SPU Main Site  |  Past & Future Meetings
Society For Pediatric Urology

Back to 2022 Abstracts


GRAFT STRETCHING WITH VITAMIN E FOR PENOSCROTAL HYPOSPADIAS AND SEVERE CHORDEE
Melissa McGrath, BASc, Yacoub Jafar, MD, BRUNO LESLIE, MD, Luis H. Braga, MD, MSc, PhD.
McMaster University, Hamilton, ON, Canada.

BACKGROUND: Concerns have been raised regarding graft contraction post-2-stage preputial graft repair for penoscrotal hypospadias with severe chordee. To reduce this complication, graft stretching has been used systematically in all patients after 2018, therefore, we sought to compare the surgical outcomes of boys who received topical application of vitamin E on the graft surface vs those who did not.METHODS:66 patients who completed both stages of primary prepuce graft repair with a minimum 6-month follow-up, from a prospectively collected hypospadias database (2008-22-n=889) were selected. Proximal TIP/Byars flaps cases and redos were excluded. Time between 1st and 2nd stage was 8 months. Stretching of the graft with vitamin E (parents were taught to stretch the graft manually in an upward motion ) was initiated 1 week postop for a 3-month period. Chordee was corrected by urethral plate division in all cases and by 3 transverse ventral corporotomies dorsal plication (80%). Residual chordee was checked in all cases during the 2nd stage. All procedures were performed by a single surgeon. Preoperative testosterone stimulation (PTS) was given as 3-IM injections, 3-weeks apart. Age at each stage of repair, meatal location, degree of chordee assessed before/after degloving with an artificial erection, complications [urethrocutaneous fistula (UCF), glans dehiscence (GD), recurrent chordee and graft contraction] were collected. Overall complication rate was compared between those who had vitamin E topical application vs. did not have.
RESULTS:Median patient age at 1st and 2ndstage was 21 and 30 months, respectively; mean follow-up was 42 months. Meatal location demographics were 49(74%) penoscrotal, 9 (14%) scrotal and 8 (12%) perineal hypospadias. Overall, 37/66(56%) patients had VC between 30-70 and 27(43%) >70 after degloving; 62/66(94%) boys received PHS (3 shots). Grafts took well in most cases with only 5(7%) contractions, 1/5 patients had graft stretching with vitamin E vs. that did not4/5. Overall, complications occurred in 14/66(21%) boys, 8 UCFs, 5 GDs and 1 recurrent VC due to skin tethering. All successful cases had the neomeatus located at the tip of the glans. Parents of 3 boys with GD decided for no further surgery, leaving the meatus at the corona. In total, re-operation rate was 17% (11/66). Pts who received vitamin E had an overall complication rate of 10% vs 29% in those who did not have it (p<0.05).
CONCLUSIONS:An overall re-operation rate of 17% was observed in patients who underwent staged preputial graft repair with 3 transverse corporotomies to treat scrotal/perineal hypospadias. Patients who underwent graft stretching with vitamin E for 3 months post-1st stage repair had a significantly lower overall complication rate compared to those who did not receive vitamin E.


Back to 2022 Abstracts