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Microscope-Assisted Hypospadias Repair, a Single Surgeon Experience
Nicholas G. Cost, M.D., Lori Hazelwood, R.N., Abbey C. Franklin, PA-C, Eugene Minevich, M.D..
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Hypospadias outcomes have improved with advances in surgical magnification. In hypospadias this is typically limited to surgical loupes and very few descriptions exist of microscopic hypospadias surgery.
We reviewed hypospadias repairs of a single surgeon (EM) and excluded DSD or Exstrophy patients. All urethroplasties were repaired in at least 2 layers. No GAP repairs were stented and all TIP and Extended TIP (E-TIP) repairs were stented. Our objective was describing and comparing the relationship between meatal location and type of repair, as well as their impact on outcomes.
532 patients met study criteria, of which 504 (94.7%) had available follow-up. Median age at surgery was 9mo (2-192). The meatal location was: Glanular: 233 (46.2%), Coronal: 178 (35.3%), Distal-Shaft: 43 (8.5%), Mid-Shaft: 25 (5%), Proximal-Shaft: 15 (3%), Penoscrotal: 9 (1.8%), and Perineal: 1 (0.2%). The type of repair was: TIP: 187 (37.1%), GAP: 182 (36.1%), E-TIP: 82 (16.3%), MAGPI: 50 (9.9%), 2-Stage: 2 (0.4%), and Mathieu: 1 (0.2%). There was a significant relationship between meatal position and repair-type: GAP was used for 71.2% of glanular hypospadias, TIP for 92.1% of coronal hypospadias, and E-TIP for 89.1% of penile shaft hypospadias, p<0.001.
Overall, 51 (10.1%) patients had 59 complications: Fistula: 29 (5.8%), Meatal Stenosis: 20 (4.0%), Bleeding: 3 (0.6%), Chordee recurrence: 3 (0.6%), Urethral Stricture: 3 (0.6%), Meatal Retraction: 1 (0.2%), Redundant Foreskin: 1 (0.2%). There was a significant relationship between meatal location and any complications: Glanular (3.4%), Coronal (10.7%), Distal-Shaft (16.3%), Mid-Shaft (28.0%), and Proximal-Shaft (33.3%), p<0.001. Similarly, there was a significant relationship between the repair-type and complications, p<0.001. For example, GAP/TIP repairs had a 7.8% overall complication rate, while E-TIP had a 22.0% complication rate. The fistula rate was 2.8% in GAP/TIP and 15.9% in E-TIP repairs, p<0.001. Meatal stenosis was observed in 3.3% of GAP/TIP and 9.8% of E-TIP repairs, p=0.007.
Overall, our review of a single surgeon experience using a surgical microscope for hypospadias repair demonstrated a low rate of complications. As expected more proximal meatal locations and those repairs done less frequently are associated with more complications.
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