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Cureus Aug 2023Background Hypospadias is a common congenital anomaly that needs repair at an early age (six months to one year). Ironically, many cases in India present late due to a...
Background Hypospadias is a common congenital anomaly that needs repair at an early age (six months to one year). Ironically, many cases in India present late due to a lack of healthcare facilities, poverty, and illiteracy. Adult patients are different from children as they are aware of their genitalia. They are concerned with the aesthetics and, predominantly, the potency. In this study, we present the perspectives and outcomes of 111 adult cases of hypospadias. Methodology In this retrospective study conducted between January 2010 and December 2020, 111 patients aged more than 14 years who were diagnosed with hypospadias of any level with or without mild-to-moderate chordee were included. Hypospadias repair using a tubularized incised plate (TIP) urethroplasty technique was performed, and patients after surgery were followed up at three months, six months, and 12 months for any complications with physical examination, uroflowmetry, and patient-related outcomes (PROs). Results Age varied from 14 years to 32 years (mean = 19.88 years, SD = 5.93). The most frequent meatus positions after chordee adjustment were distal (n = 64, 57.65%), middle (n = 25, 22.52%), and proximal (n = 22, 19.82%). Among these, four patients had penoscrotal transposition. Chordee was present in 65.7% (n = 73) of the cases. (<30° in 38.7%, n = 43; 30°-60° in 23.4%, n = 26, and >60° in 3.6%, n = 4). Chordee was corrected using many techniques, including ventral corporotomies. Urethroplasty was done using TIP and spongioplasty in 89% (n = 99), and one patient underwent inner preputial onlay flap urethroplasty. Snodgraft was used to augment the urethral plate in 10 cases. The success rate of one-stage surgery was 74.77% in our series, which significantly correlated with PROs. Uroflow varied from 12 mL/second to 18 mL/second, and in the majority of the cases, the flow rate improved over time. The most common complication was urethrocutaneous fistula in 11 (11.8%) patients, followed by glanular dehiscence in nine (8.1%) patients. Conclusions Adult patients undergoing primary hypospadias repair generally show good outcomes. Patients can have an acceptable mild degree of residual chordee and torsion, which correlate well with PROs. In our series, hypospadias fistula was the most common complication of hypospadias surgery, followed by glanular dehiscence.
PubMed: 37746428
DOI: 10.7759/cureus.44021 -
Frontiers in Pediatrics 2023Ectopic scrotum (ES) is an extremely rare congenital scrotal malformation. Ectopic scrotum with VATER/VACTERL [vertebral defects (V), anal atresia or anorectal...
BACKGROUND
Ectopic scrotum (ES) is an extremely rare congenital scrotal malformation. Ectopic scrotum with VATER/VACTERL [vertebral defects (V), anal atresia or anorectal malformations (A), cardiac defects (C), tracheoesophageal fistula with or without esophageal atresia (TE), cardiac defects, renal malformations (R), and limb defects (L)] association is even rarer. There are no uniform guidelines for diagnosis and treatment.
CLINICAL CASE
We described a 2-year-5-month-old boy who has ectopic scrotum and penoscrotal transposition and reviewed relevant literature in this report. We performed laparoscopy exploration, rotation flap scrotoplasty, and orchiopexy and achieved a great result during the postoperative follow-up.
CONCLUSIONS
Combined with the previous literature, we made a summary to come up with a plan for the diagnosis and treatment of ectopic scrotum. Rotation flap scrotoplasty and orchiopexy are worthy of considering operative methods in treating ES. For penoscrotal transposition or VATER/VACTERL association, we can treat the diseases individually.
PubMed: 36896407
DOI: 10.3389/fped.2023.1015384 -
Frontiers in Pediatrics 2022To explore a novel repair method for proximal hypospadias with incomplete penoscrotal transposition in children and evaluate its safety and outcomes.
OBJECTIVE
To explore a novel repair method for proximal hypospadias with incomplete penoscrotal transposition in children and evaluate its safety and outcomes.
METHODS
A retrospective analysis of clinical data was conducted for 86 children with severe proximal hypospadias with incomplete penoscrotal transposition who were hospitalized in our department between June 2018 and February 2021. In total, 42 patients (Group A) underwent repair following a one-stage method in which tunica vaginalis flap-covering was combined with a modified Glenn-Anderson procedure, while 44 patients (Group B) underwent a two-step repair consisting of tunica vaginalis flap-covering using the Duplay technique and the modified Glenn-Anderson procedure. The two groups were compared on operation time, length of postoperative hospital stay, postoperative complications, and associated costs.
