Hypospadias ppt. Zhonghua nan ke xue= National journal of andrology 2011;17:622-4. CONCLUSION: In cases of Duplay, a three-week instead of one-week catheterization and age below 6 months at hypospadias repair are associated with a better outcome and fewer complications. Topics: Severe hypospadias, Complications of hypospadias repair, Fistula, Diverticula, Single stage and two stage hypospadias repair, Duckett repair, Inner preputial flap repair, Tubularized incise plate urethroplasty, Diseases of the genitourinary system. Duckett repair Inner preputial flap repair Tubularized incise plate urethroplasty Introduction The management of severe or proximal hypospadias is still the 'Holy Grail' of hypospadiology. (Baskin, Duckett et al. Hypospadias is the most common congenital defect of the penis, 1 and occurs in approximately one in 250 infant boys in Europe. 18. Share this article Share with email Share with twitter Share with linkedin Share with facebook. b - i procedures of the new modification of the duckett technique for proximal hypospadias with severe chordee: single-stage tubularization of new urethral plate reconstructed using transected native urethra plate … been described by Duckett and Keating. We believe this will benefit children and their families with less surgery and anaesthesia, less cost and shortened waiting time. The chordee is corrected first, and the prepuce spread along the ventral shaft. The MAGPI repair is the preferred method in glandular type, whereas the tubularized incised plate (TIP) repair is preferred for other cases of distal hypospadias. The purpose of this study is to compare the outcomes and complications of the transverse preputial island flap (Duckett's procedure) to those of double-faced preputial flap (DFPF) for one-stage repair of penoscrotal hypospadias with chordee, in addition to clinical functional evaluation by estimated urine flow. Introduction Globally, hypospadias is one of the most common congenital anomalies . Complication rates range between 20% and 60%. Patients and methods Over a 5‐year period 381 consecutive patients (not randomized) with distal hypospadias were evaluated. Surgery, Gynecology and Ob-stetrics, 100, 184-190. Laurence S. Baskin, in Pediatric Surgery (Seventh Edition), 2012 Age for repair. All of them had posterior foreskin and a ventral curvature of the penis. If less than 30 degree ventral curvature, TIP or onlay Prepucial flap , If 30 degree & above STAG can be done. Hypospadias is an abnormality of anterior urethral and penile development in which the urethral opening is ectopically located on the ventral aspect of the penis proximal to the tip of the glans penis, which, in this condition, is splayed open. Samuel, M.; Capps, S.; Worthy, A. The urethral opening may be located as far down as in the scrotum or perineum. The MAGPI hypospadias repair in 1111 patients. Since that time, the study of hypospadias has evolved into a subspecialty within pediatric urology, hypospadiology. Management of Urethral Fistula after Hypospadias Repair: 关键字: 尿道下裂,尿瘘,修补: 作者: 陆毅群,葛琳娟: 所属期刊栏目: 临床研究, 刊名: 中华小儿外科杂志,CHINESE JOURNAL OF PEDIATRIC SURGERY: 作者单位: 陆毅群:复旦大学附属儿科医院,葛琳娟:复旦大学附属儿科医院: DOI: 10.3760/cma.j . A spectrum of abnormalities, including ventral curvature of the penis (chordee), a hooded incomplete prepuce, and an abortive corpora spongiosum, are commonly associated with hypospadias. A French collaborative controlled study of a cohort of 300 consecutive children without genetic defect . Hypospadias repair has a long and flat learning curve and requires patience, experience, and great enthusiasm to achieve acceptable results. (eds), Campbell's Urology (1998) 7th edition, vol 2, Philadelphia: WB Saunders, pp. 20. Bianchi M: Correction of hypospadias. e. DUG repair by Stock and Hanna (1997) combining U-shaped incision with vertical midline incision closed transversely. John Duckett Memorial Lecture: Nephron-Sparing Surgery in the Management of Wilms Tumor Thomas F. Kolon, MD Instructional Courses: Las Vegas: Friday, September 10 | 10:30 am - 12:30 pm A single surgeon's experience of the two-stage procedure is reported. These features can be present in varying degrees . Proximal hypospadias repair with inner prepucial island flap to create neo urethra (single stage hypospadias repair - Duckett or Asopa) advancement: a better technique for distal hypospadias repair. 19. Based on the uroflow pattern results, the quality of neourethra and function of it were better than Duckett urethroplasty. Most hypospadias repairs can be done with a single stage repair. We aimed to assess the outcome of staged transverse preputial island flap (TPIF) urethroplasty for repairing certain cases of primary proximal hypospadias with moderate-to-severe chordee in children. 