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Introduction: Urethrocutaneous fistula (UCF) is the most common complication after hypospadias repair, with an variable incidence of 2–35%, depending on defect type. The interposition of tissue between the neourethra and the skin or glans is considered an important factor to reduce the risk of UCF. Literature has focused on the comparison of different types of second layers, but there is still no consensus regarding the best tissue to adopt. By contrast, literature regarding not-covered urethroplasty is lacking. Our aim is to investigate the value of hypospadias repair without a second-layer and to compare the results with hypospadias repaired with the use of an alternative, easily available second layer of periurethral tissue. Methods: All distal and mid-penile hypospadias treated with single-stage urethroplasty at our centre between 2016 and 2020 were reviewed. Cases were divided according to the surgical technique: Group-A (urethroplasty with a second layer of periurethral tissue) and Group-B (single-layer urethroplasty). Anagraphic data and complications such as UCF and meatal stenosis were analysed. Results: 425 single-stage urethroplasties were collected. 30 cases of UCF were observed (7%), 11/164 for Group A (6,7%) and 19/261 for Group B (7,3%) at a mean follow-up of 3 years. The difference was not statistically significant (p = 0.8). In 11/30 patients (37%) the UCF was associated with meatal stenosis. Conclusions: A well-performed urethral suture, more than a second layer, is fundamental to prevent UCFs. Periurethral tissue is a valid second layer, providing good coverage with minimal tissue manipulation. Larger, prospective and randomised studies could be encouraged to confirm our data. [ABSTRACT FROM AUTHOR]

Objectives: Maternal exposure to environmental endocrine disruptors, such as phthalates, during pregnancy is a significant risk factor for the development of hypospadias. By consolidating existing research on the mechanisms by which phthalates induce hypospadias in rodent models, this systematic review aims to organize and analyze the discovered mechanisms and their potential connections. Methods: The study involved all articles that explored the mechanisms of phthalate-induced hypospadias using rodent models. A comprehensive search of the PubMed and Web of Science databases was conducted using the terms "hypospadias" and "phthalates" before January 20, 2024. Then, two investigators screened for studies worthy of inclusion by setting inclusion and exclusion criteria. Results: Of the initial 326 search results, 22 were included in the subsequent analysis. Based on the commonalities among different results, the mechanisms of phthalate-induced hypospadias could be categorized into the following five groups: sex steroids-related signaling pathways (n=10), epithelial-mesenchymal transition (n=6), autophagy (n=5), apoptosis (n=4) and angiogenesis (n=2). Among these, sex steroids-related signaling pathways might serve as a central regulator among all mechanisms, and reactive oxygen species (ROS) also played an important mediating role. Conclusion: The systematic review indicates that phthalates may initially disrupt the balance of sex steroids-related pathways, leading to abnormally elevated levels of ROS and subsequently to other functional abnormalities, ultimately resulting in the development of hypospadias. All these findings will help to improve prevention strategies during pregnancy to reduce the adverse effects of phthalates on the offspring. [ABSTRACT FROM AUTHOR]

Background: Healing complications are a significant concern after hypospadias repair, often attributed to deficient growth factors and reduced healing potential of hypospadiac tissue. Platelet-Rich Fibrin (PRF), a new generation of platelet concentrates rich in growth factors, has been successfully applied to provide a mechanical barrier and promote healing in different surgical fields. The objective of this study was to assess the role of a PRF membrane covering the neourethra, in addition to a Dartos flap, optimizing the outcomes of primary distal hypospadias repair. Methods: Forty-four patients undergoing primary distal hypospadias repair were randomized and then assigned to two groups according to the covering layer(s) applied over the neourethra in Tubularized Incised Plate (TIP) repair. Each group included 22 cases with an average age of 38 ± 28 months for group A and 30 ± 21 months for group B. In group A, the classical technique of a single Dartos flap was used. In group B, an autologous PRF membrane -prepared during surgery using the patient's own serum- was placed to the neourethra and subsequently covered with Dartos flap. Results: with a mean follow up of 17.9 ± 7.2 months (range 6–30 months), group B had the lowest rate of complicated cases (9.1% compared to 31% for group A), Nevertheless, this finding was not statistically significant. The implementation of PRF in group B scaled down the rate of urethrocutaneous fistula (UCF) formation to 4.5% compared to 18.2% in group A. Furthermore, group B had no incidence of wound infection compared to 22.7% in group A (p < 0.05). Conclusion: Combined neourethral coverage with a PRF membrane and a Dartos flap leads to a trend toward a significant decrease in rate of UCF and leads to a significant reduction in wound infection after TIP repair compared to a single Dartos flap after TIP repair compared to a single Dartos flap. The technique is technically simple, inexpensive and is also not time-consuming. [ABSTRACT FROM AUTHOR]

