Effect of surgical steps in primary hypospadias repair on penile length_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 TANG Yunman ¹ , LIU Yu ² , WANG Xuejun ¹ , MAO Yu ¹ , QIN Daorui ¹ , YANG Bo ¹ , PENG Kangjie ¹ , CHEN Zhu ¹ , LI Jiao ¹ , CHEN Shaoji ¹

1. Department of Pediatric Surgery at Children’s Medical Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu Sichuan, 610072, P. R. China;
2. Department of Urology, Chengdu Second People’s Hospital, Chengdu Sichuan, 610021, P. R. China;

Corresponding?author：

TANG Yunman, Email: tangyunman@126.com

Keywords：

Hypospadias; penile length; orthopaedics; influencing factor

DOI：

10.7507/1002-1892.202109038

Video：

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Objective To document the effect of surgical steps, including penile degloving, plate transection, dorsal plication, and fasciocutaneous coverage, in primary hypospadias repair on penile length. Methods A consecutive series of 209 prepubertal boys with primary hypospadias repair was included with the age ranged from 10 to 97 months (mean, 31.7 months). Intraoperative stretched penile length (SPL) was measured before operation (n=209), and after each step, namely penile degloving (n=152), plate transection (n=139), dorsal plication (n=170), and fasciocutaneous coverage (n=209). SPLs before and after each steps or the entire operation were analyzed. The SPL was compared between plate transection group and plate preservation group, dorsal plication group and non-plication group, and plate preservation with plication group and plate preservation without plication group, respectively. Differences of SPL between before and after each steps were analyzed with factors including neourethra length, rest dorsal penile length, rest ventral penile length, preoperative SPL, and the degree of penile curvature after penile degloving, with multivariate linear regression analysis. Results All the four steps resulted in SPL difference. The SPL increased after penile degloving and plate transection (P<0.05), and decreased after dorsal plication and fasciocutaneous coverage (P<0.05). The SPL increased after all steps were completed (P<0.05). In patients with plate transection, postoperative SPL increased when compared with that before operation (P<0.05). No significant difference was noted in patients without plate transection (P>0.05). And there was significant difference in the increased length of SPL between patients with and without plate transection (P<0.05). In patients with dorsal plication, a significant increase of postoperative SPL (P<0.05) was noted. No significant difference was noted in patients without dorsal plication (P>0.05). And there was no significant difference in increased length between patients with and without dorsal plication (P>0.05). When patients with plate transection were excluded, dorsal plication resulted in no significant difference on postoperative SPL (P>0.05). The increased length of SPL after penile degloving, dorsal plication, or cutanofascial coverage was not related to the neourethra length, the rest dorsal penile length, the rest ventral penile length, the preoperative SPL, and the degree of penile curvature (P>0.05). However, the neourethra length and preoperative SPL were the influencing factors for the increased length of SPL after plate transection (P<0.05). Conclusion The main steps in primary hypospadias repair can change SPL. The lengthening effect of plate transection would not be counteracted by dorsal plication. Dorsal plication makes no significant difference on postoperative SPL.

Citation： TANG Yunman, LIU Yu, WANG Xuejun, MAO Yu, QIN Daorui, YANG Bo, PENG Kangjie, CHEN Zhu, LI Jiao, CHEN Shaoji. Effect of surgical steps in primary hypospadias repair on penile length. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(2): 231-235. doi: 10.7507/1002-1892.202109038 Copy

