Materiały źródłowe

• #1 Assessment of Outcome in Hypospadias Surgery – A Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3895870/

  Hypospadias is a challenging field of urogenital reconstructive surgery with different techniques being currently used. […] Continuous re-evaluation and assessment of outcome may have a major impact on future clinical practice. […] Somehow in the future, we will be able to give an accurate estimation of the long-term consequences of being born with hypospadias. […] Assessment of outcome includes: complication rate, cosmetic appearance of the penis, functional outcome (micturition, sexuality), and psychological factors such as quality of life and psychosexual life. […] However, data from Gent show that there is a good long-term outcome without further complications in 75% of the patients. […] Moreover, growing and disturbing literature from adult urologists show the limitations of pediatric urologists view.

• #2 Assessment of Outcome in Hypospadias Surgery – A Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3895870/

  There is an apprehension that pediatric urologists simply do not have enough epidemiological data on the incidence of failed hypospadias repair in childhood and currently there is no reliable estimation of the number of patients undergoing further surgery in adulthood or redo-surgery. […] A recent systematic review by Rynja et al. showed that there is a substantial lack in cosmetic, functional, and psychological long-term data. […] Surgery in the future will have to take much more into consideration the long-term consequences of esthetic and functional penile reconstruction in early childhood and how it will affect the patient in his later life physically, mentally, and emotionally. […] Follow-up and adequate counseling of hypospadias patients up to adult life is necessary, although demanding. Long-term assessment should be designed in prospective studies. […] Somehow in the future, we will be able to give an accurate estimation of the long-term consequences of being born with hypospadias.

• #3 Factors affecting outcome of adult hypospadias single stage repair: A prospective observational study

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9612767/

  Furthermore, on multivariate logistic regression analysis, glans width (P .0001) was the only parameter found to be significantly associated with postsurgery complications. […] The complication rate at 6-month follow-up in our study was 54.83%, which is comparable to other studies. However, it is quite high as compared to children. […] Several factors such as small glans width, flat urethral plate, small urethral plate width, and history of previous failed repair are associated with significant complications in adult hypospadias single stage repair. Among these factors, glans width was found to be an independent significant risk factor affecting outcome.

• #4 Factors affecting outcome of adult hypospadias single stage repair: A prospective observational study

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9612767/

  Objective: In our part of the world, many patients present with hypospadias in adult age, where results are often poor and associated with increased complications. This study was conducted to assess the factors affecting outcome of single stage hypospadias surgery in adults. […] Several factors are associated with significant complications in adult hypospadias single stage repair. Among the various risk factors, glans width is an independent significant risk factor affecting outcome. […] Understanding the risk factors associated with the complications of the hypospadias surgery among adults may help in achieving better outcomes. […] On univariate logistic regression analysis, parameters comprising glans width (P .0001), urethral plate shape (P = .011), urethral plate width (P = .005), and history of surgery (P = .018) were found to be significantly associated with postsurgery complications.

• #5 Predictors of surgical complications in boys with hypospadias: data from an international registry | World Journal of Pediatric Surgery

  https://wjps.bmj.com/content/6/4/e000599

  Boys with proximal hypospadias in the I-DSD Registry have high rates of additional comorbidities and a high risk of postoperative complications. […] No clinical factors were significantly associated with complication rates. […] High complication rates with no observable cause suggest the involvement of other factors which need investigation. […] No single clinical factor or combination of risk factors was significantly associated with postsurgical complication rates in this cohort. […] It is plausible that the high rates of extragenital malformations within the current cohort prevented an association being observed and that discrepancies in the results obtained from this study may be due to variations in genetic and biochemical testing internationally. […] Further studies are needed to identify novel clinical factors which may be associated with complication rates in this complex group.

• #6 Hypospadias in toddlers: a multivariable study of prognostic factors in distal to mid-shaft hypospadias and review of literature | World Journal of Pediatric Surgery

  https://wjps.bmj.com/content/5/1/e000225

  Persistent complications were found in 16 cases (15.8%) including fistula formation, the persistence of chordee, meatal stenosis, glans, and urethral dehiscence. […] Our study on the toddlers with hypospadias surgery revealed that the location of urethral meatal was the main predicting factor in the development of major complications. Furthermore, the fistula formation at the infected surgical site emphasizes the importance of postsurgical care. […] Location of urethral meatal was the main independent predictor of the development of complications in distal mid-shaft hypospadias repair in toddlers. […] In contrast to single-variable analysis, in the multivariable study the presurgical meatal location was the only factor associated with complications (p=0.03). Consistently, the closer the meatal orifice was to the coronal margin, the fewer the complications existed (RR=7.69, p=0.01).

• #7 Hypospadias in toddlers: a multivariable study of prognostic factors in distal to mid-shaft hypospadias and review of literature | World Journal of Pediatric Surgery

  https://wjps.bmj.com/content/5/1/e000225

  The current body of literature on the hypospadias prognostic factors has been plagued by lack of age-matched patients or control for meatal location, diversity in surgical techniques, the multiplicity of surgeons, or non-uniform distributions of study population ages. Our study revealed that the location of urethral meatus was the only independent predictor of the development of complications.