Megameatus intact prepuce (MIP) presents with diverse phenotypes that complicate the management of this rare but complex hypospadias variant. Current data on optimal treatment methods and patient outcomes are sparse, unintegrated, and therefore challenging to implement clinically. A comprehensive systematic review of the existing literature on MIP was conducted according to PRISMA guidelines. Electronic databases including PubMed, Embase, and Scopus were searched for relevant articles published up to [2024]. Key aims were to assess the safety and efficacy of different surgical interventions, and synthesize corresponding outcomes reported in the literature. The search yielded 18 articles meeting the inclusion criteria, representing a total of 524 enrolled patients across multiple geographic regions. Diagnosis of MIP typically involves clinical examination, imaging studies, and urological evaluation. Surgical management options included preputial reconstruction, urethroplasty, and meatal advancement with glanuloplasty. Reported outcomes varied, with success rates ranging from [77.1–100%]. Long-term follow-up data on functional and cosmetic outcomes were limited. Megameatus intact prepuce presents diagnostic and management challenges due to low prevalence and variable presentation. This systematic review presents a current understanding of MIP diagnosis, surgical techniques, and patient outcomes. Future studies should assess the long-term functional outcomes of different surgical approaches, and investigate the underlying genetic and environmental factors contributing to the diverse clinical manifestations of MIP. [ABSTRACT FROM AUTHOR]

Purpose: The concept of interposing double dorsal preputial flaps to cover the urethroplasty was introduced in 2005 to reduce the risk of urethrocutaneous fistula (UCF). Our study aims to compare the postoperative outcomes of urethroplasty for distal hypospadias between two groups: one receiving single preputial flap coverage and another receiving double flap coverage. Materials and methods: We conducted a retrospective analysis study of boys with primary distal hypospadias who underwent surgery by the same experienced surgeon, at our department between 2010 and 2021. The study population was divided into two groups: Group A, which underwent urethroplasty coverage with single dorsal preputial flap, and Group B, which underwent coverage with double flap. Postoperative complications were compared between the two groups. Results: We collected 105 cases, comprising 51 in Group A and 54 cases in Group B. The mean age at surgery was 29 months in Group A and 24 months in Group B. Post‐operative follow‐up period ranged from 6 months to 8 years. Functional and cosmetic outcomes were judged excellent in 88.7%. Only 10 boys experienced complications requiring reoperation. UCF occurred in 5 patients from Group A, while no cases were reported in Group B (p = 0.024). Meatal stenosis was identified in three patients in Group A and in two patients in Group B (p = 1). No other complications, such as glans dehiscence or penile torsion, were noted. Conclusion: Double dorsal dartos flap is an effective method for covering the new urethra and can be recommended in the treatment of patients with virgin distal hypospadias. [ABSTRACT FROM AUTHOR]

