Surgical treatment of cripple hypospadias in the adult
DOI:
https://doi.org/10.48193/90pvqe51Keywords:
Hypospadias, Hypospadias in adult, Surgical treatmentAbstract
Clinical case: The case of a 21-year-old male with a diagnosis of hypospadias of the distal penile urethra and a history of 7 failed surgical interventions to correct hypospadias during his childhood and adolescence is reported. A urethral plasty was performed with oral mucosa graft and a Dartos flap to resolve the hypospadias.
Relevance: Hypospadias is the second most common congenital urologic condition in males and presents as incomplete closure of the urethra, ventral displacement of the meatus, and abnormalities of the prepuce, as well as other penile structures. The etiology points towards genetic causes, deficient hormonal stimulation and the placenta-fetus relationship, but the exact cause is still unknown. The treatment is surgical and consists of the tubulation of grafts for the reconstruction of the urethra, its objective is to correct the functionality and preserve the aesthetics, surgery is recommended from 6 to 18 months. Hypospadias is rare in adults, and management is also surgical; there is no treatment of choice due to the complexity of the cases and the factors specific to each patient. The risk of complications will increase with the age of the patient and the number of previous interventions.
Conclusion: Hypospadias is rare during the adult stage because most of it is treated during childhood. It is considered that the use of oral mucosa grafts plus data flap is a good option for the treatment of these patients since most present unfavorable factors such as fibrosis, ischemia and a higher risk of infection.
References
Duckett JW. Hypospadias. Pediatrics In Review. 1989;11(2): 37–42. https://doi.org/10.1542/pir.11-2-37.
van der Zanden LFM, van Rooij I a. LM, Feitz WFJ, Franke B, Knoers NV a. M, Roeleveld N. Aetiology of hypospadias: a systematic review of genes and environment. Human Reproduction Update. 2012;18(3): 260–283. https://doi.org/10.1093/humupd/dms002.
Leung AKC, Robson WLM. Hypospadias: an update. Asian Journal of Andrology. 2007;9(1): 16–22. https://doi.org/10.1111/j.1745-7262.2007.00243.x.
Gil F, Benavides J, Saldarriaga J, Henao M. Reporte de caso: nueva técnica para el manejo de hipospadias refractaria en niños. Revista Urología Colombiana / Colombian Urology Journal. 2019;28(01): 092–096. https://doi.org/10.1055/s-0038-1645848.
Keays MA, Dave S. Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes. Canadian Urological Association Journal. 2017;11(1-2Suppl1): S48–S53. https://doi.org/10.5489/cuaj.4386.
Subramaniam R, Spinoit AF, Hoebeke P. Hypospadias Repair: An Overview of the Actual Techniques. Seminars in Plastic Surgery. 2011;25(3): 206–212. https://doi.org/10.1055/s-0031-1281490.
Bhat A. General considerations in hypospadias surgery. Indian journal of urology: IJU: journal of the Urological Society of India. 2008;24(2): 188–194. https://doi.org/10.4103/0970-1591.40614.
Pisón Chacón J, Romeo Ulecia M, Gracia Romeo J, Sánchez García J. Hipospadias escrotal. Nuestra experiencia con los injertos libres de mucosa oral. Cir. pediátr. 2000; 77–80.
Barbagli G, Balò S, Montorsi F, Sansalone S, Lazzeri M. History and evolution of the use of oral mucosa for urethral reconstruction. Asian Journal of Urology. 2017;4(2): 96–101. https://doi.org/10.1016/j.ajur.2016.05.006.
Goel HK, Tirthraj CM, Kabra S, Gahlawat S, Sharma U, Sood R. Factors affecting outcome of adult hypospadias single stage repair: A prospective observational study. Turkish Journal of Urology. 2021;47(5): 420–426. https://doi.org/10.5152/tud.2021.21163.
Halaseh SA, Halaseh S, Ashour M, Hypospadias: A Comprehensive Review Including Its Embryology, Etiology and Surgical Techniques. Cureus. 2022;14(7). https://doi.org/10.7759/cureus.27544.
Gonzalez Maldonado AA, Manzo Pérez G, Vanzzini Guerrero M A, Manzo Pérez B O, Lozada Hernández E E, Sánchez López H M. Tratamiento quirúrgico del hipospadias. Experiencia de 10 años. Revista Mexicana de Urología. 2018;78(4). https://doi.org/10.48193/revistamexicanadeurologa.v78i4.88.
Van Der Horst HJR, De Wall LL. Hypospadias, all there is to know. European Journal of Pediatrics. 2017;176(4): 435–441. https://doi.org/10.1007/s00431-017-2864-5
Stecker JF, Horton CE, Devine CJ, McCraw JB. Hypospadias cripples. The Urologic Clinics of North America. 1981;8(3): 539–544.
Craig JR, Wallis C, Brant WO, Hotaling JM, Myers JB. Management of adults with prior failed hypospadias surgery. Translational Andrology and Urology. 2014;3(2): 196–204.
Kulkarni SB, Joglekar O, Alkandari MH, Joshi PM. Redo hypospadias surgery: current and novel techniques. Research and Reports in Urology. 2018;10: 117–126. https://doi.org/10.2147/RRU.S142989.
Cruz-Diaz O, Castellan M, Gosalbez R. Use of Buccal Mucosa in Hypospadias Repair. Current Urology Reports. 2013;14(4): 366–372. https://doi.org/10.1007/s11934-013-0334-9.
Fichtner J, Filipas D, Fisch M, Hohenfellner R, Th ÜJW. Long-term followup of buccal mucosa onlay graft for hypospadias repair: analysis of complications. Journal of Urology. 2004;172(5): 1970–1972. https://doi.org/10.1007/s11934-013-0334-9.
Hensle TW, Tennenbaum SY, Reiley Ea, Pollard J. Hypospadias Repair In Adults: Adventures And Misadventures. Journal of Urology. 2001;165(1): 77–79. https://doi.org/10.1097/00005392-200101000-00019.
American Academy Of Pediatrics. Timing of Elective Surgery on the Genitalia of Male Children With Particular Reference to the Risks, Benefits, and Psychological Effects of Surgery and Anesthesia. Pediatrics. 1996;97(4): 590–594. https://doi.org/10.1542/peds.97.4.590.
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