11. Kogan BA. On the other hand, nearly half carry out staged repair. Retik and Borer observed complications in only 1/31 patients (3%) who underwent distal and midshaft hypospadias repair . In Duckett cases, number of surgeries, age, severity, curvature and catheter duration were not found to be associated with complications. Duckett established the term hypospadiology [2]. The results pub- 2000 Dec; 164 (6): 2058-61. J Surg Pak 2010;15:139. to evaluate the results of DUCKETT's pedicled prepucial flap procedure for hypospadias treatment in a reference hospital in West Africa. John W. Duckett, Jr, MD* Hypospadias results in various de-grees of deficiency of the urethra, corpus spongiosum, and corpora cavernosa. An alternative to tubularised urethroplasty for complex and secondary hypospadias are two-step approaches, the most popular of them being the two-step technique of repair according to Bracka [42, 43].In the 1st step, the penis is straightened and the cicatrisation of the urethral plate eliminated. The complication rate was 58.5%. J Urol 153:1660-1663 Duplay S (1874) De l'hypospadias perinéo-scrotal et de son traitement chirurgical. (1980) Transverse Preputial Island Flap Technique for Repair of Severe Hypospadias. 1996; Duckett and Baskin 1996; Baskin and Duckett 1998) In experienced hands, the surgery is typically performed as an outpatient procedure, with 80-90% of children requiring one operation. After initial enthusiasm for single-stage procedures, many paediatric urologists have turned to the alternative two-stage approach after experiencing disappointing results. The reported . 3. Study type, settings and duration: Prospective study carried out at urology department, services hospital, Lahore from 15th April 1998 to 14th April 2000. The urethroplasty was done according to the DUCKETT procedure. 2 Methods is is a retrospective study of all hypospadias patients treated by the DUCKETT technique from January, 1st 2003 to December, 31st 2015. e patients were operated on by senior surgeons. • Hypospadias can be defined as hypoplasia of the tissues forming the ventral aspect of the penis beyond the division of the corpus spongiosum. Analysis of meatal location in 500 men: Wide variation questions need to meatal advancement in all pediatric anterior hypospadias cases. repair.21,22 Some pediatric urologists recently converted from the Duckett repair to the Koyanagi repair or its modification for proximal hypospadias with severe penile curvature,23 because in tube island flap repair, a stricture often occurred at the circumferential end-to-end anastomosis between the native meatus and the neourethra, and diver- 4. 2. Materials and Methods: Twenty-six cases undergoing hypospadias repair over 1 year (tubularized incised plate [TIP] Snodgrass [17 patients], TIP with Snodgraft [5 patients], Duckett's onlay flap [2 patients], and Duckett's tube [2 patients . 4. Hypospadias results from abnormal development of the penis that leaves the urethral meatus proximal to its normal glanular position anywhere along the penile shaft, scrotum, or perineum. overall complication rate is <10%. Glassberg KI. Semi-Live Surgery: Hypospadias Repair Surgeon: João Luiz Pippi-Salle, Sidra Medical and Research Center. Duckett Jr., J.W. The modified Glassberg -Duckett technique for the treatment of severe hypospadias is feasible with an acceptable complication rate and the technique still ha. CONCLUSION: In cases of Duplay, a three-week instead of one-week catheterization and age below 6 months at hypospadias repair are associated with a better outcome and fewer complications. In Western civilization the incidence of hypospadias is reported to . The treatment of hypospadias has a long and colorful history dating back to AD 100-200, when Heliodorand Antyl is credited with the first surgical management. Secondary hypospadias repair using Buccal mucosa graft: case series of 50 patients Neeraj Sharma, Mayank Mishra* INTRODUCTION Hypospadias is a birth defect of urethra in the male that involves an abnormally placed urethral meatus.1 A successful repair in hypospadias is very important in the first operation. Long-term outcome following hypospadias repair Long-term outcome following hypospadias repair Wilcox, Duncan; Snodgrass, Warren 2006-03-08 00:00:00 Hypospadias is a common problem affecting approximately one boy in 300; it is usually corrected in the first few years of life. Byars, L.T. Hastie KJ, Deshpande SS, Moisey CU. The Journal of Urology, 01 Aug 1987, 138(2): 380-381 DOI: 10.1016/s0022-5347(17)43153-3 PMID: 3599259 . Although more pediatric urologists prefer staged repair for proximal hypospadias with severe chordee right now, we still stick to one stage repair by transverse preputial island flap initially reported by Dr. Duckett. J Urol. HYPOSPADIAS Dr. Vivek K Gowda. Abstract . Six of them had a previous hypospadias repair. Is hypospadias associated with prenatal exposure to endocrine disruptors? 