• #8 Is Routine Uroflowmetry Necessary following Hypospadias Repair?

  https://clinmedjournals.org/articles/iauc/international-archives-of-urology-and-complications-iauc-4-038.php?jid=iauc

  Uroflow parameters post hypospadias repair are known to remain poor initially but most improve with time. […] There is a recognised group of patients who develop late deterioration of flow and may require surgical intervention, but at present there are no standardised guidelines as to length and nature of follow up. […] We found routine uroflow at age 5 years following hypospadias is predictive of the need for regular follow up and potential for late deterioration needing surgery. […] Abnormal uroflow parameters predicts need for late surgery. […] No asymptomatic child with normal uroflow findings at 5 years required subsequent surgery, with a negative predictive value of 100%. […] Urinary flow rate was the primary uroflow parameter predictor of outcomes, irrespective of absolute or relative post void residual volumes. […] There are an appreciable number of children who require delayed surgical intervention post hypospadias repair. […] Our findings indicate puberty is a time where mild symptomology or poor flow rates are provoked into necessitating late surgical intervention.

• #9 Use of Validated Questionnaires to Predict Cosmetic Outcomes of Hypospadias Repair

  https://www.mdpi.com/2227-9067/11/2/189

  Over 80% of boys undergoing hypospadias repair achieve optimal cosmetic outcomes. […] Predictors of optimal cosmetic outcomes after hypospadias surgery include degree of chordee, glans width, and preoperative HOPE and GMS scores, which are the best predictors of satisfactory cosmetic results. […] Although meatal location is the main predictor for postoperative complications, it is not a predictor of cosmetic outcomes. […] Factors affecting cosmetic outcomes should be clearly explained to parents during the preoperative consultation.

• #10 Efficacy of preoperative testosterone therapy in hypospadias: a systematic review and meta-analysis | Annals of Pediatric Surgery | Full Text

  https://aops.springeropen.com/articles/10.1186/s43159-021-00117-4

  The purpose of this paperwork is to evaluate the impact of preoperative testosterone treatment in hypospadias based on clinical data from published trials. […] This study discovered that a patient who got testosterone before surgery had a considerably decreased complication risk for glandular dehiscence. Reoperation rate, urethral-cutaneous fistula, meatal stenosis, and penile scarring in children with hypospadias, on the other hand, revealed no significant difference in the testosterone-treated group against the control group. […] Preoperative hormone treatment with human chorionic gonadotropin (HCG), dihydrotestosterone (DHT), or testosterone (T) was recommended to improve the surgical result of people having hypospadias correction. […] According to the study, DHT pretreatment improved penile cosmesis (moderate-to-severe scarring in 2 patients in the treatment group vs. 16 patients in the no-treatment group).

• #11 Efficacy of preoperative testosterone therapy in hypospadias: a systematic review and meta-analysis | Annals of Pediatric Surgery | Full Text

  https://aops.springeropen.com/articles/10.1186/s43159-021-00117-4

  According to Babu and Chakravarthi, preoperative testosterone significantly increases glans width and reduces difficulties and the necessity for reoperation as well. […] We discovered a much decrease complication rate for glandular dehiscence in this trial. Reoperation rate, urethral-cutaneous fistula, meatal stenosis, and penile scarring in children with hypospadias, on the other hand, demonstrated that there was no significant difference in the result or side effects in the group receiving testosterone therapy compared to the control group in terms of method of administration (parenteral or topical).

• #12 Does the Anogenital Distance Predict Outcome of Hypospadias Repair? | ESPE2019 | 58th Annual ESPE (ESPE 2019) | ESPE Abstracts

  https://abstracts.eurospe.org/hrp/0092/hrp0092p2-247

  Does the Anogenital Distance Predict Outcome of Hypospadias Repair? […] In this study we sought to determine whether the AGD is predictive for surgical outcome in hypospadias repair. […] Severe hypospadias had a significantly shorter AGD (P=0.003). […] AGD was significantly shorter in patients undergoing staged repair (37mm vs. 26mm, P=0.001). […] AGD was significantly shorter in patients who developed postoperative complications (38mm vs. 29mm, P=0.04). […] Shorter AGD predicts higher complication rate and the need for more extensive surgery. […] These fetal androgen deficiencies may be reflected in hypospadias minor tissue quality resulting in delayed wound healing, inflammation and a higher complication rate or more difficult surgery resulting in staged repair.

• #13 Trends and predictors of incidence of hypospadias in a tertiary hospital in South Africa | African Journal of Urology | Full Text

  https://afju.springeropen.com/articles/10.1186/s12301-023-00353-7

  Maternal age above 36 years appeared to have a stratification effect on hypospadias presentation. […] The trends in incidence of clinically diagnosed hypospadias at birth did not indicate major changes over time. […] The years assessed did not have a significant effect on the number of cases. […] The most important association revealed in this study is the increased risk of hypospadias amongst boys born by CS as one of the supportive modes of delivery, combined M-H (OR 3.93; 95% CI 1.81; 5.55). […] Our findings for the smoking variable concur with a meta-analysis reported that maternal smoking may be associated with a modest decreased risk of hypospadias. […] Our study further indicated an association between maternal alcohol consumption and the risk of developing hypospadias using unadjusted logistic regression OR 3.10; (95% CI 1.19; 8.09).

• #14 Trends and predictors of incidence of hypospadias in a tertiary hospital in South Africa | African Journal of Urology | Full Text

  https://afju.springeropen.com/articles/10.1186/s12301-023-00353-7

  The analysis of maternal age above 36 years presented an effect on stratification with the likelihood of hypospadias occurrence. […] It is clear that normal birth weight is protective against hypospadias since the M-H OR 0.351 and the 95% confidence interval (0.19; 0.62) does not include one. […] The important outcomes of this case-control study on the assessment of potentially predicting factors associated with hypospadias including mode of delivery, maternal advanced age, alcohol use, traditional herbal use, and low birth weight, are that all the mentioned factors independently increase the likelihood of an infant being born with hypospadias.

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