Comparative analysis of one- and two-stage urethroplasty in the treatment of proximal hypospadias in children: flap or transplant?
- Authors: Surov R.V.1, Kagantsov I.M.2, Shmyrov O.S.1, Sizonov V.V.3, Volkova A.A.1, Zadykyan R.S.4, Kulaev A.V.1, Lazishvili M.N.1, Velskaya J.I.1
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Affiliations:
- Morozovskaya City Children’s Clinical Hospital
- Almazov National Medical Research Center
- Rostov State Medical University
- Center of Protection of Motherhood and Childhood
- Issue: Vol 11, No 4 (2021)
- Pages: 437-444
- Section: Original Study Articles
- URL: https://journals.rcsi.science/2219-4061/article/view/123510
- DOI: https://doi.org/10.17816/psaic968
- ID: 123510
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Abstract
BACKGROUND: Surgical treatment of proximal forms of hypospadias in children is still a complex and largely unsolved problem. The large number of postoperative complications following reconstructive surgery for proximal forms of hypospadias supports scientific interest in this issue.
AIM: This study aimed to conduct a retrospective comparative analysis of the effectiveness of two types of urethroplasty. We compared fundamentally different approaches to the formation of the artificial urethra, surgical techniques that use a different type of movement, and blood supply of the plastic materials — a flap and a graft.
MATERIALS AND METHODS: The study included 113 primary patients with proximal hypospadias aged 8 months to 15 years who underwent surgery between 2013 and 2019 and were divided into two comparison groups. Group 1 included 53 (46.9%) boys; a single-stage urethroplasty was performed by the onlay-tube method, where a longitudinal skin flap of the dorsal surface of the penis was used as a plastic material. Group 2 included 60 (53.1%) patients; two-stage urethroplasty was performed by the Bracka method, where the plastic material for the formation of the artificial urethra was a preputial graft in 44 (73.3%) patients and a graft of the oral mucosa in 16 (26.7%) patients.
RESULTS: When comparing the surgical results in the form of the number of complications requiring repeated surgical interventions under anesthesia to eliminate them, corresponding to Clavien–Dindo 3B complications, a significant difference was obtained in the study groups. The surgical results were significantly better when performing the two-stage Bracka method.
CONCLUSIONS: In the surgical treatment of proximal forms of hypospadias in children, the two-stage Bracka method, where the plastic material for the formation of the artificial urethra is a preputial or mucosal graft, significantly reduced the number of postoperative complications.
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##article.viewOnOriginalSite##About the authors
Roman V. Surov
Morozovskaya City Children’s Clinical Hospital
Email: rimvs@mail.ru
ORCID iD: 0000-0001-9081-8321
SPIN-code: 3964-1815
MD, Cand. Sci. (Med.), pediatric urologist-andrologist
Russian Federation, 1/9, 4th Dobryninsky Lane, Moscow, 119049Ilya M. Kagantsov
Almazov National Medical Research Center
Email: ilkagan@rambler.ru
ORCID iD: 0000-0002-3957-1615
SPIN-code: 7936-8722
Dr. Sci. (Med.), Professor, Chief Researcher
Russian Federation, Saint PetersburgOleg S. Shmyrov
Morozovskaya City Children’s Clinical Hospital
Email: moroz-uro@mail.ru
ORCID iD: 0000-0002-0785-0222
SPIN-code: 1228-5484
MD, Cand. Sci. (Med.), Head of the Department of Pediatric Urology
Russian Federation, 1/9, 4th Dobryninsky Lane, Moscow, 119049Vladimir V. Sizonov
Rostov State Medical University
Email: vsizonov@mail.ru
ORCID iD: 0000-0001-9145-8671
SPIN-code: 2155-5534
Dr. Sci. (Med.), Professor of the Department of Urology and Reproductive Health with a course of pediatric urology-andrology
Russian Federation, Rostov-on-DonAnastasiya A. Volkova
Morozovskaya City Children’s Clinical Hospital
Email: doc.uro@bk.ru
ORCID iD: 0000-0003-4178-4668
SPIN-code: 4292-3149
pediatric urologist-andrologist
Russian Federation, 1/9, 4th Dobryninsky Lane, Moscow, 119049Robert S. Zadykyan
Center of Protection of Motherhood and Childhood
Email: robs90@inbox.ru
ORCID iD: 0000-0002-5994-0537
SPIN-code: 7964-7037
surgeon
Russian Federation, SochiArtur V. Kulaev
Morozovskaya City Children’s Clinical Hospital
Email: arturkulaev@gmail.com
ORCID iD: 0000-0002-6758-2442
SPIN-code: 7887-3930
pediatric urologist-andrologist
Russian Federation, 1/9, 4th Dobryninsky Lane, Moscow, 119049Marina N. Lazishvili
Morozovskaya City Children’s Clinical Hospital
Email: pedurology@bk.ru
ORCID iD: 0000-0002-1892-7328
SPIN-code: 9632-8895
MD, Cand. Sci. (Med.), pediatric urologist-andrologist
Russian Federation, 1/9, 4th Dobryninsky Lane, Moscow, 119049Juliana I. Velskaya
Morozovskaya City Children’s Clinical Hospital
Author for correspondence.
Email: velskayadoc@gmail.com
ORCID iD: 0000-0003-1877-9940
SPIN-code: 1213-3425
MD, Cand. Sci. (Med.), plastic surgeon
Russian Federation, 1/9, 4th Dobryninsky Lane, Moscow, 119049References
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