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Urethroplasty by use of turnover flaps (modified mathieu procedure) for distal hypospadias repair in adolescents: comparison with the tubularized incised plate procedure.

Bae SH, Lee JN, Kim HT, Chung SK - Korean J Urol (2014)

Bottom Line: The patient demographics were similar in the two groups.There were no significant differences in perioperative outcomes between the groups, including mean operative time, duration of hospital stay, and urethral catheterization.In postoperative uroflowmetry, the plateau-shaped curve rate was lower in the turnover flap group (1/12, 8.3%) than in the TIP group (5/19, 26.3%); the peak flow was higher (p=0.030).

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea.

ABSTRACT

Purpose: The purpose of this study was to examine whether urethroplasty with a turnover flap, as an alternative method of distal hypospadias repair in adolescents, improves the outcome of surgery.

Materials and methods: Between January 2004 and December 2013, a total of 38 adolescents (aged 11-17 years) underwent distal hypospadias repair with either the tubularized incised plate (TIP) procedure (n=25) or the turnover flap procedure (n=13). The turnover flap procedure was performed with a proximal, ventral penile flap that was turned over to cover the urethral plate. Patient demographics, perioperative outcomes, complications, and postoperative uroflowmetry in each surgical group were analyzed retrospectively.

Results: The patient demographics were similar in the two groups. There were no significant differences in perioperative outcomes between the groups, including mean operative time, duration of hospital stay, and urethral catheterization. The number of patients with at least one complication, including wound dehiscence, urethrocutaneous fistula, meatal stenosis, and urethral stricture, was lower in the turnover flap group (1/13, 7.7%) than in the TIP group (11/25, 44%, p=0.030). The incidence of meatal stenosis was lower in the turnover flap group (0/12, 0%) than in the TIP group (6/25, 24%). In postoperative uroflowmetry, the plateau-shaped curve rate was lower in the turnover flap group (1/12, 8.3%) than in the TIP group (5/19, 26.3%); the peak flow was higher (p=0.030).

Conclusions: The turnover flap procedure is clinically useful for repairing adolescent distal hypospadias because it offers lower complication rates and better functional outcomes than TIP.

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Images of the turnover flap technique: (A) preoperative, (B) 2 weeks after surgery, (C) 3 months after surgery.
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Figure 1: Images of the turnover flap technique: (A) preoperative, (B) 2 weeks after surgery, (C) 3 months after surgery.

Mentions: The surgery commenced by insertion of a urethral catheter, followed by constructing a stay suture on the penile glans. Depending on the size of the urethral plate, an operative site was designed with a U-shaped marking on the mucosal edge of the exposed urethra and an appropriate site proximal to the urethral plate. The ventral skin was then incised along the marking. Unlike in TIP urethroplasty, the midsection of the urethral plate was not incised. Penile curvature with chordee was corrected by dorsal plication after penile degloving, if any. The flap containing skin and subcutaneous tissue were carefully detached, taking precautions to maintain the blood supply to the flap. The flap was turned over distally to cover the urethral plate. Subsequently, bilateral edge-to-edge anastomosis between the flap and the urethral plate was completed. The penile skin beside the flap was dissected and closed with a midline suture to cover the raw surface of the flap (Fig. 1).


Urethroplasty by use of turnover flaps (modified mathieu procedure) for distal hypospadias repair in adolescents: comparison with the tubularized incised plate procedure.

Bae SH, Lee JN, Kim HT, Chung SK - Korean J Urol (2014)

Images of the turnover flap technique: (A) preoperative, (B) 2 weeks after surgery, (C) 3 months after surgery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231153&req=5

Figure 1: Images of the turnover flap technique: (A) preoperative, (B) 2 weeks after surgery, (C) 3 months after surgery.
Mentions: The surgery commenced by insertion of a urethral catheter, followed by constructing a stay suture on the penile glans. Depending on the size of the urethral plate, an operative site was designed with a U-shaped marking on the mucosal edge of the exposed urethra and an appropriate site proximal to the urethral plate. The ventral skin was then incised along the marking. Unlike in TIP urethroplasty, the midsection of the urethral plate was not incised. Penile curvature with chordee was corrected by dorsal plication after penile degloving, if any. The flap containing skin and subcutaneous tissue were carefully detached, taking precautions to maintain the blood supply to the flap. The flap was turned over distally to cover the urethral plate. Subsequently, bilateral edge-to-edge anastomosis between the flap and the urethral plate was completed. The penile skin beside the flap was dissected and closed with a midline suture to cover the raw surface of the flap (Fig. 1).

Bottom Line: The patient demographics were similar in the two groups.There were no significant differences in perioperative outcomes between the groups, including mean operative time, duration of hospital stay, and urethral catheterization.In postoperative uroflowmetry, the plateau-shaped curve rate was lower in the turnover flap group (1/12, 8.3%) than in the TIP group (5/19, 26.3%); the peak flow was higher (p=0.030).

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea.

ABSTRACT

Purpose: The purpose of this study was to examine whether urethroplasty with a turnover flap, as an alternative method of distal hypospadias repair in adolescents, improves the outcome of surgery.

Materials and methods: Between January 2004 and December 2013, a total of 38 adolescents (aged 11-17 years) underwent distal hypospadias repair with either the tubularized incised plate (TIP) procedure (n=25) or the turnover flap procedure (n=13). The turnover flap procedure was performed with a proximal, ventral penile flap that was turned over to cover the urethral plate. Patient demographics, perioperative outcomes, complications, and postoperative uroflowmetry in each surgical group were analyzed retrospectively.

Results: The patient demographics were similar in the two groups. There were no significant differences in perioperative outcomes between the groups, including mean operative time, duration of hospital stay, and urethral catheterization. The number of patients with at least one complication, including wound dehiscence, urethrocutaneous fistula, meatal stenosis, and urethral stricture, was lower in the turnover flap group (1/13, 7.7%) than in the TIP group (11/25, 44%, p=0.030). The incidence of meatal stenosis was lower in the turnover flap group (0/12, 0%) than in the TIP group (6/25, 24%). In postoperative uroflowmetry, the plateau-shaped curve rate was lower in the turnover flap group (1/12, 8.3%) than in the TIP group (5/19, 26.3%); the peak flow was higher (p=0.030).

Conclusions: The turnover flap procedure is clinically useful for repairing adolescent distal hypospadias because it offers lower complication rates and better functional outcomes than TIP.

Show MeSH
Related in: MedlinePlus