ESPU Meeting on Friday 5, September 2025, 12:40 - 13:15
12:40 - 12:43
S27-1 (OP)
Fang CHEN, Yichen HUANG, Yan CHEN, Yiqing LYU, Yu DING, Zhiwei PENG and Ming WU
Shanghai Children's Hospital, Urology, Shanghai, CHINA
PURPOSE
To assess the effectiveness of combining urethroplasty with penoscrotal transposition correction during the second stage of Byar’s repair for proximal hypospadias, with a focus on improving genital appearance and reducing the incidence of penoscrotal junction fistula.
MATERIAL AND METHODS
95 patients with proximal hypospadias and penoscrotal transposition underwent two-stage repairs at our hospital. In the first stage, a modified Byar’s repair with bilateral flaps affixed to the ventral corpus cavernosum along the penile midline was performed. Patients were then divided into two groups for the second stage. Group A (n=44) received both urethroplasty (Duplay) and penoscrotal transposition correction (modified Glenn-Anderson) together, while Group B (n=51) underwent only urethroplasty (Duplay). The Hypospadias Objective Scoring Evaluation (HOSE) and Pediatric Penile Perception Score (PPPS) were used to assess urinary function and cosmetic outcomes as perceived by parents.
RESULTS
The median HOSE was significantly higher in Group A (16.00 [15.00, 16.00]) than in Group B (14.00 [13.00, 15.00]), P<0.001. Similarly, the PPPS score was higher in Group A (12.00 [12.00, 15.00]) compared to Group B (12.00 [10.00, 12.00]), P=0.043. Complications were significantly less frequent in Group A (13.64%, 6/44) versus Group B (31.37%, 16/51), P=0.041. The incidence of fistulae was also lower in Group A (6.82%, 3/44) than in Group B (21.57%, 11/51), P=0.043. Notably, Group A had no case of fistula in the penoscrotal area, and satisfactory correction of penoscrotal transposition was achieved. In contrast, six cases of penoscrotal area urinary fistulas occurred in Group B.
CONCLUSIONS
Adding penoscrotal transposition correction to urethroplasty during the second stage of Byar’s repair for proximal hypospadias is a safe and effective strategy. This combined approach reduces the risk of urethral fistula, especially in the penoscrotal area, enhances cosmetic outcomes, and minimizes the need for further surgeries and anesthesia.
12:43 - 12:46
S27-2 (OP)
Robert MCCUSKER, Ma'in MARSAWEH, Laura JACKSON, Karim AWAD, Mark WOODWARD and Mohamed SHALABY
Bristol children's hospital, Paediatric surgery, Bristol, UNITED KINGDOM
PURPOSE
To compare urethral plate graft dimensions for the treatment of proximal hypospadias using a three stage "STraighten And Close" (STAC) technique versus the traditional two stage Bracka procedure.
MATERIAL AND METHODS
Demographic and operative data were collected on consecutive patients who underwent either Bracka, or primary STAC procedures at our institution. The two groups were compared for age, weight, clinical features and urethral plate graft dimensions at time of grafting. Urethral plate dimensions were then corrected to rule out age-related differences.
RESULTS
52 Bracka and 35 STAC patients were included for analysis. STAC patients were significantly older (3.6 vs 1.4 years) and heavier (14.7 vs 10.1kg) than the Bracka patients at the time of grafting. The STAC grafts were 96% longer (mean length 45 vs 23mm), 62% wider (mean width 21 vs 13mm), with a 216% greater area of 945 vs 299mm2. When corrected for normative stretched penile length for age, the STAC grafts remained statistically significantly larger.
CONCLUSIONS
This study demonstrates that by employing a STAC technique, patients are receiving a significantly larger urethral plate graft. The patients in the STAC group were older due to pandemic related waitlists at the time of adoption of this technique, and because grafting is performed in the second stage, in contrast to Bracka. After correcting for age, the STAC urethral plate graft is still longer and wider. We anticipate this will be associated with less curvature and a longer phallus in the final reconstruction and later life.
12:46 - 12:49
S27-3 (OP)
Alina PUZKO
National Children's Specialized Hospital "OKHMATDYT"., Pediatric urology, Kyiv, UKRAINE
PURPOSE
This study aims to present our experience and long-term results of using a buccal flap for the formation of the urethral plate as a material that closely resembles urothelium, as opposed to using a free skin graft. This approach aims to reduce long-term complications, such as urethral stricture due to skin scarring in the future.
MATERIAL AND METHODS
We conducted a retrospective study over the period from 2014 to 2024. A total of 344 two-stage urethroplasties were performed during this time. The average age of the patients was 1.8 years. The study is divided into two periods: Period I (2014-2020) involved 158 children who received free skin grafts from the prepuce, with complications occurring in 21% (33 cases), including urethral fistula in 26.8% and distal urethral strictures in 4%. Period II (2021-2024) involved 186 children who received buccal flaps, with complications occurring in 3%: urethral fistula in 1% and urethral strictures in 3.7%. Additionally, we evaluated long-term results in adulthood: 5 adult males, with an average age of 21 years, presented with distal urethral strictures after prior urethroplasty using a free graft.