2094-6. Onlay preputial flap repair was first described by Duckett in 1987. 2002-07-01 00:00:00 Objective To compare the function, complications and cosmesis after a modified Thiersch‐Duplay and Mathieu unstented urethroplasty. Distal hypospadias: which repair? 2015 ;68: 1023 - 1030 . 3. Duckett urethroplasty-urethrotomy can be used as staged repair for primary treatment of hypospadias because of high safety, low complication incidence, and satisfactory appearance. Proximal hypospadias repair remains a challenging reconstructive procedure for even the most seasoned pediatric urologist. However, in many published reports, the complication rate of TIP for distal and midshaft hypospadias repair is low. Whether dorsal plication or ventral lengthening should be used to correct penile curvature is still controversial, and long-term results are required. [2] Hence, new modifications of repair techniques are usually attempted with the aim of obtaining better results and fewer complications. The only treatment for hypospadias is surgical repair of the anatomical defect. 1994; Baskin, Duckett et al. Distal hypospadias: which repair? Aims: To compare the efficacy, safety and complication of Barcat-Redman technique with conventional duckett technique in the management of distal hypospadias. The repair of severe primary hypospadias represents a major surgical challenge. Complication from distal hypospadias repair includes UCF, meatal Stenosis, urethral Stricture & glans denisence. Schultz and colleagues 149 pointed out that an ideal age might be 6 to 18 months to minimize the emotional effect of this traumatic experience. Small fistulas are common complications and can be repaired easily. Augmented Duckett repair for severe hypospadias. : Technical challenge of . The urethral meatus was posterior in 37%. Hypospadias repair is being performed at progressively younger ages. Meatal advancement and glanuloplasty (MAGPI) described by Duckett, has been the most accepted technique for distal hypospadias repair along the last 20 years. Baskin LS, Duckett JW. Duckett J.W. Sometimes a 2-stage repair is necessary, especially for very long urethral defects. Two-stage procedure usually offers better functional and cosmetic results with fewer complications ( 8 ). • Hypospadias can be defined as hypoplasia of the tissues forming the ventral aspect of the penis beyond the division of the corpus spongiosum. The incidence of strictures was dramatically lowered in patients with proximal hypospadias. The length of urethra repair ranged from 1.5 to 10 cm. The fibrous tissue that . DR.LEELA KRISHNA. Ultimately the nature of the repair is a consultant decision and is influenced by the Other techniques have been proposed when chordee is present, for example 'transversal preputial pedicle flap' for the repair of both anterior and median hypospadias (Duckett, 1981, cited in De Sy, 1996b), and also the technique known as 'tubular transversal preputial pedicle flap' , a technique for complete replacement of the urethra . Although the basic steps are similar to those of a distal repair, there is a wide array of procedures to correct penile curvature associated with a proximal hypospadias as well as a need… 5. Duckett established the term hypospadiology [2]. The MAGPI procedure allows the surgeon to avoid an urethroplasty, and provides a reliable, reproducible procedure for reconfiguring the glans and meatus without the use of catheters . Proximal hypospadias repair. Six months later, the neourethra is completed in a second stage repair. Dorsal tunica plication for hypospadias curvature. Mathieu's repair gave good results with 20 % incidence of fistula formation. Definition In most cases, hypospadias in the male is associated with . The meatal advancement and glanduloplasty (MAGPI) procedure was first described in 1981 for the repair of distal hypospadias. The incidence of strictures was dramatically lowered in patients with proximal hypospadias. c. Pyramid repair by Duckett and Keating (1989) for Megameatus Intact prepuce (MIP). 1. Conclusion: TIP urethroplasty is a safe and reliable method of hypospadias repair. Complications after hypospadias repair are common. 