We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Two Stage Perineal Hypospadias Cripple Repair - case report.
- Authors
Gingu, C.; Ianiotescu, S.; Dick, A.; Baston, C.; Crasneanu, M.; Andresanu, A.; Himedan, O.; Mihancea, A.; Domnisor, L.; Sinescu, I.
- Abstract
Introduction and Objectives. Hypospadias, one of the most prevalent birth malformation of the male genitalia, consists of the insertion of the urethral meatus on the ventral side of the penis instead of the tip of the glans common associated with other penile defects and ventral chordee. It can vary in location from the glandular region (distal hypospadias) towards the perineum (proximal hypospadias). The later, although far less common, it is a lot more difficult to treat as it requires the reconstruction of the whole circumference and the full length of the urethra. The aim of this paper is to present the surgical management of a difficult case of perineal hypospadias cripple. Materials and Methods. A 21 years old patient presented in our clinic with a perineal hypospadias, inadequately treated during his infancy and early childhood at a pediatric department, when the perineal segment of the urethra was created using a scrotal skin graft, while the penile segment was reconstructed from a prepuce and penile skin flap and left "a plat". The physical examination revealed a perineal urethral meatus, with urethral calculi formed on hair grown inside the perienal segment. No ventral chordee was observed in this case. We decided on a two stage repair technique, spaced over a six months period. During the first stage the defective perineal urethra was completely removed, and two long buccal mucosa segments were harvested from both inner cheeks and grafted to the corpora cavernosa to replace the old scrotal skin graft. After the wait period of six months the matured buccal mucosa graft was tubularized in continuity with the prepuce flap and the neourethra was created. A 16 Fr Foley catheter was left in place for about three weeks. Results. No immediate or late complications were observed after any of the two stages of the intervention. The patient was discharged 5 days after the grafting and 6 days after the tubularization. The Foley catheter was removed after 21 days and normal micturitions using the neomeatus were possible, voiding at 18 ml/sec. Conclusions. Although hypospadias remains one of the most challenging problems of the urologist, even the more severe perineal cases can be successfully treated. A two stage repair is a versatile technique as it allows the use of buccal mucosa grafts in combination with prepuce and penile skin flaps to reconstruct of the whole circumference and full length of the urethra.
- Subjects
HYPOSPADIAS; URETHRA abnormalities; PERINEUM
- Publication
Romanian Journal of Urology, 2017, Vol 16, Issue 4, p40
- ISSN
1223-0650
- Publication type
Case Study