Outcome analysis of staged preputial graft technique for primary proximal hypospadias with and without post-operative vacuum physiotherapy

Muthana Al-Salihi; Tariq Abbas; Ahmed Albakr; Santiago Vallasciani; Abderrahman Elkadhi; J L Pippi Salle

doi:10.1016/j.jpurol.2023.07.018

Outcome analysis of staged preputial graft technique for primary proximal hypospadias with and without post-operative vacuum physiotherapy

J Pediatr Urol. 2023 Dec;19(6):699.e1-699.e7. doi: 10.1016/j.jpurol.2023.07.018. Epub 2023 Aug 1.

Authors

Muthana Al-Salihi¹, Tariq Abbas¹, Ahmed Albakr², Santiago Vallasciani³, Abderrahman Elkadhi³, J L Pippi Salle⁴

Affiliations

¹ Department of Surgery, Division of Urology, Sidra Medicine, Doha, Qatar; Department of Surgery, Weill Cornel Medicine - Qatar, Doha, Qatar.
² Urology Department, Hamad Medical Corporation, Qatar.
³ Department of Surgery, Division of Urology, Sidra Medicine, Doha, Qatar.
⁴ Department of Surgery, Division of Urology, Sidra Medicine, Doha, Qatar. Electronic address: sallepippi@gmail.com.

PMID: 37558593
DOI: 10.1016/j.jpurol.2023.07.018

Abstract

Purpose: Management of proximal hypospadias remains challenging. We assessed the results of staged preputial graft repairs (SPG) for proximal hypospadias and hypothesize that post-operative vacuum physiotherapy (VP) improves graft suppleness and overall outcomes.

Materials and methods: Retrospective analysis of n = 71 patients with proximal hypospadias and severe ventral penile curvature (PC) of ≥50° after degloving. PC was corrected using ventral transverse incisions of the tunica albuginea (VTITA) without applying a tourniquet, taking care to avoid injuring the underlying erectile tissue. The ventral raw area at the penile shaft, including VTITA, were covered with either divided and partially mobilized urethral plate, or with the inner preputial graft itself. During the second stage, a tunica vaginalis flap was often used to cover the tubularized neourethra. Outcomes and post-op complications were assessed after each stage, comparing patients who received vacuum physiotherapy (VP+, n = 49) with those who did not (VP-, n = 22).

Results: Mean PC was 66°, average follow-up duration was 13.01 months, and overall complication rate was 22.5%. Only 6 of 49 VP + patients experienced complications (12.24%; 4 fistulas; 2 urethral strictures) and no recurrence of PC after second stage was observed in this group. VP- patients displayed a significantly higher rate of complications, with 10 of 22 cases (45.45%) exhibiting fistula development (n = 5) and glans dehiscence (n = 5). Recurrence of mild PC after first-stage repair was comparable between patient groups (12% VP+, 18% VP-) and easily corrected by simple graft tubularization or dorsal plication during second-stage repair.

Conclusions: Staged repair using VTITA is effective for correcting proximal hypospadias with severe chordee. VP appears to promote and expedite graft suppleness and significantly improves patient outcomes.

Keywords: Outcome; Proximal hypospadias; Severe chordee; Staged repair; Vacuum physiotherapy.

MeSH terms

Humans
Hypospadias* / complications
Infant
Male
Retrospective Studies
Treatment Outcome
Urethra / surgery
Urologic Surgical Procedures, Male / methods
Vacuum