To elucidate the incidence, presentation timing, and determinants of adulthood neourethral strictures after childhood hypospadias repair, using data from a database derived from a single procedure performed by a single surgeon. Pediatric patients with hypospadias who underwent staged surgery using a foreskin-derived neourethra served as the Denominator population. Clinical data from adult neourethral stricture patients who re-visited us were analyzed. Fourteen of 723 Denominator population (1.9%) re-visited for adult neourethral stricture. The median age at completion of the initial hypospadias repair was 6 years (IQR 4-7). Seven patients (50.0%) underwent surgical interventions in childhood, and 6 (42.9%) had a history of childhood stricture surgery at the age of 4-17 years (median, 5.5). Strictures sites were meatal in 3 (21.4%), entire neourethra in 2 (14.3%), and junctional in 9 (64.3%), with a median length of 17.5 mm (IQR 15-25). Urethral self-dilation was initiated in 9 patients. Eleven patients, including 6 initially treated with self-dilation, required open urethral repair. Time from childhood repair to stricture symptoms ranged from 18 to 34 years (median, 26.5). Median ages at urethral stricture symptoms, re-visit, and open urethral repair were 34 (IQR 25-38), 38.5 (IQR 32-45) and 45 years (IQR 37-53), respectively. Multivariate Cox hazard analysis identified childhood surgical intervention post-initial repair as the only significant risk factor for neourethral stricture (P <.05). These results highlight the importance of educating patients about the risk of late strictures following childhood hypospadias repair. [ABSTRACT FROM AUTHOR]

Objective: To assess the cumulative rates of re‐operations after hypospadias repair and evaluate long‐term surgical outcomes at a tertiary paediatric urology centre. Patients and Methods: Retrospective analysis of 293 boys born between 1991 and 2003 undergoing hypospadias surgery was conducted. The study included 274 patients: 165 with distal, 34 with midshaft, and 75 with proximal hypospadias. Kaplan–Meier methods were used to evaluate the re‐operation data. Results: The median age at primary surgery was 1.3 years, with a median follow‐up of 14.4 years. The overall re‐operation rate was 48.2%, with approximately half of the problems detected within the first 3 months after surgery. The risk of re‐operation was correlated with hypospadias severity, with 5‐ and 15‐year re‐operation risks at 39.3% and 51.8%, respectively. Limitations of the study include its retrospective nature and variations in surgical techniques from current standards. Conclusion: There is a significant risk of unplanned re‐operations following hypospadias repair, increasing with the severity of the original condition. This underscores the need for extended follow‐up and effective communication with patients and their families about the likelihood of requiring multiple surgeries for optimal outcomes. [ABSTRACT FROM AUTHOR]

Introduction The original description of tubularized incised plate urethroplasty (TIPU) was provided by Snodgrass in 1994. The results were significantly improved by several modifications. To decrease the incidence of complications, interposing a vascularized flap after tubularization of the neourethra is recommended. The extent to which the type of interposed tissue has a direct effect on the rate of complications and cosmetic outcomes after TIPU repair is considered the answer to the main hypothesis of this study. Materials and Methods This prospective controlled randomized trial was conducted in the Department of Pediatric Surgery, Al-Azhar University, Cairo, Egypt, between May 2019 and May 2023. A total of 220 patients were included in this study. Patients were randomly assigned to either group A or group B. Group A included 110 patients who underwent TIPU with spongioplasty–dartosoraphy reinforcement. The other 110 patients (group B) underwent TIPU with dorsal dartos flap interposition, without spongioplasty. Results Complications developed in 34 of 220 patients (15.4%). In group A, complications developed in 11 of 110 patients (10.0%). In group B, complications occurred in 23 of 110 patients (20.9%). Although the fistula rate, glanular dehiscence, disruption, and meatal stenosis were not significantly different between the study groups, the skin necrosis rate was significantly lower in group A than in group B. The overall complication rate was significantly lower in group A than in group B. Also, the difference in the mean Hypospadias Objective Scoring Evaluation between the two groups was statistically significant. Conclusion TIPU with spongioplasty–dartosoraphy reinforcement is an effective modification of conventional TIPU. This modification appears to reduce the rate of complications and yield better cosmetic outcomes. [ABSTRACT FROM AUTHOR]