1.	唐耘熳, 陳紹基. 縱行帶蒂島狀包皮瓣尿道成形術矯治近端型尿道下裂. 現代泌尿外科雜志, 2021, 26(4): 277-280.
2.	Veale D, Miles S, Bramley S, et al. Am I normal? A systematic review and construction of nomograms for flaccid and erect penis length and circumference in up to 15, 521 men. BJU Int, 2015, 115(6): 978-986.
3.	van der Horst HJ, de Wall LL. Hypospadias, all there is to know. Eur J Pediatr, 2017, 176(4): 435-441.
4.	Ciancio F, Lo Russo G, Innocenti A, et al. Penile length is a very important factor for cosmesis, function and psychosexual development in patients affected by hypospadias: Results from a long-term longitudinal cohort study. Int J Immunopathol Pharmacol, 2015, 28(3): 421-425.
5.	Upadhyay J, Shekarriz B, Khoury AE. Midshaft hypospadias. Urol Clin North Am, 2002, 29(2): 299-310.
6.	Snodgrass W, Bush N. Primary hypospadias repair techniques: A review of the evidence. Urol Ann, 2016, 8(4): 403-408.
7.	Snodgrass W, Bush N. Recurrent ventral curvature after proximal TIP hypospadias repair. J Pediatr Urol, 2021, 17(2): 222.e1-222.e5.
8.	Pippi Salle JL, Sayed S, Salle A, et al. Proximal hypospadias: A persistent challenge. Single institution outcome analysis of three surgical techniques over a 10-year period. J Pediatr Urol, 2016, 12(1): 28.e1-7.
9.	唐耘熳. DUCKETT手術矯治尿道下裂的新解析(附視頻). 現代泌尿外科雜志, 2016, 21(9): 657-660.
10.	Donnahoo KK, Cain MP, Pope JC, et al. Etiology, management and surgical complications of congenital chordee without hypospadias. J Urol, 1998, 160(3 Pt 2): 1120-1122.
11.	Karaku? SC, Süzen A. Vertical plication: A penile curvature correction technique that reduces the need for urethral plate transection in penoscrotal hypospadias. J Pediatr Urol, 2021, 17(4): 516.e1-516.e5.
12.	吳少峰, 何蓉, 孫杰, 等. 腹側延長術和背側折疊術治療近端型尿道下裂的療效對比. 臨床小兒外科雜志, 2020, 19(7): 603-607.
13.	Braga LH, Lorenzo AJ, Bägli DJ, et al. Ventral penile lengthening versus dorsal plication for severe ventral curvature in children with proximal hypospadias. J Urol, 2008, 180(4 Suppl): 1743-1747.

1. 唐耘熳, 陳紹基. 縱行帶蒂島狀包皮瓣尿道成形術矯治近端型尿道下裂. 現代泌尿外科雜志, 2021, 26(4): 277-280.
2. Veale D, Miles S, Bramley S, et al. Am I normal? A systematic review and construction of nomograms for flaccid and erect penis length and circumference in up to 15, 521 men. BJU Int, 2015, 115(6): 978-986.
3. van der Horst HJ, de Wall LL. Hypospadias, all there is to know. Eur J Pediatr, 2017, 176(4): 435-441.
4. Ciancio F, Lo Russo G, Innocenti A, et al. Penile length is a very important factor for cosmesis, function and psychosexual development in patients affected by hypospadias: Results from a long-term longitudinal cohort study. Int J Immunopathol Pharmacol, 2015, 28(3): 421-425.
5. Upadhyay J, Shekarriz B, Khoury AE. Midshaft hypospadias. Urol Clin North Am, 2002, 29(2): 299-310.
6. Snodgrass W, Bush N. Primary hypospadias repair techniques: A review of the evidence. Urol Ann, 2016, 8(4): 403-408.
7. Snodgrass W, Bush N. Recurrent ventral curvature after proximal TIP hypospadias repair. J Pediatr Urol, 2021, 17(2): 222.e1-222.e5.
8. Pippi Salle JL, Sayed S, Salle A, et al. Proximal hypospadias: A persistent challenge. Single institution outcome analysis of three surgical techniques over a 10-year period. J Pediatr Urol, 2016, 12(1): 28.e1-7.
9. 唐耘熳. DUCKETT手術矯治尿道下裂的新解析(附視頻). 現代泌尿外科雜志, 2016, 21(9): 657-660.
10. Donnahoo KK, Cain MP, Pope JC, et al. Etiology, management and surgical complications of congenital chordee without hypospadias. J Urol, 1998, 160(3 Pt 2): 1120-1122.
11. Karaku? SC, Süzen A. Vertical plication: A penile curvature correction technique that reduces the need for urethral plate transection in penoscrotal hypospadias. J Pediatr Urol, 2021, 17(4): 516.e1-516.e5.
12. 吳少峰, 何蓉, 孫杰, 等. 腹側延長術和背側折疊術治療近端型尿道下裂的療效對比. 臨床小兒外科雜志, 2020, 19(7): 603-607.
13. Braga LH, Lorenzo AJ, Bägli DJ, et al. Ventral penile lengthening versus dorsal plication for severe ventral curvature in children with proximal hypospadias. J Urol, 2008, 180(4 Suppl): 1743-1747.

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