RESULTS
All operations were successful in both groups. No statistical difference was observed between the two groups in incidence of stenosis of the urinary meatus (2.38% vs. 4.54%, = 0.279), urethral stricture (2.38% vs. 2.27%, = 0.948), urinary fistula (7.14% vs. 6.82%, = 0.907), or urinary infection (7.14% vs. 4.55%, = 0.309). Additionally, there was no statistical difference between the groups in operation time (63.21 ± 5.20 vs. 62.07 ± 4.47 min, = 0.059), postoperative off-bed time (7.02 ± 1.32 vs. 6.84 ± 1.20 days, = 0.456), or duration of hospitalization (10.55 ± 1.15 vs. 10.15 ± 1.45 days, = 0.092). However, Group B patients underwent an additional second-stage operation, incurring extra costs. Three months after surgery, Group A were judged more positively on the PPPS (specifically receiving higher scores on shaft skin and general appearance) by both the parents (shaft skin: 2.10 ± 0.82 vs. 1.93 ± 0.62, = 0.024; general appearance: 2.16 ± 0.91 vs. 1.93 ± 0.72, = 0.042) and the surgeon (shaft skin: 2.42 ± 0.70 vs. 2.25 ± 0.58, = 0.025; general appearance: 2.38 ± 0.69 vs. 2.29 ± 0.51, = 0.041). In most cases, the parents and surgeon were satisfied with the appearance of the genitals after one-stage repair.
CONCLUSION
The advantages of the novel repair technique include use of a single-stage operation, producing a better appearance at a lower cost. The tunica vaginalis flap-covering method is not only demonstrated to be safe and effective, but it is also a simpler method than the conventional operation.
PubMed: 36582507
DOI: 10.3389/fped.2022.872027 -
Translational Andrology and Urology Nov 2022To determine the risk factors for postoperative complications after primary hypospadias repair. Hypospadias has a high postoperative complication rate, and the risk...
BACKGROUND
To determine the risk factors for postoperative complications after primary hypospadias repair. Hypospadias has a high postoperative complication rate, and the risk factors of postoperative complications have attracted extensive attention.
METHODS
A total of 857 children who received primary surgical repair for hypospadias in our center between 3 January 2017 and 29 January 2021 were retrospectively analyzed. The collected data included age at time of surgery, type of hypospadias, body mass index (BMI), surgeon, operation time, length of reconstructed urethra, method of anesthesia (general anesthesia or general anesthesia combined with caudal anesthesia), and postoperative constipation. The risk factors for postoperative complications were analyzed by multivariate analysis.
RESULTS
The follow-up time in this study was 6-54 months, with a mean follow-up time of 29 months. A total of 96 (11.2%) of the 857 pediatric patients had postoperative complications, including 44 (45.8%) cases of urethral fistula, 14 (14.6%) cases of urethral stricture, 5 (5.2%) cases of urethral diverticula, 5 (5.2%) cases of distal dehiscence, 3 (3.1%) cases of poor exposure, 2 (2.1%) cases of residual curvature, 1 (1.0%) case of penoscrotal transposition, 6 (6.3%) cases of urethral stricture and diverticulum, 6 (6.3%) cases of urethral fistula and diverticulum, 3 (3.1%) cases of urethral fistula and postoperative residual curvature, 2 (2.1%) cases of urethral fistula and distal dehiscence, and 1 (1.0%) case each of urethral fistula and transposition, urethral diverticulum and poor exposure, urethral stricture and poor exposure, distal dehiscence and transposition, and residual curvature and transposition. After univariate analysis, type of hypospadias (P=0.038), operation time (P<0.001), length of reconstructed urethra (P=0.007), and postoperative constipation (P=0.019) were included in the multivariate logistic regression analysis. The results showed that postoperative constipation was an independent risk factor for complications [P=0.027, odds ratio (OR) =1.793, confidence interval (CI): 1.067 to 3.012].
CONCLUSIONS
Postoperative constipation is an important influencing factor for postoperative complications following primary hypospadias repair. Therefore, defecation management should be strengthened for hypospadias patients during the perioperative period.