Hypospadias is a common disease that affects approximately 1 in every 200 live male births in the United States, and long-term studies of individuals who have undergone repair demonstrate complication rates of 15%–70%. The Hypospadias-Specific Health-related Quality of Life (HRQOL) Conceptual Framework for youth and adults suggests that additional morbidity may be incurred from poor psychological, social, and sexual health. The current study sought to clarify hypospadias-specific HRQOL and care priorities in a pre-pubertal population. This IRB-approved, semi-structured interview study used rigorous qualitative research methods. Eligible patients were English-speaking 8–12-year-old males with hypospadias and their parents. Families completed a demographic questionnaire and separate youth and parent 30-min telephone interviews. We used hybrid thematic analysis to develop an operational codebook, analyze participant responses, and generate conceptual themes. Mixed methods analysis was used to explore patterns of experiences across groups defined by socioeconomic level. We interviewed 10 parents and 8 children (Median age 9 years, Range 8–11). We generated three overarching themes: Penile Factors, Psychosocial Concerns, and Expectations of Surgery and the Healthcare Team. These highest-order themes were generated for youth, parent-proxy, and parent self-reported experiences, and there were different sub-themes for each participant type (Figure). Youth were focused on avoidance of disclosure and the psychological impact of self-comparisons and embarrassment, while the parental perspective centered on worries about future fertility, complications, psychological health, and normality. Some youth and parents from disadvantaged neighborhoods or those with public insurance indicated a need for more education on normal penile functions and provision of strategies for long-term self-monitoring and facilitation of long-term follow-up on mixed methods analysis. These findings add insight into the multifaceted experiences of pre-pubertal youth and families dealing with hypospadias, and underscore the consistent, wide-ranging interplay between medical, psychological, and social concerns. Patterns in themes across socioeconomic status and insurance coverage suggest that access to information and quality care may vary significantly and could contribute to health disparities. Urologists should employ an individualized approach to counseling and care delivery. Future studies will seek to characterize care priorities in pubertal and post-pubertal age groups to design developmentally adjusted support tools for youth and adults with hypospadias and their families. [ABSTRACT FROM AUTHOR]

Patient-reported outcome measures (PROMs) for hypospadias care are lacking, and most existing instruments were developed without patient input. The objective of this study was to 1) use our previously developed Hypospadias Journal for concept elicitation in a sample of adolescent and young adult hypospadias patients and 2) develop a new hypospadias PROM. We recruited English-speaking males ages 13–30 living in the United States with a self-reported history of hypospadias through targeted advertisements on Facebook and Instagram from March to June 2022. Using a Qualtrics screening survey ineligible respondents were identified using automated fraud detection and manual review. Consenting participants were sent an electronic Hypospadias Journal containing brief creative writing exercises and multiple-choice scales to facilitate participant reflections about genital appearance, urination, sexual function, and psychosocial well-being. Demographics were summarized using descriptive statistics. Human-centered design researchers synthesized the journals' key themes to 1) create an affinity diagram with hypospadias-related quality of life (QOL) domains and 2) draft items for the PROM covering each domain and sub-domain. Journal participants were asked to complete a survey to 1) rank hypospadias QOL domains, subdomains, and draft items for the PROM, and 2) explore their preferences for item phrasing. In a small group virtual interview, a urologist and a hypospadias patient reviewed and revised draft PROM items, and a final PROM was created. Of the 411 completed screening surveys, 391 were ineligible. Journals were sent to 20 eligible participants. Of these, 12 completed journals: 8 adults; 4 adolescents (11 surgical/1 non-surgical): 66.7% White, 8.3% Black, 16.7% Asian, 8.3% >1 race. The meatal location was distal for 41.7%, proximal for 41.7%, unknown/missing for 16.7%. We identified four hypospadias-related quality-of-life domains and 13 respective sub-domains (Extended Summary Figure) of these, two were novel domains: 1) knowledge about the condition/treatment and comfort with treatment decision, and 2) impact on relationships with caregivers, medical providers, and sexual partners. A final PROM prototype, the Patient Assessment Tool for Hypospadias (PATH) was created, covering all QOL domains identified by participants. We created a simple, brief hypospadias PROM to screen for salient topics to be addressed by providers in the clinical setting. Limitations include the small sample size and limited clinical details about participants. Our study provides a hypospadias PROM that is ready for psychometric assessment in a larger sample. [ABSTRACT FROM AUTHOR]

