Complications requiring additional unplanned operation(s) were observed in 38 patients (68{\%}), including fistulas in 32 (57{\%}), diverticula in 8 (14{\%}), meatal stenosis in 5 (9{\%}), urethral stricture in 8 (14{\%}) and glans dehiscence in 3 (5{\%}). In addition, redo first stage repair was performed in 4 patients (7{\%}). Since some patients had more than 1 complication, the total number of complications is greater than the number of patients undergoing a redo operation. On univariate analyses the use of small intestinal submucosa was significantly associated with an increased risk of fistula (91{\%} vs 49{\%}, p = 0.02) and urethral diverticulum (64{\%} vs 24{\%}, p = 0.04). Incision of the tunica albuginea of the corpora was associated with an increased likelihood of fistula (77{\%} vs 44{\%}, p = 0.03). Finally, patients with glans dehiscence were significantly younger at first stage (5.8 vs 14.8 months, p = 0.01). Conclusions The reoperation rate for complications in children undergoing staged hypospadias repair using transposed preputial skin flaps is higher than previously reported.",
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AB - Purpose Proximal hypospadias repair using a staged approach is a complex reconstructive operation with the potential for significant complications requiring repeat surgery. We report outcomes of staged hypospadias repair using transposed preputial skin flaps and factors predictive of postoperative complications. Materials and Methods We retrospectively analyzed patients who underwent staged proximal hypospadias repair using transposed preputial skin flaps between 2002 and 2013. Patient demographics, operative details, complications, reoperations and factors predictive of complications were reviewed. Results A total of 56 patients were identified with a mean age of 14.1 months (median 14.3) at first stage. Mean followup was 38.6 months (median 34.1). Complications requiring additional unplanned operation(s) were observed in 38 patients (68%), including fistulas in 32 (57%), diverticula in 8 (14%), meatal stenosis in 5 (9%), urethral stricture in 8 (14%) and glans dehiscence in 3 (5%). In addition, redo first stage repair was performed in 4 patients (7%). Since some patients had more than 1 complication, the total number of complications is greater than the number of patients undergoing a redo operation. On univariate analyses the use of small intestinal submucosa was significantly associated with an increased risk of fistula (91% vs 49%, p = 0.02) and urethral diverticulum (64% vs 24%, p = 0.04). Incision of the tunica albuginea of the corpora was associated with an increased likelihood of fistula (77% vs 44%, p = 0.03). Finally, patients with glans dehiscence were significantly younger at first stage (5.8 vs 14.8 months, p = 0.01). Conclusions The reoperation rate for complications in children undergoing staged hypospadias repair using transposed preputial skin flaps is higher than previously reported.

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