The following is a summary of “Outcome analysis of staged preputial graft technique for primary proximal hypospadias with and without post-operative vacuum physiotherapy,” published in the December 2023 issue of Urology by Al-Salihi, et al.
It is still hard to treat proximal hypospadias. For a study, researchers sought to look at the outcomes of staged preputial graft repairs (SPG) for proximal hypospadias and think that vacuum physiotherapy (VP) after surgery improves the flexibility of the graft and the overall results. They looked back at 71 patients who had proximal hypospadias and serious ventral penile curve (PC) of ≥50° after degloving. PC was fixed by making cuts on the ventral side of the tunica albuginea (VTITA) without using a bandage and being careful not to hurt the erectile tissue underneath.
The ventral raw area at the penile shaft, including VTITA, was covered with either the inner preputial graft or a urethral plate split up and partly moved around. During the second stage, a tunica vaginalis flap was often used to cover the tubularized neourethra. After each stage, results and problems after surgery were compared between patients who got vacuum physiotherapy (VP+, n = 49) and those who didn’t (VP-, n = 22). The mean PC angle was 66°, the mean follow-up time was 13.01 months, and the total complication rate was 22.5%. Only 6 of the 49 VP+ patients (12.24%) had problems, including 4 fistulas and 2 urethral strictures.
In this group, PC did not come back after the second stage. A much higher percentage of problems happened in VP- patients; 10 of the 22 cases (45.45%) had fistulas form (n = 5) and glans dehiscence (n = 5). After the first stage of repair, weak PC came back in the same percentage of patients (12% VP+ and 18% VP-), and it was easy to fix with simple graft tubularization or dorsal plication during the second stage of repair. For fixing proximal hypospadias with bad chordee, staged treatment with VTITA works well. VP speeds up and improves the graft’s flexibility, significantly improving the patient’s result.
Source: sciencedirect.com/science/article/abs/pii/S1477513123003121