Hypospadias repair surgery, though necessary, can be painful after the procedure, especially for children. Effective pain management is essential in all surgeries, but particularly in pediatric procedures. The current study was conducted to evaluate the analgesic efficacy of intravenous ketorolac versus dexmedetomidine after hypospadias repair surgery. Patients and methods: A total of 60 children aged between 2 and 7 years old undergoing hypospadias repair under general anesthesia enrolled in the study. Those children were randomly divided into either group Ketorolac (group A) or Dexmedetomidine group (group B). Group (A) included 30 patients who received IV ketorolac in a dose 0.9 mg/kg after intubation for general anesthesia while group (B) included 30 patients who received IV dexmedetomidine in a dose 1 μg/kg after intubation. Pain scores (FLACC), sedation and emergence agitation (EA) scores, 1st analgesic dose, hemodynamics, and any side events were recorded. Results: The main finding in this study was that group (B) had significantly lower FLACC at different postoperative times compared to group n(A)with p < 0.05; with exception at 4th and 12th hours. It was found that FLACC was zero in group (B) till the 6th hour postoperatively. All patients in the studied groups had sedation scale was 3 starting from the 4th postoperative hour. Immediate and 2-hour postoperatively, the score was significantly higher among the dexmedetomidine group.Two patients developed EA in group A but non in group B. Conclusion: Adjuvant intravenous dexmedetomidine is more effective than intravenous ketorolac in postoperative analgesia children after hypospadias repair surgery under general anaesthesia. [ABSTRACT FROM AUTHOR]

In patients with proximal hypospadias, often no genetic cause is identified despite extensive genetic testing. Many genes involved in sex development encode transcription factors with strict timing and dosing of the gene products. We hypothesised that there might be recurrent differences in DNA methylation in boys with hypospadias and that these might differ between patients born small versus appropriate for gestational age. Genome-wide Methylated DNA sequencing (MeD-seq) was performed on 32bp LpnPI restriction enzyme fragments after RE-digestion in leucocytes from 16 XY boys with unexplained proximal hypospadias, one with an unexplained XX testicular disorder/difference of sex development (DSD) and twelve, healthy, sex- and age-matched controls. Five of seven differentially methylated regions (DMRs) between patients and XY controls were in the Long Intergenic Non-Protein Coding RNA 665 (LINC00665; CpG24525). Three patients showed hypermethylation of MAP3K1. Finally, no DMRs in XX testicular DSD associated genes were identified in the XX boy versus XX controls. In conclusion, we observed no recognizable epigenetic signature in 16 boys with XY proximal hypospadias and no difference between children born small versus appropriate for gestational age. Comparison to previous methylation studies in individuals with hypospadias did not show consistent findings, possibly due to the use of different inclusion criteria, tissues and methods. [ABSTRACT FROM AUTHOR]

