Recent surgical advances in management Of Hypospadias
Mahmoud Shamaash Ismail;
Abstract
SUMMARY
H
ypospadias refers to a penile defect in which the urethral orifice terminates on the ventral aspect of the penis proximal to the normal site. It may be anywhere from the tip of the penis to the perineum. Hypospadias may be associated with a variable degree of ventral curvature of the penis called chordee.
Hypospadias is one of the commonest congenital anomalies in males with an incidence of one in 250 live male births.
Hypospadias is classified into distal & proximal hypospadias. Proximal hypospadias represent 20% of the total number of cases. It is subdivided into mid penile, posterior penile, penoscrotal, scrotal & perineal hypospadias.
Early operation before one year of age is of great benefit up to the school age to achieve:
- Easy nursing of young infants.
- Reduction the psychological impact of surgery on the child and his parents.
Fine or microsurgical instruments, delicate suture material (6-0 or 7-0) combined with good optical magnification (3.5 times) is recommended in all hypospadias surgery.
For avoidance of complications of electrocautery the use of bipolar electrocautery or a low setting of 5 watts coagulation for hemostasis is recommended.
No single technique is fit for one type of hypospadias, every patient has it proper selected operation.
Single stage operations are now well established especially after the introduction of artificial erection test and for those cases of anterior hypospadias, in particular.
Lingual mucosa may provide a substitute in the absence of suitable tissue for urethroplasty.
In comparison of grafts and flaps, there is no significant difference regarding operative time, catheter duration, and complication rate. Furthermore, with ease of preputial graft harvest and presence of ENT team working at the same time for buccal grafts, operative time can be shortened.
Multilayered closure using meticulous surgical techniques should be undertaken, and a subcutaneous flap created by dissection from the lateral skin flap should be brought over the suture line to avoid opposing of suture lines and decreasing the incidence of recurrence of fistula.
Post-operative care including good analgesia, antibiotics prophylactically proper method of urine diversion, proper
H
ypospadias refers to a penile defect in which the urethral orifice terminates on the ventral aspect of the penis proximal to the normal site. It may be anywhere from the tip of the penis to the perineum. Hypospadias may be associated with a variable degree of ventral curvature of the penis called chordee.
Hypospadias is one of the commonest congenital anomalies in males with an incidence of one in 250 live male births.
Hypospadias is classified into distal & proximal hypospadias. Proximal hypospadias represent 20% of the total number of cases. It is subdivided into mid penile, posterior penile, penoscrotal, scrotal & perineal hypospadias.
Early operation before one year of age is of great benefit up to the school age to achieve:
- Easy nursing of young infants.
- Reduction the psychological impact of surgery on the child and his parents.
Fine or microsurgical instruments, delicate suture material (6-0 or 7-0) combined with good optical magnification (3.5 times) is recommended in all hypospadias surgery.
For avoidance of complications of electrocautery the use of bipolar electrocautery or a low setting of 5 watts coagulation for hemostasis is recommended.
No single technique is fit for one type of hypospadias, every patient has it proper selected operation.
Single stage operations are now well established especially after the introduction of artificial erection test and for those cases of anterior hypospadias, in particular.
Lingual mucosa may provide a substitute in the absence of suitable tissue for urethroplasty.
In comparison of grafts and flaps, there is no significant difference regarding operative time, catheter duration, and complication rate. Furthermore, with ease of preputial graft harvest and presence of ENT team working at the same time for buccal grafts, operative time can be shortened.
Multilayered closure using meticulous surgical techniques should be undertaken, and a subcutaneous flap created by dissection from the lateral skin flap should be brought over the suture line to avoid opposing of suture lines and decreasing the incidence of recurrence of fistula.
Post-operative care including good analgesia, antibiotics prophylactically proper method of urine diversion, proper
Other data
| Title | Recent surgical advances in management Of Hypospadias | Other Titles | التقنيات الجراحية الحديثة لعلاج الاحليل السفلى | Authors | Mahmoud Shamaash Ismail | Issue Date | 2014 |
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