Comparative analysis of one- and two-stage urethroplasty in the treatment of proximal hypospadias in children: flap or transplant?

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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.

作者简介

Roman Surov

Morozovskaya City Children’s Clinical Hospital

Email: rimvs@mail.ru
ORCID iD: 0000-0001-9081-8321
SPIN 代码: 3964-1815

MD, Cand. Sci. (Med.), pediatric urologist-andrologist

俄罗斯联邦, 1/9, 4th Dobryninsky Lane, Moscow, 119049

Ilya Kagantsov

Almazov National Medical Research Center

Email: ilkagan@rambler.ru
ORCID iD: 0000-0002-3957-1615
SPIN 代码: 7936-8722

Dr. Sci. (Med.), Professor, Chief Researcher

俄罗斯联邦, Saint Petersburg

Oleg Shmyrov

Morozovskaya City Children’s Clinical Hospital

Email: moroz-uro@mail.ru
ORCID iD: 0000-0002-0785-0222
SPIN 代码: 1228-5484

MD, Cand. Sci. (Med.), Head of the Department of Pediatric Urology

俄罗斯联邦, 1/9, 4th Dobryninsky Lane, Moscow, 119049

Vladimir Sizonov

Rostov State Medical University

Email: vsizonov@mail.ru
ORCID iD: 0000-0001-9145-8671
SPIN 代码: 2155-5534

Dr. Sci. (Med.), Professor of the Department of Urology and Reproductive Health with a course of pediatric urology-andrology

俄罗斯联邦, Rostov-on-Don

Anastasiya Volkova

Morozovskaya City Children’s Clinical Hospital

Email: doc.uro@bk.ru
ORCID iD: 0000-0003-4178-4668
SPIN 代码: 4292-3149

pediatric urologist-andrologist

俄罗斯联邦, 1/9, 4th Dobryninsky Lane, Moscow, 119049

Robert Zadykyan

Center of Protection of Motherhood and Childhood

Email: robs90@inbox.ru
ORCID iD: 0000-0002-5994-0537
SPIN 代码: 7964-7037

surgeon

俄罗斯联邦, Sochi

Artur Kulaev

Morozovskaya City Children’s Clinical Hospital

Email: arturkulaev@gmail.com
ORCID iD: 0000-0002-6758-2442
SPIN 代码: 7887-3930

pediatric urologist-andrologist

俄罗斯联邦, 1/9, 4th Dobryninsky Lane, Moscow, 119049

Marina Lazishvili

Morozovskaya City Children’s Clinical Hospital

Email: pedurology@bk.ru
ORCID iD: 0000-0002-1892-7328
SPIN 代码: 9632-8895

MD, Cand. Sci. (Med.), pediatric urologist-andrologist

俄罗斯联邦, 1/9, 4th Dobryninsky Lane, Moscow, 119049

Juliana Velskaya

Morozovskaya City Children’s Clinical Hospital

编辑信件的主要联系方式.
Email: velskayadoc@gmail.com
ORCID iD: 0000-0003-1877-9940
SPIN 代码: 1213-3425

MD, Cand. Sci. (Med.), plastic surgeon

俄罗斯联邦, 1/9, 4th Dobryninsky Lane, Moscow, 119049

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