Background Objectives Materials and methods Results Conclusions Hypospadias with lichen sclerosus (LS) poses surgical challenges due to lack of materials for urethral reconstruction and coverage and the limited number of reports on this clinical condition.To report surgical strategies and outcomes for primary and redo hypospadias patients with LS.We conducted a retrospective observational descriptive study with 31 patients with primary/redo hypospadias and LS between 2013 and 2023. Of these patients, 9 had primary hypospadias with 7 distal types and 2 proximal types, and 22 were redo patients. Nineteen of the 31 patients underwent various surgical techniques, and 12 underwent the oral mucosa onlay procedure (OMOP). Postoperative uroflowmetry, hypospadias objective scoring evaluation (HOSE), and complications were evaluated.For primary distal hypospadias with LS‐affected skin, five patients underwent circumcision; these patients had normal postoperative urinary flow, and only one patient had an inconspicuous penis after surgery. For the patients with primary proximal hypospadias with an LS‐affected urethra, one patient required perineal urethrostomy following a modified Koyanagi procedure for recurrent stricture; the other patient underwent two‐stage transverse preputial island flap urethroplasty with no postoperative lower urinary tract symptoms (LUTS) and satisfactory aesthetic scores. In two remaining cases of primary distal hypospadias with meatus/urethral LS, no LUTS or postoperative complications occurred following meatoplasty/circumcision and penile basal fixation. During reoperations, compared with those of patients who underwent other redo procedures, twelve patients who underwent OMOP had better Qmax and uroflowmetry (p = 0.002) and higher HOSE scores (p = 0.01).For primary hypospadias patients with LS, enhanced exposure of the penile shaft and glans may benefit distal hypospadias, whereas staged surgery may be suitable for proximal hypospadias. The oral mucosa is favored for urethral augmentation in patients with redo hypospadias complicated with LS, and the OMOP can address neourethra coverage effectively. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate our experience with different surgical techniques and to find clinical factors that affect the outcome of treatment in cases of redo-hypospadias. Methods: We have retrospectively evaluated demographic and clinical data of children who underwent redo or cripple-hypospadias repair. Results: Between 2004 and 2021, 76 patients met the inclusion and exclusion criteria. The median age of the first cripple-hypospadias surgery was 64.8 ± 62.9 months. Upon primary surgery 5(6.6%) patients presented with distal-hypospadias, 13(17.1%) midshaft-hypospadias, 37(48.7%) proximal-hypospadias and 21(27.6%)with an unknown initial meatal status. To correct cripple-hypospadias 3(3.9%) patients underwent meatal-advancement and meatoplasty 32(42.1%) different tubularization techniques, 25(32.9%) required flap/graft, 13(17.1%) staged procedure and in 3(3.9%) surgical technique was undefined. Fifty-four (71%) children presented with post-surgery complications: 25(32.9%) meatal retraction, 19(25.3%) meatal stenosis and 17(22.3%) developed urethro-cutaneous fistula. Thirty-six (47.4%) patients underwent additional surgeries. There was no association between surgical technique or age and the need for additional surgeries (P = 0.831, P = 0.425 respectively). There was no association between surgical technique or age and surgical complications (P = 0.514, P = 0.425 respectively). All surgical techniques except meatal-advancement might lead to urethral stricture on long term follow-up (P = 0.028). Conclusions: Our data show that treatment of cripple-hypospadias is challenging for both surgeon and patients alike. There is a need to tailor a surgical technique to each patient and there is no one technique which is appropriate for all patients. [ABSTRACT FROM AUTHOR]

Objectives: Hypospadias is the most common anomaly of the male genital system after undescended testis. More than 200 surgical repair techniques have been described for the treatment of hypospadias due to many different meatus localisations and other accompanying anomalies. Kutlay defined a new technique in 2010 with 10 patients with distal hypospadias patients. We compared this new technique with tubularized incised plate urethroplasty (TIP) which is one of the most frequently performed methods. Methods: 148 patients with hypospadias who underwent surgery at the Urology and Pediatric Surgery Clinic during the period of January 2010 to December 2022 in the first and 2nd clinic, were retrospectively analyzed. The study focused on the remaining 83 patients with distal hypospadias for the purpose of comparison. Results: The mean age of group one was 10.0 (± 6.9, range 2–27), while for group two it was 10.8 (± 5.9, range 3–23). There was no statistically significant difference between the two groups in terms of anatomical position of the meatus, stricture and fistula complications (p > 0.5). Conclusion: The Kutlay technique has been described as an easy-to-learn and feasible method with reliable results. No significant difference in complications was observed in this study compared with TIP, which is known as the standard technique worldwide. We would like to suggest that the method be considered for further evaluation with larger patient groups and different techniques. [ABSTRACT FROM AUTHOR]