RESULTS
The harvesting of the buccal flap is a straightforward process with significant advantages in the postoperative period. This technique allows for the exclusion of long-term complications such as urethral strictures.
CONCLUSIONS
The use of buccal flaps in the first stage of urethroplasty for proximal hypospadias demonstrates a marked reduction in complications compared to traditional free skin grafts, suggesting it as a favorable option for surgical management.
13:01 - 13:04
S27-4 (OP)
Fatih OZKAYA 1, Ahmet Furkan ÖZSOY 1, Araz MUSAEV 1, Aykut AKINCI 2, Bahri Efe TURGUT 3, Berk BURGU 1 and Tarkan SOYGUR 1
1) Ankara University Faculty of Medicine, Paediatric Urology, Ankara, TÜRKIYE - 2) Pamukkale University Faculty of Medicine, Paediatric Urology, Denizli, TÜRKIYE - 3) Ankara University Faculty of Medicine, Ankara, TÜRKIYE
PURPOSE
Crippled hypospadias is a severe form of failed hypospadias repair requiring complex reconstructive surgery. The choice of graft material plays a critical role in surgical success, impacting complications and long-term outcomes. This study evaluates postauricular and inguinal grafts in hypospadias salvage surgery whom had previous failed buccal graft surgery and patients with who don't have healthy penile skin and/or shaft.
MATERIAL AND METHODS
Retrospective review of 47 patients undergoing hypospadias salvage surgery over five years was performed. Twenty-two patients received postauricular grafts, while twenty-five had inguinal grafts. Outcome measures included dehiscence rates, second-stage repair failure, fistula formation, and parental penile perception scores. Chi-square tests and independent t-tests were used for statistical analysis, with significance set at p < 0.05.
RESULTS
Postauricular grafts demonstrated better outcomes, but not all differences were statistically significant. Dehiscence occurred in 2/22 (9.1%) postauricular cases vs. 5/25 (20%) inguinal cases (p = 0.08). Failed second-stage repairs were 3/22 (13.6%) in the postauricular group vs. 7/25 (28%) in the inguinal group (p = 0.04). Fistula formation was lower in the postauricular group (4/22, 18.2%) compared to the inguinal group (8/25, 32%), though this difference was not significant (p = 0.09). Parental penile perception scores were higher in the postauricular group
(p = 0.02), indicating better aesthetic satisfaction.
CONCLUSIONS
While postauricular grafts showed lower complication rates and better aesthetic outcomes, not all differences were statistically significant. These findings suggest that postauricular grafts may be preferable for complex hypospadias repair, particularly for aesthetic reasons and lower second-stage failure rates, but further studies are warranted.
13:04 - 13:07
S27-5 (OP)
Yiqing LYU, Fang CHEN, Yichen HUANG and Yu DING
Shanghai Children's Hospital, Urology, Shanghai, CHINA
PURPOSE
This study explores the use of autologous exosomes derived from urine-derived stem cells(USC-exosomes) to stimulate the regeneration of spongiosum tissue beneath the neourethra epithelium, utilizing endothelial and smooth muscle cells remaining in the defect area.
MATERIAL AND METHODS
Forty patients with proximal hypospadias were enrolled and randomly divided into two groups. Both groups underwent repair using the two-stage Byars procedure. The exosomes group (n=20) received autologous USC-exosomes. During the first stage operation, exosomes mixed with 1% sodium hyaluronate were applied to the underside of the flap at a dosage of 1-3x10^10/ml, 0.5ml for each cm^2 flap. The control group (n=20) received sodium hyaluronate. Six months later, tissue samples were harvested from the reconstructed urethral plate in both groups. All patients were evaluated after the second stage, assessing repair complications, urine flow rate, and urethral wall thickness via ultrasound.
RESULTS
Both groups completed the study without any patient losses. Histological examinations of the exosomes group revealed a greater presence of sinusoidal vascular structures beneath the neo-urethral plate compared to the control group. Additionally, there was increased expression of VEGF and a-SMA, indicating active angiogenesis in the exosomes group. There were 4 cases of urinary fistula in both exosomes group and control group. And 1 case of of urethral stricture in control group. Urethral wall thickness was greater in the exosomes group(3.01±0.54mm vs. 2.26±0.33mm, P<0.001), and the Qmax was higher in the exosomes group (6.70±3.14 ml/s vs. 4.30±2.78 ml/s, P=0.009).
CONCLUSIONS
Autologous USC-exosomes can effectively stimulate the regeneration of corpus spongiosum-like tissue beneath the neo-urethral plate, resulting in increased urethral wall thickness and urine flow rate. This study highlights the potential for reconstructing a more physiologically normal urethra while preserving the corpus spongiosum.