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A modified onlay island flap vs. Mathieu urethroplasty for distal hypospadias repair: A prospective randomised study.

ElGanainy EO - Arab J Urol (2015)

Bottom Line: The duration of follow-up was insignificantly different between the groups.Patients treated with the MOIF had a statistically significant lower complication rate (P = 0.036), and a better cosmetic outcome, urinary stream and relatives' satisfaction (P < 0.001 for all).Further studies including more patients, and a longer follow-up with an objective evaluation of functional outcome should be encouraged to confirm these early results.

View Article: PubMed Central - PubMed

Affiliation: Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.

ABSTRACT

Objective: To compare the outcome of a modified onlay island flap (MOIF) with that of the Mathieu urethroplasty for distal hypospadias repair.

Patients and methods: In a prospective randomised study, 60 patients with coronal, subcoronal and distal penile hypospadias, with a urethral plate width of ⩽6 mm, and minimal or no chordee, underwent either MOIF using a midline longitudinal outer preputial skin flap passed ventrally by penile buttonholing through dartos fascia incision, or a Mathieu urethroplasty. Closed envelopes were used for randomly selecting patients for each procedure. The operative duration, complications, cosmetic outcome, urinary stream and relatives' satisfaction were reported for each procedure.

Results: Preoperative data (patients' age and site of urethral meatus) and operative duration were insignificantly different between the groups (P = 0.653, 0.786 and 0.710, respectively). There were no intraoperative complications in either group. The duration of follow-up was insignificantly different between the groups. Patients treated with the MOIF had a statistically significant lower complication rate (P = 0.036), and a better cosmetic outcome, urinary stream and relatives' satisfaction (P < 0.001 for all).

Conclusions: The MOIF urethroplasty seemed to be better than the Mathieu urethroplasty in patients with distal hypospadias and narrow urethral plates. Further studies including more patients, and a longer follow-up with an objective evaluation of functional outcome should be encouraged to confirm these early results.

No MeSH data available.


Related in: MedlinePlus

Operative steps of the MOIF urethroplasty; (A) skin incisions delineating the flap. (B) Excision of skin lateral to the flap. (C) Excision of the preputial mucosa with preservation of the dartos fascia. (D) Longitudinal incision of the dartos fascia. (E) Meatoplasty by excising excess preputial skin flush with the glans penis.
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f0005: Operative steps of the MOIF urethroplasty; (A) skin incisions delineating the flap. (B) Excision of skin lateral to the flap. (C) Excision of the preputial mucosa with preservation of the dartos fascia. (D) Longitudinal incision of the dartos fascia. (E) Meatoplasty by excising excess preputial skin flush with the glans penis.

Mentions: The first step was to place a traction suture at the dorsum of the glans penis distally, then place a suitably sized Nelaton catheter. The technique began with three incisions: (1) a U-shaped incision delineating the UP laterally and proximally, passing superficial to the distal urethral end; (2) a circumferential incision 1 cm proximal to the coronal sulcus (CS), made on the inner prepuce and deepened to the plane between the dartos layer and Buck’s fascia (proximally to the middle of the penis); and (3) a circumferential incision (corresponding to the circumcision incision) made on the penile skin and deepened to the plane between the skin and dartos layer proximally for ≈5 mm. The flap was fashioned using two longitudinal incisions made on the skin surface, beginning proximally at the circumferential skin incision and extending distally to the muco-cutaneous junction and deepened to the plane superficial to dartos fascia, and separated by a distance corresponding to the required flap width to create the neo-urethral floor (Figs. 1A and 2A).


A modified onlay island flap vs. Mathieu urethroplasty for distal hypospadias repair: A prospective randomised study.

ElGanainy EO - Arab J Urol (2015)

Operative steps of the MOIF urethroplasty; (A) skin incisions delineating the flap. (B) Excision of skin lateral to the flap. (C) Excision of the preputial mucosa with preservation of the dartos fascia. (D) Longitudinal incision of the dartos fascia. (E) Meatoplasty by excising excess preputial skin flush with the glans penis.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4563012&req=5

f0005: Operative steps of the MOIF urethroplasty; (A) skin incisions delineating the flap. (B) Excision of skin lateral to the flap. (C) Excision of the preputial mucosa with preservation of the dartos fascia. (D) Longitudinal incision of the dartos fascia. (E) Meatoplasty by excising excess preputial skin flush with the glans penis.
Mentions: The first step was to place a traction suture at the dorsum of the glans penis distally, then place a suitably sized Nelaton catheter. The technique began with three incisions: (1) a U-shaped incision delineating the UP laterally and proximally, passing superficial to the distal urethral end; (2) a circumferential incision 1 cm proximal to the coronal sulcus (CS), made on the inner prepuce and deepened to the plane between the dartos layer and Buck’s fascia (proximally to the middle of the penis); and (3) a circumferential incision (corresponding to the circumcision incision) made on the penile skin and deepened to the plane between the skin and dartos layer proximally for ≈5 mm. The flap was fashioned using two longitudinal incisions made on the skin surface, beginning proximally at the circumferential skin incision and extending distally to the muco-cutaneous junction and deepened to the plane superficial to dartos fascia, and separated by a distance corresponding to the required flap width to create the neo-urethral floor (Figs. 1A and 2A).

Bottom Line: The duration of follow-up was insignificantly different between the groups.Patients treated with the MOIF had a statistically significant lower complication rate (P = 0.036), and a better cosmetic outcome, urinary stream and relatives' satisfaction (P < 0.001 for all).Further studies including more patients, and a longer follow-up with an objective evaluation of functional outcome should be encouraged to confirm these early results.

View Article: PubMed Central - PubMed

Affiliation: Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.

ABSTRACT

Objective: To compare the outcome of a modified onlay island flap (MOIF) with that of the Mathieu urethroplasty for distal hypospadias repair.

Patients and methods: In a prospective randomised study, 60 patients with coronal, subcoronal and distal penile hypospadias, with a urethral plate width of ⩽6 mm, and minimal or no chordee, underwent either MOIF using a midline longitudinal outer preputial skin flap passed ventrally by penile buttonholing through dartos fascia incision, or a Mathieu urethroplasty. Closed envelopes were used for randomly selecting patients for each procedure. The operative duration, complications, cosmetic outcome, urinary stream and relatives' satisfaction were reported for each procedure.

Results: Preoperative data (patients' age and site of urethral meatus) and operative duration were insignificantly different between the groups (P = 0.653, 0.786 and 0.710, respectively). There were no intraoperative complications in either group. The duration of follow-up was insignificantly different between the groups. Patients treated with the MOIF had a statistically significant lower complication rate (P = 0.036), and a better cosmetic outcome, urinary stream and relatives' satisfaction (P < 0.001 for all).

Conclusions: The MOIF urethroplasty seemed to be better than the Mathieu urethroplasty in patients with distal hypospadias and narrow urethral plates. Further studies including more patients, and a longer follow-up with an objective evaluation of functional outcome should be encouraged to confirm these early results.

No MeSH data available.


Related in: MedlinePlus