1. Results: Ahmed J. Transverse Preputial Island Flap for hypospadias repair. In the past decade, our experience has grown to more than 1000 procedures. Eur Urol. Highest numbers of complications (60%) were seen in patients who had Island flap urethroplasty for proximal hypospadias with chordee. 12. 21, 22 Some pediatric urologists recently converted from the Duckett repair to the Koyanagi repair or its modification for proximal hypospadias with severe penile curvature, 23 because in tube island flap repair, a stricture often occurred at the circumferential end‐to‐end anastomosis . Arch Ital Urol Semantic Scholar extracted view of "One-stage correction of hypospadias/chordee." by R. Filmer et al. Generally surgical repair of proximal hypospadias is performed by two categories: Free graft as Bracka technique ( 3) and vascularized preputial island flap as Duckett procedure ( 4 ). Eur Urol 4:411-413 Duckett JW (1981) The island flap technique for hypospadias repair. and Keattng M.A. Compared with the use of mucous membrane of the bladder, it has t … Hypospadias Repair, Preoperative Symptoms, Age, Meatal Location, Outcome, Complications 1. Duckett's procedure of one-stage urethroplasty with the transverse preputial island flap is effective in hypospadias repair, with a success rate close to that of other types of operations and a low rate of postoperative complications. 2. Duckett JW. Repair of a distal hypospadias vari- nephrine solution has been helpful in maintaining ant, the megameatus intact prepuce (MIp), has adequate hemostasis. If your urologist performs a hypospadias repair for a pediatric patient, you must look for important details in the documentation when choosing the appropriate codes for your claim including the location of the meatus, what your urologist does surgically, and how many stages it takes him to complete the repair. Based on the uroflow pattern results, the quality of neourethra and function of it were better than Duckett urethroplasty. Ann Surg, 1991;213: 620-5. The consensus statement on the timing of genital surgery from the American Academy of Pediatrics also . Zaontz MR. Duckett JW, "Hypospadias," Walsh C et al. Urol Clin N Am 3:152-159 Duckett JW, Coplen D, Ewalt D, Baskin LS (1995) Buccal mucosal ure-thral replacement. J Urol 1994;151:1668-71. Hypospadias repair in: O'Donnel and Koff SA, Editors Pediatric Urology 3rd ed. Results The patients mean age was 11 ± 8.5 years. Fichtner J et al. 3. 8:50 - 9:10 am. observed complications in 10/148 patients (7%) who underwent distal hypospadias repair. Urology, RC870-923 2. Distal hypospadias repair. 2 It is characterised by a urethral meatus on the ventral aspect of the penis or scrotum, dorsal winged prepuce (foreskin), and ventral curvature of the penis (chordee). Snodgrass et al. The MAGPI procedure allows the surgeon to avoid an urethroplasty, and provides a reliable, reproducible procedure for reconfiguring the glans and meatus without the use of catheters . In cases of proximal hypospadias, one-stage repairs such as the Duckett repair or the Koyanagi repair have been well established, while two-stage repairs remain important alternatives. Hypospadias repair has a long and flat learning curve and requires patience, experience, and great enthusiasm to achieve acceptable results. This study was to evaluate the outcomes, complications and long term follow-up of these two techniques in our. The most common complication of hypospadias repair is urethrocutaneous fistula. 300 different operations for hypospadias repair being cited in the literature (Winslow Devine, 1996). Introduction • Hypospadias is believed to result from arrested penile development, leaving a proximal urethral meatus. Several techniques have been described to achieve The reconstruction for this cond[1] i-tion is a delicate procedure, and based on the literature, it is clear that pediatric surgeons and plastic surgeons 3. Hypospadias is an abnormality of anterior urethral and penile development in which the urethral opening is ectopically located on the ventral aspect of the penis proximal to the tip of the glans penis, which, in this condition, is splayed open. Proximal hypospadias can be repaired by Duckett or Bracka two-stage repair procedure. Nighty-two consecutive boys who underwent either one-stage or staged TPIF urethroplasty for the repair of proximal hypospadias with moderate-to-severe chordee between August 2015 and December 2019 . CONCLUSION: Duckett's procedure of one-stage urethroplasty with the transverse preputial island flap is effective in hypospadias repair, with a success rate close to that of other types of operations and a low rate of postoperative complications. In severe cases of hypospadias the meatus, either before or after . INTRODUCTIO N • Hypospadias