PubMed: 36507491
DOI: 10.21037/tau-22-691 -
European Journal of Pediatric Surgery... Jan 2022"Cloaca" is a term used to describe an anomaly in the female where a single orifice is located in the perineum draining both urogenital and gastrointestinal tracts. Few...
"Cloaca" is a term used to describe an anomaly in the female where a single orifice is located in the perineum draining both urogenital and gastrointestinal tracts. Few reports used the same term "cloaca" to describe the counterpart anomaly in the male. We present two "male" cases of anorectal anomalies associated with significant penile deformity (caudally displaced penis) that were managed during the period between January 2010 and September 2021. Characteristically, both cases had a single "central" perineal orifice. The latter was located anterior to the predestined site of the normal anus and just beneath a caudally positioned hypospadiac phallus. The caudal displacement of the penis was strikingly obvious by the presence of severe form of penoscrotal transposition. Both cases were associated with a perineal swelling (hamartoma) just beside the central perineal orifice. The urethra was very short (like that in the female), besides the single perineal orifice, which makes the presentation very similar to cloacal anomalies.
PubMed: 35911497
DOI: 10.1055/s-0042-1750409 -
Clinical Case Reports Jul 2022We report a preterm male neonate presenting with a short trunk, short neck, low hairline, deformed ears, preauricular skin tag, penoscrotal transposition (PT), palmar...
We report a preterm male neonate presenting with a short trunk, short neck, low hairline, deformed ears, preauricular skin tag, penoscrotal transposition (PT), palmar crease, short and broad fingers and toes (brachydactyly), hypoplastic and deep-set nails, metatarsal abductus, and cross-fused, small echogenic kidneys. Radiologic findings and genetic studies are consistent with spondylocostal dysostosis (SCD) and autosomal dominant brachydactyly. This is the first case report of spondylocostal dysostosis and brachydactyly associated with and variants. We reviewed the literature and compared our patient's phenotype with previously reported cases of SCD.
PubMed: 35846898
DOI: 10.1002/ccr3.6000 -
European Journal of Medical Research Jul 2022Hypospadias is one of the most common congenital diseases of the genitourinary system in children. The European Association of Urology (EAU) Guidelines recommend that...
Clinical characteristics, socioeconomic factors and COVID-19 were associated with delayed surgery in children with hypospadias: a retrospective study of 4439 cases in a single center.
BACKGROUND
Hypospadias is one of the most common congenital diseases of the genitourinary system in children. The European Association of Urology (EAU) Guidelines recommend that children undergoing hypospadias surgery should be between 6 and 18 months. In China, where many children have hypospadias, it remains unknown whether clinical characteristics, socioeconomic factors and COVID-19 were associated with delayed surgery in children with hypospadias.
METHODS
We retrospectively analyzed children with hypospadias who underwent primary surgery at the Department of Pediatric Urology in Guangzhou Women and Children's Medical Center between January 2010 and October 2021. Patients who had two-stage surgery or a second round of surgery due to complications were excluded to eliminate data duplication. The clinical characteristics and demographic information were collected. We defined delayed surgery as primary surgery performed after 18 months following the EAU Guidelines.
RESULTS
A total of 4439 children diagnosed with hypospadias were included in the study. The median age (29.1 ± 16.7 months) of surgery for hypospadias in our study was much higher than the recommended age reported in the EAU guidelines, and 76.6% of the children underwent surgery after the age of 18 months. Children without comorbidities including cryptorchidism (odds ratio [OR] = 1.562; 95% confidence interval [CI] 1.199-2.034; p = 0.001), prostatic cyst (OR = 2.613; 95% CI 1.579-4.324; p < 0.001), penile hypoplasia (OR = 1.778; 95% CI 1.225-2.580; p = 0.002), inguinal hernia (OR = 2.070; 95% CI 1.394-3.075; p < 0.001), and penoscrotal transposition (OR = 4.125; 95% CI 1.250-13.619; p = 0.020) were more likely to receive delayed surgery. Living in a low economic area (OR = 1.731; 95% CI 1.068-2.806; p = 0.026) or not close to a main medical center (OR = 1.580; 95% CI 1.370-1.824; p < 0.001) was highly associated with delayed surgery. The proportion of children undergoing delayed surgery and the median age of surgery during the COVID-19 pandemic were significantly higher than those before the COVID-19 pandemic (p = 0.004 and < 0.001, respectively).
