Lei Kang1, Guizhen Huang1, Li Zeng1, Yidong Huang1, Xue Ma1, Yue Zhang1, Miao Yuan1, Jie Zhang1, Lugang Huang2. 1. Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China. 2. Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China. Electronic address: lugang992001@aliyun.com.
Abstract
OBJECTIVE: To describe a new modification of the Koyanagi technique for the one-stage repair of severe hypospadias and its short-term outcomes. PATIENTS AND METHODS: Our modified Koyanagi technique was performed in 24 patients with severe hypospadias between February 2012 and January 2015. The age of the patients ranged from 1.9 to 11.9 years (mean = 3.5 years). The flap design was similar to the Koyanagi technique, but our modified technique highlighted the following points: after the chordee was completely corrected, the urethral plate was recreated using foreskin, and then a U-shaped incision was made on the original and recreated urethral plate (as in the Duplay technique); a pedicled flap of the tunica vaginalis or scrotal dartos was used for additional coverage of the neourethra. RESULTS: The operation time lasted from 120 to 150 minutes (mean = 140 minutes). There were 5 patients (20.8%) who developed complications: 4 patients (16.7%) developed a fistula and 1 patient (4.2%) developed dehiscence of the urethra. There were no reported urethral strictures, meatal stenosis, or urethral diverticula. The complications in the 5 patients were successfully addressed with secondary repair, and all patients achieved satisfactory cosmetic and urethral functional results. CONCLUSION: The modified Koyanagi technique simplified the operation and better preserved the blood supply to the flap. The additional coverage of the neourethra using a pedicled flap of the tunica vaginalis or scrotal dartos significantly decreased the rate of fistula formation. This technique is highly suitable for the one-stage repair of severe hypospadias with penoscrotal transposition.
OBJECTIVE: To describe a new modification of the Koyanagi technique for the one-stage repair of severe hypospadias and its short-term outcomes. PATIENTS AND METHODS: Our modified Koyanagi technique was performed in 24 patients with severe hypospadias between February 2012 and January 2015. The age of the patients ranged from 1.9 to 11.9 years (mean = 3.5 years). The flap design was similar to the Koyanagi technique, but our modified technique highlighted the following points: after the chordee was completely corrected, the urethral plate was recreated using foreskin, and then a U-shaped incision was made on the original and recreated urethral plate (as in the Duplay technique); a pedicled flap of the tunica vaginalis or scrotal dartos was used for additional coverage of the neourethra. RESULTS: The operation time lasted from 120 to 150 minutes (mean = 140 minutes). There were 5 patients (20.8%) who developed complications: 4 patients (16.7%) developed a fistula and 1 patient (4.2%) developed dehiscence of the urethra. There were no reported urethral strictures, meatal stenosis, or urethral diverticula. The complications in the 5 patients were successfully addressed with secondary repair, and all patients achieved satisfactory cosmetic and urethral functional results. CONCLUSION: The modified Koyanagi technique simplified the operation and better preserved the blood supply to the flap. The additional coverage of the neourethra using a pedicled flap of the tunica vaginalis or scrotal dartos significantly decreased the rate of fistula formation. This technique is highly suitable for the one-stage repair of severe hypospadias with penoscrotal transposition.
Authors: Vanesa Rodríguez Fernández; Carlos López Ramón Y Cajal; Elena Marín Ortiz; Nerea Sarmiento Carrera Journal: Case Rep Obstet Gynecol Date: 2016-09-27
Authors: Tuan Hong Vu; Hoa Viet Nguyen; Quan Quy Hong; Hung Quang Pham; Tung Thanh Pham; Đang Hai Do; Thanh Đo Truong Journal: Ann Med Surg (Lond) Date: 2021-11-02