OBJECTIVE: To describe a surgical method (a modified Duplay technique), and its results, for hypospadias repair, developed to avoid the common complication of fistula. PATIENTS AND METHODS: The urethroplasty was modified so that it no longer comprises a simple approximation of the urethral plate with no dissection. The inferior surface of the corpora cavernosa is exposed as far as the lateral border and to the end of the glans, allowing tension- free suturing of urethral tissues, with a lengthening effect of the intermediate plane. This corrects chordee and especially the 'bucket-handle' glans, and protects the reconstructed urethra and proximal urethra. The study included 51 children who had their hypospadias repaired over a 9-month period (mean age at surgery 20.6 months, range 1-11 years); 14 had coronal, three anterior penile juxta-coronal, 23 anterior penile, four medium penile, five posterior and two penoscrotal hypospadias. RESULTS: All children were followed and no fistula was apparent in any with anterior hypospadias; two fistulae occurred after repair of the posterior form. The risk of fistula is therefore reduced (two in 51). CONCLUSION: This technical modification can be used to treat all forms of distal hypospadias (glanular, glanulo-preputial, and anterior penile). It was also used for several cases of more severe hypospadias. These good results must be confirmed in a larger series of patients.
OBJECTIVE: To describe a surgical method (a modified Duplay technique), and its results, for hypospadias repair, developed to avoid the common complication of fistula. PATIENTS AND METHODS: The urethroplasty was modified so that it no longer comprises a simple approximation of the urethral plate with no dissection. The inferior surface of the corpora cavernosa is exposed as far as the lateral border and to the end of the glans, allowing tension- free suturing of urethral tissues, with a lengthening effect of the intermediate plane. This corrects chordee and especially the 'bucket-handle' glans, and protects the reconstructed urethra and proximal urethra. The study included 51 children who had their hypospadias repaired over a 9-month period (mean age at surgery 20.6 months, range 1-11 years); 14 had coronal, three anterior penile juxta-coronal, 23 anterior penile, four medium penile, five posterior and two penoscrotal hypospadias. RESULTS: All children were followed and no fistula was apparent in any with anterior hypospadias; two fistulae occurred after repair of the posterior form. The risk of fistula is therefore reduced (two in 51). CONCLUSION: This technical modification can be used to treat all forms of distal hypospadias (glanular, glanulo-preputial, and anterior penile). It was also used for several cases of more severe hypospadias. These good results must be confirmed in a larger series of patients.
Authors: Fayez Almodhen; Ahmed Alzahrani; Roman Jednak; Jean Paul Capolicchio; Mohamed T El Sherbiny Journal: Can Urol Assoc J Date: 2008-04 Impact factor: 1.862