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Study on foreskin reconstruction (FR) post single-stage hypospadias repair finds no link between anatomy and issues, suggesting FR may be suitable for all boys after initial repair.
The following is a summary of “Are there anatomical limiting factors to foreskin reconstruction at the time of single-stage hypospadias repair?,” published in the December 2023 issue of Urology by Mosa, et al.
Once hypospadias healing is complete, foreskin reconstruction (FR) is performed. For a study, researchers sought to assess penile and preputial anatomy in children with single-stage hypospadias repair and FR to investigate whether anatomy and issues are connected. A prospective study examined FR-related single-stage hypospadias repair in children from 2016 to 2019. They recorded internal foreskin and penile measurements and post-op findings. Logistic Regression was used to analyze urethroplasty and skin issue-independent factors. VFD width, Glans size, age following surgery, and meatal location were compared using the chi-square test. The study included 86 boys from 181 consecutive patients who had FR for single-stage hypospadias. They eliminated patients who were lost at follow-up (n = 10), required a 2-stage repair (n = 2), were circumcised at birth (n = 3), or had parents seek a circumcision (n = 78). Two individuals had interoperative circumcision for monkhood prepuce malformation on aesthetic grounds.
The median surgery age was 17 months. The mean glans width was 14.4 mm. Mean unstretched and stretched foreskin circumferences were 29.5 and 40.9 mm. Mean VFD (distance between foreskin hood proximal insertion on either side of the midline at the coronal sulcus) was 7.2 mm. The median follow-up was 8 months (6–23), and 9 problems (10.4%) were recorded: foreskin dehiscence in 1% (1/86), fistula in 4.6% (4/86), tight, non-retractile foreskin in 1% (1/86), urethrocutaneous fistula in 2.3% (2/86) and total glans and dehiscence in 1 (1.2%). Multiple logistic regression analysis showed no independent risk factor for urethroplasty or skin issues.
No significant differences in problems were seen between broad and narrow VFDs, big and small glans, age after surgery (≤24 months vs. >24 months), and meatal position (glanular, coronal, subcoronal, distal penile vs. mid penile, proximal penile, and penoscro The Researchers believe this is the first prospective and objective foreskin assessment in single-stage hypospadias treatment. Skin and urethroplasty issues are unaffected by preputial and penile architecture. Thus, all boys following initial single-stage hypospadias repair may develop FR. The researchers need larger studies and external validation of these measures.
Source: sciencedirect.com/science/article/abs/pii/S1477513123003170