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Indocyanine Green (ICG)-Guided Onlay Preputial Island Flap Urethroplasty for the Single-Stage Repair of Hypospadias in Children: A Case Report

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Publisher MDPI
Date 2023 Jul 14
PMID 37444094
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Abstract

First described by Duckett in 1981, and initially employed for the surgical correction of mid-penile hypospadias, the onlay preputial island flap urethroplasty has progressively gained increasing popularity, extending its indication to proximal forms. However, with the complexity of the penile anomaly, the rate of postoperative complications related to poor tissue perfusion (including skin and glans dehiscence, urethral stenoses, and fistulas) has also increased. Conventionally, the visual assessment of the onlay preputial island flap is the only option available to establish the appropriate tissue vascularization during surgery. To this end, we have first introduced the EleVision IR system (Medtronic Ltd., Hong Kong, China) to assess the vascular perfusion of the preputial island flap in a 13-month-old boy undergoing the onlay urethroplasty for the surgical correction of a mid-shaft hypospadias. This was possible 80 s after the intravenous injection of indocyanine green (ICG, 0.15 mg/kg, Diagnostic Green GmbH, Munich, Germany). ICG-based laser angiography helped define the proximal resection margin of the preputial flap, and proved to be safe, effective, and easy to employ. This innovative intraoperative imaging modality can be considered a useful adjunct for tissue perfusion evaluation and intraoperative decision-making during the onlay preputial island flap urethroplasty in children.

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References
1.
Chua M, Gnech M, Ming J, Silangcruz J, Sanger S, Lopes R . Preoperative hormonal stimulation effect on hypospadias repair complications: Meta-analysis of observational versus randomized controlled studies. J Pediatr Urol. 2017; 13(5):470-480. DOI: 10.1016/j.jpurol.2017.06.019. View

2.
Scarpa M, Minoli D, Paraboschi I, Gnech M, DE Marco E, Manzoni G . Androgen stimulation before the one-stage urethroplasty with preputial island flap (the Duckett's procedure) for proximal hypospadias repair. Minerva Urol Nephrol. 2022; 74(5):641-642. DOI: 10.23736/S2724-6051.22.04967-9. View

3.
Chao M, Zhang Y, Liang C . Impact of preoperative hormonal stimulation on postoperative complication rates after hypospadias repair: a meta-analysis. Minerva Urol Nefrol. 2016; 69(3):253-261. DOI: 10.23736/S0393-2249.16.02634-5. View

4.
Privitera L, Paraboschi I, Dixit D, Arthurs O, Giuliani S . Image-guided surgery and novel intraoperative devices for enhanced visualisation in general and paediatric surgery: a review. Innov Surg Sci. 2022; 6(4):161-172. PMC: 9294338. DOI: 10.1515/iss-2021-0028. View

5.
Springer A, Krois W, Horcher E . Trends in hypospadias surgery: results of a worldwide survey. Eur Urol. 2011; 60(6):1184-9. DOI: 10.1016/j.eururo.2011.08.031. View