The Influence of Perioperative Factors on Primary Severe Hypospadias Repair

Overview

Journal Nat Rev Urol

Specialty Urology

Date 2011 Apr 9

PMID 21475332

Citations 7

Authors

Marco Castagnetti

Alaa El-Ghoneimi

Affiliations

Soon will be listed here.

Abstract

Hypospadias is one of the most common congenital malformations of the male genitalia. Severe cases present with associated curvature greater than 30° and the meatus opening proximally to the penoscrotal junction. The perioperative management of patients with primary severe hypospadias is variable. Systematic evaluation of the upper urinary tract and the search for enlarged prostatic utricles seem unnecessary in patients with isolated primary severe hypospadias, and should be limited to severe cases with associated extraurinary malformations. Detection of a disorder of sex development is key for gender assignment and prognosis, but the identification of cases warranting a full work-up and the influence of such a diagnosis on the success of hypospadias repair is controversial. Preoperative hormonal stimulation allows for penile growth irrespective of the administration route. Associated morbidity is minimal, but its influence on the success of surgery is still unknown. An age of 6-18 months is generally recommended for surgery, but no trial data support this policy. Second-layer coverage of the urethroplasty and postoperative urinary drainage seem to reduce the complications of surgery, whereas postoperative antibiotic prophylaxis and type of dressing have minimal impact on surgical success. Overall, most interventions are based on weak evidence, and their influence on the outcomes of repair is ill-defined. Clinicians should be made aware of the evidence supporting any single intervention in order to standardize their management policies. We hope the issues outlined here will prompt researchers to design new studies to address the clinically relevant questions.

Citing Articles

Surgical management of primary severe hypospadias in children: an update focusing on penile curvature.

Castagnetti M, El-Ghoneimi A Nat Rev Urol. 2022; 19(3):147-160.

PMID: 35039660 DOI: 10.1038/s41585-021-00555-0.

Outcome of restricted antibiotic policy in a tertiary-level paediatric surgical unit.

Basavaraju M, Alladi A, Vepakomma D Afr J Paediatr Surg. 2021; 18(1):28-32.

PMID: 33595538 PMC: 8109756. DOI: 10.4103/ajps.AJPS_127_20.

Surgical management of hypospadias in cases with concomitant disorders of sex development.

Ochi T, Ishiyama A, Yazaki Y, Murakami H, Takeda M, Seo S Pediatr Surg Int. 2019; 35(5):611-617.

PMID: 30762107 DOI: 10.1007/s00383-019-04457-6.

Concordance of Expert and Parental Opinion about Hypospadias Surgical Outcome Is Severity Dependent.

Perez-Brayfield M, Jorge J, Aviles L, Diaz J, Ortiz V, Morales-Cosme W Front Pediatr. 2016; 4:2.

PMID: 26835440 PMC: 4725097. DOI: 10.3389/fped.2016.00002.

Disorders of sex development in a developing country: perspectives and outcome of surgical management of 39 cases.

Ekenze S, Nwangwu E, Amah C, Agugua-Obianyo N, Onuh A, Ajuzieogu O Pediatr Surg Int. 2014; 31(1):93-9.

PMID: 25326123 DOI: 10.1007/s00383-014-3628-1.

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