Document Detail


Surgical management of primary severe hypospadias in children: systematic 20-year review.
MedLine Citation:
PMID:  20727541     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: We systematically reviewed the literature published during the last 20 years on the treatment of primary proximal hypospadias associated with severe ventral curvature.
MATERIALS AND METHODS: We reviewed studies published between 1990 and December 2009, searching for "hypospadias" in MEDLINE/PubMed, EMBASE, Web of Science and the Cochrane Library.
RESULTS: The search yielded 69 pertinent studies. These studies were generally of low quality (69.5% surgical series). Based on the literature, curvature should be addressed stepwise starting with ventral dissection that extends underneath the urethral plate (urethral plate mobilization). Contrary to former practice, urethral plate division seems to have more of a role if significant curvature persists. Dorsal plication seems sufficient to correct only minor degrees of curvature, while a minority of cases require ventral lengthening. No urethroplasty techniques appear to be definitively superior. After urethral plate division a staged urethroplasty has lower complication rates but a second operation is required, which might otherwise be avoided in approximately 70% of cases.
CONCLUSIONS: The present systematic review shows the weak evidence backing current management of primary severe hypospadias. We even lack a clear-cut definition of severe hypospadias and associated curvature. Hence, while we developed general recommendations for treatment based on our review of available evidence, we emphasize the need to establish shared criteria for accurate preoperative or introperative patient stratification, and to define objective outcome measures and followup intervals for data reporting to make comparison of surgical approaches reliable.
Authors:
Marco Castagnetti; Alaa El-Ghoneimi
Publication Detail:
Type:  Journal Article; Review     Date:  2010-08-19
Journal Detail:
Title:  The Journal of urology     Volume:  184     ISSN:  1527-3792     ISO Abbreviation:  J. Urol.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-13     Completed Date:  2010-10-04     Revised Date:  2010-12-22    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1469-74     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Oncological and Surgical Sciences, University Hospital of Padova, Padua, Italy. marcocastagnetti@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Algorithms
Child
Humans
Hypospadias / surgery*
Male
Severity of Illness Index
Urethra / surgery
Urologic Surgical Procedures, Male / methods
Comments/Corrections
Comment In:
J Urol. 2010 Oct;184(4):1255-6   [PMID:  20723935 ]
J Urol. 2010 Oct;184(4):1474-5   [PMID:  20727536 ]
Nat Rev Urol. 2010 Dec;7(12):647

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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