Purpose: To explore the efficacy of active fistulation in the treatment of proximal hypospadias in children by comparing one-stage and two-stage Duckett procedure. Materials and Methods: A total of sixty-seven children who were diagnosed with proximal hypospadias and underwent Duckett operation at our hospital between January 2013 and January 2021 were selected for this study. These subjects were divided into two groups: the research group (n = 36), using two-stage Duckett procedure with active fistulation, and the control group (n = 31), using one-stage Duckett procedure. The incidence of postoperative complications and the score of pediatric penile perception Scale were compared between the two groups. Results: The research group exhibits a significantly lower incidence rate of urethral fistula (8.3% Vs 16.1%) and urethral stricture (5.6% Vs 12.9%) in comparison to the control group (P < 0.01). Furthermore, the analysis of Pediatric Penile Perception Scale scores indicates that the research group achieves significantly higher scores in terms of urethral shape, penile skin shape, and overall appearance than the control group (P < 0.05). Conclusion: In the treatment of proximal hypospadias in children, active fistulation within the two-stage Duckett procedure significantly reduces the rate of stage 1 postoperative complications and improves parental satisfaction. Active fistulation may offer a more promising option for the treatment of proximal hypospadias in children. [ABSTRACT FROM AUTHOR]

To describe a new technique or adjunct—telescoping the dorsal hood—with a view to banking excess skin on the penile shaft in hypospadias surgery. This would help if redo surgery, not a rare occurrence, is required in the future. A review of a prospectively maintained database of hypospadias surgeries conducted between 1997 and 2023 by a single surgeon. After the hypospadias repair, instead of excising the dorsal hood and suturing the ventral penile skin in the usual way, a skin hook is applied on the ventral penile skin in the midline. As the skin hook is pulled down towards the scrotum, anywhere from 1 to 4 cm, it telescopes the dorsal hood down the penile shaft and also pulls in dorsal skin ventrally. (Technique described more fully in the manuscript) Around 1084 patients were operated for hypospadias over these 27 years. Telescoping of the dorsal hood was used in all patients, and in the 126 with proximal hypospadias, none had any skin of the dorsal hood excised! Sixty-two patients presented later with 73 fistulae which were operated on. Of note, no patient needed more than 2 surgical attempts for a cure. The dorsal hood is a useful source of not only skin but also underlying vascularised soft tissue. In hypospadias surgery where redo-operations are a predictable reality, preserving any excess skin on the phallus seems sensible. Our innovation of telescoping the dorsal hood achieves this goal nicely and takes only a few minutes to perform. [ABSTRACT FROM AUTHOR]

Introduction: Distal hypospadias accounts for the majority of hypospadias. Mathieu and Snodgrass techniques are widely used for repair of distal hypospadias but their comparative efficacy and reported outcomes are still debated. We conducted a systematic review and meta-analysis to compare the outcomes of these two techniques. Methods: Electronic databases and trial registries were searched for randomized controlled trials (RCTs) comparing Mathieu and Snodgrass techniques for primary distal hypospadias repair. Outcome measures included complication rates and cosmetic outcomes. Risk of bias assessment was performed using the ROB2. Data was analyzed using Review Manager 5.4; Trial Sequential Analysis (TSA) also was conducted for important outcomes. Results: Twelve RCTs were eligible for inclusion. The Snodgrass technique showed a significantly lower incidence of urethrocutaneous fistula (UCF) (RR 0.48, 95% CI [0.30–0.77]). However, there was no significant difference in the incidence of meatal stenosis (MS) between the two (RR 1.64, 95% CI [0.85–3.15]). TSA supports the findings for outcome UCF but not for MS. Operative time was shorter with the Snodgrass technique. Conclusion: This SRMA indicates a lower incidence of UCF with Snodgrass technique compared to the Mathieu technique in distal hypospadias repair. However, there was no significant difference in the risk of MS. [ABSTRACT FROM AUTHOR]

