Staged Buccal Mucosa Graft Urethroplasty for Proximal Hypospadias in Children: A Short- to Mid-Term Follow-Up Retrospective Study

Abstract

Introduction The aim of this study is to report our experience with modified staged buccal mucosa graft urethroplasty for the repair of proximal hypospadias in children and adolescents.

Materials and Methods A total of 183 patients were treated at the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between 2010 and 2019. The patients were grouped according to age: (1) within 1.5-year-old group, (2) prepuberty group (Tanner stage 1), and (3) puberty group.

Results In total, 153 patients were included in this study. Thirty-six patients had complications: seven after stage one; 29 after stage two; one patient had two complications. Maximum flow rates were 11.80 ± 1.46 mL/s in the 1.5-year-old group, 13.24 ± 2.61 mL/s in the prepuberty group, and 13.60 ± 2.20 mL/s in the puberty group (p = 0.199). Average flow rates were 6.86 ± 1.37, 7.94 ± 1.74, and 7.88 ± 1.22 mL/s, respectively (p = 0.203). The optimal hypospadias objective scoring evaluation score of 16 was seen in 117 patients (76%), the score of 15 in 23 patients (15%), 14 in 10 (7%), and 13 in 3 patients (2%). Patients with an uncomplicated treatment (no complication) had a higher clinical outcome than patients with a complication (15.8 ± 0.53 vs. 15.3 ± 0.97, with or without complication, p = 0.000). Multivariable analyses showed that previous treatment was closely related to the complication rate (p = 0.016).

Conclusion The modified procedure allows for two-stage repair of proximal hypospadias with good results with a low complication rate and good functional results. Delaying operation did not increase complication rates in our research.

Keywords

oral mucosa graft - proximal hypospadias - staged hypospadias repair

• References

• 1 Springer A, van den Heijkant M, Baumann S. Worldwide prevalence of hypospadias. J Pediatr Urol 2016; 12: 151-152
• 2 Castagnetti M, El-Ghoneimi A. Surgical management of primary severe hypospadias in children: systematic 20-year review. J Urol 2010; 184 (04) 1469-1474
• 3 Al-Adl AM, Abdel Aal AM, El-Karamany TM, Noureldin YA. Two-stage repair of proximal hypospadias with moderate to severe chordee using inner preputial skin graft: prospective evaluation of functional and cosmetic outcomes. World J Urol. 2020 . Doi: 10.1007/s00345-020-03075-5
• 4 Misra D, Elbourne C, Vareli A. et al. Challenges in managing proximal hypospadias: a 17-year single-center experience. J Pediatr Surg 2019; 54 (10) 2125-2129
• 5 Saltzman AF, Carrasco Jr A, Colvin A, Campbell JB, Vemulakonda VM, Wilcox D. Patients with disorders of sex development and proximal hypospadias are at high risk for reoperation. World J Urol 2018; 36 (12) 2051-2058
• 6 Snodgrass W, Bush N. Staged tubularized autograft repair for primary proximal hypospadias with 30-Degree or greater ventral curvature. J Urol 2017; 198 (03) 680-686
• 7 Zhao M, Li Y, Tang Y. et al. Two-stage repair with buccal mucosa for severe and complicated hypospadias in adults. Int J Urol 2011; 18 (02) 155-161
• 8 Austin PF, Bauer SB, Bower W. et al. The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the International Children's Continence Society. Neurourol Urodyn 2016; 35 (04) 471-481
• 9 Manasherova D, Kozyrev G, Nikolaev V. et al. Bracka's method of proximal hypospadias repair: preputial skin or buccal mucosa?. Urology. 2019
• 10 Stanasel I, Le HK, Bilgutay A. et al. Complications following staged hypospadias repair using transposed preputial skin flaps. J Urol 2015; 194 (02) 512-516
• 11 Nelson CP, Bloom DA, Kinast R, Wei JT, Park JM. Patient-reported sexual function after oral mucosa graft urethroplasty for hypospadias. Urology 2005; 66 (05) 1086-1089
• 12 Lorenzo AJ, Pippi Salle JL, Zlateska B, Koyle MA, Bägli DJ, Braga LH. Decisional regret after distal hypospadias repair: single institution prospective analysis of factors associated with subsequent parental remorse or distress. J Urol 2014; 191 (5, Suppl): 1558-1563
• 13 Snodgrass W, Prieto J. Straightening ventral curvature while preserving the urethral plate in proximal hypospadias repair. J Urol 2009; 182 (4, Suppl): 1720-1725
• 14 Rynja SP, de Jong TPVM, Bosch JLHR, de Kort LMO. Proximal hypospadias treated with a transverse preputial island tube: long-term functional, sexual, and cosmetic outcomes. BJU Int 2018; 122 (03) 463-471
• 15 Riedmiller H, Androulakakis P, Beurton D, Kocvara R, Gerharz E. ; European Association of Urology. EAU guidelines on paediatric urology. Eur Urol 2001; 40 (05) 589-599
• 16 Holland AJ, Smith GH, Ross FI, Cass DT. HOSE: an objective scoring system for evaluating the results of hypospadias surgery. BJU Int 2001; 88 (03) 255-258
• 17 Springer A. Assessment of outcome in hypospadias surgery: a review. Front Pediatr 2014; 2: 2
• 18 Leunbach TL, O'Toole S, Springer A. et al. A systematic review of core outcomes for hypospadias surgery. Sex Dev 2019; 13: 165-170
• 19 Liu MM, Holland AJ, Cass DT. Assessment of postoperative outcomes of hypospadias repair with validated questionnaires. J Pediatr Surg 2015; 50 (12) 2071-2074