3.3.1 Complications
Whereas meatal narrowing after splint removal can be corrected by careful stretching and the Dittel device, operative revision is needed in cases of a scarred meatus as slitting and stretching are ineffective in the long term. In urethral stricture, open surgery should be performed after one attempt at internal urethrotomy. With fistulae, revision should not be planned before a lapse of 6 months. Urethral stricture should be excluded intra-operatively as a cause of the fistula. To prevent the recurrent fistula formation, a dartos flap or a free tunica vaginalis patch may be used. Attention should be paid to adequate subsequent cover with mobilized Scarpa's fasciae.
Correction of a minor residual curvature, sometimes reported by the parents, should be discouraged, as it has no functional relevance. It can be easily corrected after puberty, if significant.
Table 2: Algorithm for the management of hypospadia
Hypospadia
|
|
|
|
|
Diagnosis |
|
Intersex |
|
at birth |
| |
|
1 |
|
|
|
Paediatric |
|
No |
|
urologist |
|
reconstruction |
Reconstructionrequired
Preparation
(foreskin, hormone therapy)
Distal
Proximal
Chordee
No Chordee
Urethral
plate cut
Urethral plate preserved
MAGPI,
Mathieu, King, Duplay,
Snodgrass etc.
Tube-onlay
inlay-onlay,
two-stage procedure
Onlay local skin, buccal mucosa
3.4 REFERENCES
1. Abu Arafeh W, Chertin B, Zilberman M, Farkas A.
One-stage repair of hypospadias: experience with 856 cases. Eur Urol 1998; 34: 365-367.
2. Ahmed S, Gough DC.
Buccal mucosal graft for secondary hypospadias repair and urethral replacement. Br J Urol 1997; 80:328-330.
3. Aho MO, Tammela OK, Tammela TL.
Aspects of adult satisfaction with the result of surgery for hypospadias performed in childhood. Eur Urol 1997; 32: 218-222.
4. Asopa HS.
Newer concepts in the management of hypospadias and its complications. Ann R Coll Surg Engl 1998; 80: 161-168.
5. Baskin LS, Duckett JW.
Dorsal tunica albuginea plication for hypospadias curvature. J Urol 1994; 151: 1668-1671.
6. Baskin LS, Duckett JW, Ueoka K, Seibold J, Snyder HM.
Changing concepts of hypospadias curvature lead to more onlay island flap procedures. J Urol 1994; 151:191-196.
7. Borer JG, Retik AB.
Current trends in hypospadias repair. Urol Clin North Am, 1999; 26: 15-37.
8. Bracka A.
Hypospadias repair: the two-stage alternative. Br J Urol 1995; 76 Suppl 3: 31-41.
9. Bronshtein M. Riechler A, Zimmer EZ.
Prenatal sonographic signs of possible fetal genital anomalies. Prenat Diagn 1995; 15: 215-219.
10. Burbige К A.
Simplified postoperative management of hypospadias repair. Urology 1994; 43: 719-721.
11. Buson H, Smiley D, Reinberg Y, Gonzalez R.
Distal hypospadias repair without stents: is it better? J Urol 1994; 151: 1059-1060.
Caldamone AA, Edstrom LE, Koyle MA, Rabinowitz R, Hulbert WC. Buccal mucosal grafts for urethral reconstruction. Urology 1998; 51: 15-19.
De Grazia E, Cigna RM, Cimador M.
Modified-Mathieu's technique: a variation of the classic procedure for hypospadias surgical repair. Eur J Pediatr Surg 1998; 8: 98-99.
14. Dubois R, Pelizzo G, Nasser H, Valmalle AF, Dodat H.
Les fistules de I'uretre apres traitement chirurgical d'hypospadias. A propos d'une serie de 74 cas. Prog Urol 1998; 8: 1029-1034.