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Outcome of Pediatric Hypospadias

This document discusses hypospadias, a birth defect where the opening of the urethra is on the underside of the penis instead of at the tip. It summarizes the surgical techniques used to repair hypospadias in children and examines the long-term outcomes of these surgeries as patients reach adulthood, including potential difficulties with voiding and sexual function. The most common technique now is tubularized incised plate urethroplasty. The conclusion calls for more valid studies on how hypospadias repairs performed in childhood affect adult patients' cosmetic results, urination, and sexual performance.

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joerizal
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© © All Rights Reserved
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Download as PPTX, PDF, TXT or read online on Scribd
175 views

Outcome of Pediatric Hypospadias

This document discusses hypospadias, a birth defect where the opening of the urethra is on the underside of the penis instead of at the tip. It summarizes the surgical techniques used to repair hypospadias in children and examines the long-term outcomes of these surgeries as patients reach adulthood, including potential difficulties with voiding and sexual function. The most common technique now is tubularized incised plate urethroplasty. The conclusion calls for more valid studies on how hypospadias repairs performed in childhood affect adult patients' cosmetic results, urination, and sexual performance.

Uploaded by

joerizal
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Outcome of Pediatric

Hypospadias
Repair in Adulthood
dr. Johanes R.M Marpaung

dr. Suwardi Sp.B, Sp.BA


Open Access Journal of Urology
28 April 2010
Boris Chertin1,Dan Prat1,Ofer Z Shenfeld2

Introduction
Hypospadias may be defined as a ventral
penile hypoplasia with some associated
anomalies such as the following: opening of
the meatus below the tip of the penis, ventral
penile curvature (chordee) and a hooded
foreskin with excessive dorsal part.
The incidence of hypospadias in the Western
countries has been in rise tremendously and
is approximately 1 to 150,300 male births
Mouriquand PDE, Persad R, Sharma S.

Journal of Pediatric Urology (2013)


9, 1006 - 1017

Journal of Pediatric Urology (2013)


9, 1006 - 1017

Hypospadias
surgical
procedure
characterized by three steps:

is

1. Correction of chordee straightening of the penis;


2. Urethroplasty reconstruction of the missing part
of the urethra;
3. Restoration of the tissues forming the ventral
radius of the penis the glans, corpus spongiosum,
and skin, which finally will lead to the normal
cosmetic appearance of the penis.
Chertin B, Koulikov D, Fridmans A, Farkas A.

Methods
All surgical technique for
hypospadias repair may be divided
into four groups
1. Urethral Advancement
2. Urethral Tubularization
3. Vascularized Flaps
4. Graft

Journal of Pediatric Urology (2013)


9, 1006 - 1017

Urethral Advancement - The techniques


for advancing the urethra refer to
processes of adjusting the distal extremity
of the penis, used in repairing anterior
forms of hypospadias, without associated
chordee.
Urethral Tubularization - The general
principle of these techniques is, as their
name indicates, to use the urethral plate,
which, once preserved, can be tubularized
upon itself as far as the tip of the glans.
Journal of Pediatric Urology (2013)
9, 1006 - 1017

The vascularized flaps - consist of the


creation of a new urethral tube using
various flaps of skin taken directly
from the penis
Grafts - In the last group are those
children in whom the preputial
mucosa is insufficient, the use a free
graft of buccal mucosa

Journal of Pediatric Urology (2013)


9, 1006 - 1017

Voiding difficulties following


hypospadias repair
Potential long-term sequels of hypospadias and its

surgical correction may include difficulties in voiding,


sexual function, psychosexual adjustment and selfappraisal. These difficulties often evolve long after
surgical repair, as children grow to adulthood. Despite
this,

patient-driven

data

on

long-term

functional

outcomes and satisfaction are very limited, leaving the


true

success

of

hypospadias

surgery

unknown.
Journal of Pediatric Urology (2013)
9, 1006 - 1017

essentially

Recently a Canadian group20 published their


experience with the long term follow-up after
hypospadias repair with special emphasis on
urinary symptoms in adulthood.
They evaluated 115 patients who underwent
different types of hypospadias repair.
Only 28 patients answered on the mailed
questionnaire.
The average age of respondents was 20
years.
52% of subjects reported difficulty starting
their streams when voiding
van der Werff JFA, Boeve E, Brus CA, van der Meulen JC

Sexual function in adults, who have


previously undergone hypospadias
repairs
As the child grows into adulthood, sexual function
becomes an important issue
Sexual dysfunction in adults that have undergone
hypospadias surgery may take on many forms
including body image issues due to a history of
genital surgery, and genital scaring, residual or
recurrent penile curvature possibly causing both
cosmetic and functional difficulties, erectile
dysfunction and ejaculatory problems.
Journal of Pediatric Urology (2013)
9, 1006 - 1017

Not surprisingly, data concerning these questions


are scant and difficult to assess, since most
pediatric urologists do not follow their patients
into adulthood and are not experts in sexual
medicine
An additional confounding factor is the fact that
most reports in the literature concerning the long
term results of hypospadias surgery in general,
and sexual outcomes in particular, are based on
patients
operated
decades
ago
using
reconstructive techniques that today would be
considered outdated

Journal of Pediatric Urology (2013)


9, 1006 - 1017

Results:
The techniques for hypospadias repair
have evolved over the years. The most
popular technique now is tubularized
incised plate urethroplasty. Long-term
results with the use of the new
techniques of the hypospadias repair in
terms of voiding and sexual problems
should be addressed.
Journal of Pediatric Urology (2013)
9, 1006 - 1017

Conclusion
There is a need for valid studies on the
outcomes of hypospadias repair in
adults
that
were
performed
in
childhood in terms of cosmetic
appearance,
voiding
and
sexual
performance.

Boris Chertin1, Dan Prat1,Ofer Z Shenfeld2


Journal of Pediatric Urology (2013)
9, 1006 - 1017

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