CONCLUSIONS
Most children with hypospadias received delayed surgery (surgical age > 18 months). Comorbidities, living in a low economic area, too far from a main medical center and the COVID-19 pandemic were highly associated with delayed surgery. It is vital to improve the public awareness of hypospadias and strengthen the re-education of primary community doctors to reduce delayed surgery.
Topics: Adult; COVID-19; Child; Child, Preschool; Female; Humans; Hypospadias; Infant; Male; Middle Aged; Pandemics; Retrospective Studies; Socioeconomic Factors
PubMed: 35843999
DOI: 10.1186/s40001-022-00744-6 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Jun 2022To investigate the effectiveness of penile up transfer method in the treatment of penoscrotal transposition (PST) in children.
OBJECTIVE
To investigate the effectiveness of penile up transfer method in the treatment of penoscrotal transposition (PST) in children.
METHODS
A clinical data of 46 children with PST admitted between January 2015 and March 2021 and met selective criteria was retrospectively analyzed. The M-shaped scrotal flap method was adopted in 21 cases (group A), and the penile up transfer method was adopted in 25 cases (group B). There was no significant difference in age and PST typing between the two groups ( =0.491, =0.626; =0.710, =0.790). The operation time and postoperative complications of the two groups were recorded and compared, and the correction effect of PST was evaluated.
RESULTS
All operations were successfully completed, and no urethral injury occurred during operation. The operation time was significantly less in group B than in group A [(70.36±9.76) minutes . (96.62±13.18) minutes; =7.553, =0.000]. All children were followed up 6-33 months (mean, 13.2 months). There were 5 cases (23.8%) of skin necrosis and 6 cases (28.6%) of scar hyperplasia in group A, and 1 case (4.0%) of skin necrosis and 1 case (4.0%) of scar hyperplasia in group B. The incidence of complication was significantly lower in group B than in group A ( =3.949, =0.047; =5.341, =0.021). In the evaluation of PST correction at 6 months after operation, there were 15 cases of complete correction and 6 cases of incomplete correction in group A, 24 cases of complete correction and 1 case of incomplete correction in group B, and the difference was significant ( =5.341, =0.021).
CONCLUSION
The penis up transfer method is not only easy to correct PST, but also can correct scrotal separation at the same time, with fewer postoperative complications and satisfactory correction effect of penile scrotal appearance.
Topics: Abnormalities, Multiple; Child; Cicatrix; Humans; Hyperplasia; Male; Necrosis; Penis; Postoperative Complications; Retrospective Studies; Scrotum; Urethral Diseases
PubMed: 35712938
DOI: 10.7507/1002-1892.202201010 -
Complete Penoscrotal Transposition with Other Extragenital Anomalies in a Neonate Delivered at Term.Case Reports in Urology 2021A complete penoscrotal transposition (CPST) is a very uncommon congenital maldevelopment that is always associated with other abnormal body variations (malformations)....
A complete penoscrotal transposition (CPST) is a very uncommon congenital maldevelopment that is always associated with other abnormal body variations (malformations). We report a rare case of a term neonate delivered with CPST, which had a flaccid penis and an intact scrotum with unilateral limb and digital deformity, imperforate anus, cardiac malformation a facial deformity. Neonate died two hours after delivery. The foetal abnormality was not detected through routine antenatal services received by the mother.
PubMed: 33859860
DOI: 10.1155/2021/6676301 -
Radiology Case Reports Apr 2021Diphallia or duplication of penis is extremely rare condition with a reported incidence of 1 in 5-6 million live births. Approximately around 100 cases of diphallia have...
Diphallia or duplication of penis is extremely rare condition with a reported incidence of 1 in 5-6 million live births. Approximately around 100 cases of diphallia have been described in literature, each case have a unique presentation from associated anomalies. Clinically these patients can be classified into complete (true diphallia) or partial duplication. In true diphallia, each penis has 2 corpora cavernosa and 1 corpus spongiosum. If the duplicate penis is smaller or rudimentary with complete structure, it is described as true partial diphallia. The term bifid phallus is used if there is only one corpus cavernosum in each penis. Due to low incidence and varied presentation, not much is known about the underlying pathophysiology, management options, and outcomes. Here, we report a case of partial diphallia with associated penoscrotal transposition of 2 hemi-scrotums.
PubMed: 33537104
DOI: 10.1016/j.radcr.2020.12.031