Urethral plate (UP) reserved Onlay urethroplasty is currently used widely in mid-distal hypospadias. However, for children with 15–30° residual curvature after degloving, only dorsal tunica albuginea plication is performed to correct penile ventral curvature (VC), and long-term follow-up showed a high recurrence rate of penile curvature. We developed a modified Onlay urethroplasty, which dissociates the UP and completely removes the tissue beneath the UP to fully correct penile curvature. Furthermore, we compared it with the standard Onlay urethroplasty to explore its rationality and feasibility. We prospectively collected clinical data from 68 children with hypospadias who underwent standard or modified Onlay urethroplasty between September 2019 and June 2021, and evaluated the interim outcomes to identify the complications between the two groups. Additionally, we conducted histological examination of the tissue beneath the UP. A total of 32 patients underwent modified Onlay urethroplasty. Intraoperative curvature measurements showed that 37.5% (12/32) of the patients had completely straightened their penis after UP dissection and removal of the fibrous tissue beneath it. A total of 36 patients underwent standard Onlay urethroplasty. Totally, five fistulas each were reported in the first and second groups, and the complication rates were 15.6% and 13.9%, respectively (P > 0.05). The histological results showed that the tissue below the UP contains a large amount of collagen, mainly type I collagen. The dissociated UP Onlay urethroplasty can maximally remove factors limiting penis growth and completely correct penile curvature, without increasing the incidence of postoperative complications. Therefore, we recommend the application of the improved Onlay urethroplasty in children with mid-distal hypospadias. [ABSTRACT FROM AUTHOR]

Background and Objectives: The purpose of this study is to report on the results of hypospadias surgery in boys using newly developed methods compared with traditional methods of urethroplasty. Materials and Methods: A total of 136 patients were divided into two groups. Fifty patients with coronal, subcoronal, and distal penile types of hypospadias were allocated to Group I. These patients were treated with a new method of SMU I and urethroplasty according to the Snodgrass procedure and MAGPI. Group II consisted of 86 patients with mid- and proximal shaft penile types of hypospadias who underwent urethroplasty using the new SMU II method and urethroplasty according to the Snodgraft and Bracka procedures. The outcomes were assessed according to the level of postoperative wound healing and the presence of complications. Results: The mean age of the patients was 41 to 60 months. After urethroplasty using the SMU I and SMU II methods, recovery was noted in 92.9% of the patients, and repeated surgery was performed in 7.1%. In the patients undergoing operations utilizing the SMU I and SMU II methods, neomeatus dystopia was not detected and postoperative fistulas were observed in 16.7% of incidence. With the standard urethroplasty method, the rate of complications was higher (p < 0.05). Even though the duration of surgery in the group undergoing a procedure using the standard urethroplasty method was lower (p < 0.001), the frequency of primary wound healing was higher in the SMU I and SMU II groups (p < 0.001). Conclusions: The proposed new methods of distal and shaft hypospadias surgery, in comparison with traditional surgical techniques, have the following advantages: good cosmetic appearance of the penis, complete straightening of the shaft, and right outflow of urine through the slit-like neomeatus at the apex of the glans penis. [ABSTRACT FROM AUTHOR]

Background/Objectives: Several surgical procedures have been proposed for the treatment of hypospadias, a common and heterogeneous congenital abnormality in males. Most surgeons utilize either a urethral stent or bladder catheter for 2–14 days as a postoperative urine diversion method depending on the severity of each case and the surgeon's preferences. The aim of the present study was to evaluate the feasibility of anterior and mid-penile hypospadias repair while placing the urethral catheter for only 20 h. Methods: A single-centre retrospective study was conducted, including all patients who underwent anterior or penile hypospadias repair from January 2012 to January 2023. All operations were performed based on the Tubularized Incised Plate (TIP) Urethroplasty. At the end of the operation, a 6 Fr 100% silicon catheter was stabilized. The catheter was removed 20 h postoperatively, and all patients were discharged on the first postoperative day. The primary endpoint of the study was the complication rate. Results: In total, 104 patients were enrolled. Eighty (76.9%) patients presented with distal penile hypospadias, while 24 patients (23.1%) had mid-penile hypospadias. The mean age at the operation was 20.8 ± 12.4 months, while the mean operative time was 114.2 ± 28.7 min. All the operations were successfully completed. During the follow-up period (mean duration 101.1 ± 44.8 months), complications were recorded in 16.3% of the patients. Conclusions: The application of 20-h catheterization seems to be an effective alternative with outcomes comparable to other conventional drainage approaches, as it reduces the discomfort of the patients without increased risk of complications. [ABSTRACT FROM AUTHOR]