is believed to result from arrested penile development, leaving a proximal urethral meatus. Aims: To study the role of uroflowmetry in the preoperative and early postoperative period in children undergoing hypospadias repair. If there is underdevelopment of the urethral plate, fibrous tethering is the usual situation and release of this The results pub- This has also been considered by Duckett, who mentioned that one of four goals in the one-stage repair of hypospadias is to cover the penis with skin that is pliable, elastic and symmetrical and preferably non-hair-bearing [Duckett, 1981]. Onlay, proximal tubularized incised plate (TIP), and Duckett are among the popular choices because they can be performed as a one-step procedure. " Skin incisions are made perpendicular to the tissue with a fine knife blade. Jiang X, Yang J, Zeng Q, Wan B, He L. Transverse preputial island flap technique (Duckett's procedure) for hypospadias repair: a report of 356 cases. Hypospadias surgery aims to create a straight urinary stream from a meatus with a normal anatomical position, a straight penis, and a normal circumcised penile appearance. Full Text Links Definition In most cases, hypospadias in the male is associated with . the repair without dividing it. hypospadias repair with any technique ranging from fistula to complete loss of neourethra, requiring reconstruction. However, Magpi, Mathieu, Duckett, Snodgrass and Onlay Island flap repair are common one-stage repairs. Long-term follow up of the MAGPI operation for distal hypospadias. Bracka A. Hypospadias repair: The twostage alternative. Duckett JW, Snyder Hd. Oxford: Butter worth, Heinemann 1997: 551-568. highlights of the modified duckett technique repair. Numerous methods have been described for the treatment of this clinical entity with varying results. J Urol 1990;143:98-101. (1955) A Technique for Consistently Satisfactory Repair of Hypospadias. Preservation of the urethral plate in hypospadias repair: Extended applications and further experience with the onlay island flap urethroplasty. Hypospadias is one of the most common congenital anomalies in males, occurring in 1 of 300 live births. d. glanular hypospadias with cleft glans. The MAGPI repair is the preferred method in glandular type, whereas the tubularized incised plate (TIP) repair is preferred for other cases of distal hypospadias. Full text links Read article at publisher's site (DOI): 10.7507/1002-1892.20160120 Similar Articles 2. first described in 1981 by duckett, the meatal advancement and granuloplasty (magpi) technique is one of the most commonly performed hypospadias repair techniques that has withstood the stand of time.6,7it has a low complication rate (1.2% overall, 0.45 fistulas, no meatal stenoses) and reoperation is very seldom needed.8there are some concerns … Abstract. Following staged proximal repair, BMG showed significant increase in the Qmax values after 6 months postoperatively then remained steady high with insignificant increase. Hypospadias. A total of 356 patients with hypospadias were treated by Duckett's procedure from March 1995 to December 2010, of whom 324 (91.0%) were younger than 14 years. Small fistulas are common complications and can be repaired easily. a, b penoscrotal hypospadias with severe chordee, even after skin degloving. (B) Qmax (mL/s) changes over the postoperative time (months) for Proximal TIP, Onlay, and Duckett techniques for one-stage proximal hypospadias repair. The urethral opening may be located as far down as in the scrotum or perineum. Br J Urol, 1989;63: 320-2. repair.21,22 Some pediatric urologists recently converted from the Duckett repair to the Koyanagi repair or its modification for proximal hypospadias with severe penile curvature,23 because in tube island flap repair, a stricture often occurred at the circumferential end-to-end anastomosis between the native meatus and the neourethra, and diver- Pediatr Surg Int, 2013;29: 633-8. Intra operative pharmacological erection as an aid to pediatric hypospadias repair. repair of hypospadias [Baskin and Ebbers, 2006]. While early outcome data is widely available, little has been reported on the long-term problems that these men suffer. The Urologic Clinics of North America, 7, 423-430. The prevalence of hypospadias in China is approximately 90.3 per 10 000 births. A variety of techniques are available for proximal hypospadias repair. Hint: Differentiate between initial repair versus repair of complication. In Duckett cases, number of surgeries, age, severity, curvature and catheter duration were not found to be associated with complications.

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