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The management of moderate and severe congenital penile torsion associated with hypospadias: Urethral mobilisation is not a panacea against torsion

View Article: PubMed Central

ABSTRACT

Objectives: To evaluate the effectiveness of urethral mobilisation for correcting moderate and severe penile torsion associated with distal hypospadias.

Patients and methods: Nineteen patients with distal hypospadias and congenital moderate and severe penile torsion were treated surgically. The hypospadias was at the distal shaft, coronal and glanular in seven, eight and four patients, respectively, and six had mild chordee. The mean (SD, range) angle of torsion was 94.7 (19.9, 75–160)°. The urethra was mobilised down to the perineum. If the urethral mobilisation was insufficient the right border of the tunica albuginea was anchored to the pubic periosteum. The hypospadias was repaired using the urethral mobilisation and advancement technique, with a triangular plate flap for meatoplasty. The patients were followed up for 12–18 months.

Results: All patients had a successful functional and cosmetic outcome, with no residual torsion. Two patients had a small subcutaneous haematoma that resolved after conservative treatment. Massive oedema occurred in three patients and was treated conservatively. Urethral mobilisation did not correct the penile torsion completely. Although the mean (SD, range) angle of torsion was reduced to 86.1 (14.3, 65–130)°, statistically significantly different (P = 0.001), it was not clinically important. The presence of chordee had no significant correlation with the reduction of penile torsion.

Conclusion: Urethral mobilisation cannot completely correct moderate and severe penile torsion but it might only partly decrease the angle of torsion. Periosteal anchoring of the tunica albuginea might be the most reliable manoeuvre for the complete correction of penile torsion.

No MeSH data available.


Related in: MedlinePlus

The optimal correction of penile torsion and a successful hypospadias repair at 3 months after surgery.
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f0015: The optimal correction of penile torsion and a successful hypospadias repair at 3 months after surgery.

Mentions: Urethral mobilisation decreased the angle of penile torsion in 12 patients and did not change it in the remaining seven, as indicated by an artificial erection. The mean (SD, range) reduction in the angle of torsion was 8.7 (7.6, 0–30)°. Thus, after urethral mobilisation the angle of penile torsion decreased from 94.7 (19.7, 75–160)° to 86.1 (14.3, 65–130)°, a statistically significant difference (P = 0.001). However, the difference between the angles of torsion before and after urethral mobilisation was trivial in practice and of no clinical significance. The presence of chordee had no significant correlation with the degree of reduction of the angle of penile torsion after urethral mobilisation (P = 0.961). Fixation of the lateral border of the right tunica albuginea to the pubic periosteum (periosteal anchoring of the tunica albuginea) was necessary for the optimal and complete correction of penile torsion in all patients. This manoeuvre was repeated once or twice in nine patients to avoid the over- or under-correction of penile torsion. Based on our extensive experience in hypospadias surgery and drug records in the patients’ files, the periosteal anchoring suture did not cause significant pain after surgery, and no extra doses of analgesia were required. The corrected position of the penile shaft and glans penis was maintained throughout the follow-up, either when flaccid (Fig. 3) or during a morning erection, as noted by the parents.


The management of moderate and severe congenital penile torsion associated with hypospadias: Urethral mobilisation is not a panacea against torsion
The optimal correction of penile torsion and a successful hypospadias repair at 3 months after surgery.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4442919&req=5

f0015: The optimal correction of penile torsion and a successful hypospadias repair at 3 months after surgery.
Mentions: Urethral mobilisation decreased the angle of penile torsion in 12 patients and did not change it in the remaining seven, as indicated by an artificial erection. The mean (SD, range) reduction in the angle of torsion was 8.7 (7.6, 0–30)°. Thus, after urethral mobilisation the angle of penile torsion decreased from 94.7 (19.7, 75–160)° to 86.1 (14.3, 65–130)°, a statistically significant difference (P = 0.001). However, the difference between the angles of torsion before and after urethral mobilisation was trivial in practice and of no clinical significance. The presence of chordee had no significant correlation with the degree of reduction of the angle of penile torsion after urethral mobilisation (P = 0.961). Fixation of the lateral border of the right tunica albuginea to the pubic periosteum (periosteal anchoring of the tunica albuginea) was necessary for the optimal and complete correction of penile torsion in all patients. This manoeuvre was repeated once or twice in nine patients to avoid the over- or under-correction of penile torsion. Based on our extensive experience in hypospadias surgery and drug records in the patients’ files, the periosteal anchoring suture did not cause significant pain after surgery, and no extra doses of analgesia were required. The corrected position of the penile shaft and glans penis was maintained throughout the follow-up, either when flaccid (Fig. 3) or during a morning erection, as noted by the parents.

View Article: PubMed Central

ABSTRACT

Objectives: To evaluate the effectiveness of urethral mobilisation for correcting moderate and severe penile torsion associated with distal hypospadias.

Patients and methods: Nineteen patients with distal hypospadias and congenital moderate and severe penile torsion were treated surgically. The hypospadias was at the distal shaft, coronal and glanular in seven, eight and four patients, respectively, and six had mild chordee. The mean (SD, range) angle of torsion was 94.7 (19.9, 75–160)°. The urethra was mobilised down to the perineum. If the urethral mobilisation was insufficient the right border of the tunica albuginea was anchored to the pubic periosteum. The hypospadias was repaired using the urethral mobilisation and advancement technique, with a triangular plate flap for meatoplasty. The patients were followed up for 12–18 months.

Results: All patients had a successful functional and cosmetic outcome, with no residual torsion. Two patients had a small subcutaneous haematoma that resolved after conservative treatment. Massive oedema occurred in three patients and was treated conservatively. Urethral mobilisation did not correct the penile torsion completely. Although the mean (SD, range) angle of torsion was reduced to 86.1 (14.3, 65–130)°, statistically significantly different (P = 0.001), it was not clinically important. The presence of chordee had no significant correlation with the reduction of penile torsion.

Conclusion: Urethral mobilisation cannot completely correct moderate and severe penile torsion but it might only partly decrease the angle of torsion. Periosteal anchoring of the tunica albuginea might be the most reliable manoeuvre for the complete correction of penile torsion.

No MeSH data available.


Related in: MedlinePlus