ESPU Meeting on Saturday 20, June 2026, 09:40 - 10:20
09:40 - 09:45
S29-1 (VP)
Ted LEE, Noa FERZIGER, Joseph BORER, Evalynn VASQUEZ and Richard LEE
Boston Children's Hospital, Department of Urology, Boston, USA
PURPOSE
Penile skin coverage during epispadias repair can be challenging in patients with isolated epispadias and classic bladder exstrophy. Patients with bladder exstrophy and penopubic epispadias are particularly at high risk for scar formation in the penopubic junction, which is the area under the most tension following reconstruction. Byar’s flap technique results in anastomosis of the most distal aspect of flap into the penopubic junction, resulting in high risk of improper healing. Buttonhole technique results in redundant skin at the 3 and 9 o’clock positions that creates a “dog ear” appearance. The traditional ventral rotational flap circumvents the aforementioned issues and also helps reduce dorsal chordee that is typically present in patients with epispadias and bladder exstrophy. However, the traditional ventral rotational flap may place the patient at higher risk of penile torsion. In this study, we hypothesize that dartos buttonhole modification of the ventral rotational flap can provide adequate penile skin coverage in epispadias and bladder exstrophy repair while minimizing the risk of penile torsion.
MATERIAL AND METHODS
In this surgical video, we demonstrate the ventral rotational flap with dartos buttonhole modification. The two cases include isolated penile epispadias undergoing modified Cantwell-Ransley technique and classic bladder exstrophy undergoing one-stage radical soft tissue mobilization, also known as the “Kelly” repair. In the patient with classic bladder exstrophy, a larger ventral flap was lifted in an effort to minimize the large defect between scrotum and penile shaft. Furthermore, a hypospadiac meatus was matured to maximize anterior penile length.
RESULTS
A ventral rotational flap with dartos buttonhole modification was successfully performed without complications in both cases.
CONCLUSIONS
A ventral rotational flap with dartos buttonhole modification may help circumvent many of the issues related to epispadias penile skin coverage witnessed in reverse Byar’s, skin buttonhole, and traditional ventral rotational flap techniques.
09:45 - 09:48
S29-2 (CP)
Zoe GUCKIEN 1, Renee SHAVNORE 2, Zach EARDLEY 2, Ashorne MAHENTHIRAN 1, Nikhil BATRA 2, Mark CAIN 2, Martin KAEFER 2, Kristan MELDRUM 2, Rosalia MISSERI 2, Richard RINK 2, Joshua ROTH 2, Konrad SZYMANSKI 2, Benjamin WHITTAM 2 and Pankaj DANGLE 2
1) Indiana University, Department of Urology, Indianapolis, USA - 2) Riley Hospital for Children, Department of Pediatric Urology, Indianapolis, USA
PURPOSE
First stage proximal hypospadias repair with associated severe chordee can necessitate corporal grafting with either tunica vaginalis, dermal, or small intestine submucosa (SIS) graft. This study aimed to compare long term surgical outcomes by graft type.
MATERIAL AND METHODS
An IRB approved retrospective review and prospective survey-based study was performed of patients who underwent staged hypospadias repair between 1992 and 2006. Patients with history of proximal hypospadias requiring corporal grafting with tunica vaginalis, dermal, or SIS graft for severe chordee and long-term follow-up (> 10 years) were included. We collected retrospective surgical, complication, and follow-up data. Prospective long term outcome data was collected from consenting participants including Penile Perception Score (PPS) and Internation Index of Erectile Function 6 (IIEF-6).
RESULTS
Twenty-seven patients met inclusion criteria. Twenty-four had single grafts. Three patients required multiple grafts due to the extent of the corporotomy and were excluded. Nine patients (37.5%) received dermal, 6 (25.0%) received tunica vaginalis, and 9 (37.5%) received SIS grafts. Mean follow-up was 17.1 years +/- 3.43 years after initial repair (range 11.4 to 24.0 years). There was no statistically significant difference in rate of fistula, stricture, diverticulum, meatal stenosis, glans dehiscence, or recurrent chordee (Table 1). Three patients with dermal grafts (33%), 2 patients with tunica vaginalis grafts (33%), and 4 patients with SIS grafts (44%) experienced more than one of the included complications. Seven patients had patient reported long term outcome survey results with 5/7 (71.4%) satisfied or very satisfied with penile straightness upon erection based on PPS and 5/7 (71.4%) rating erections as completely hard/fully rigid based on IIEF-6.
|
|
Complication (n, %) |
|||||
|
Fistula |
Stricture |
Diverticulum |
Meatal Stenosis |
Glans Dehiscence |
Recurrent Chordee |
|
|
Dermal |
1 (11%) |
4 (44%) |
0 (0%) |
4 (44%) |
1 (11%) |
2 (22%) |
|
Tunica Vaginalis |
4 (67%) |
1 (17%) |
1 (17%) |
2 (33%) |
0 (0%) |
1 (17%) |
|
SIS |
4 (44%) |
4 (44%) |
2 (22%) |
2 (22%) |
1 (11%) |
2 (22%) |
|
Total |
10 (37%) |
10 (37%) |
4 (15%) |
8 (30%) |
2 (7%) |
6 (22%) |
|
p-value |
0.08 |
0.51 |
0.37 |
0.63 |
0.72 |
0.96 |
Table 1: Rate of complication by graft type, significance level p < 0.05
CONCLUSIONS
Long-term surgical outcomes are equivalent between corporal graft types and there are no significant differences in rate of complications.Future studies are ongoing to compare patient reported outcomes by graft type.
09:58 - 10:01
S29-3 (CP)
Warren SNODGRASS and Nicol BUSH
Hypospadias Specialty Center, Dallas, USA
PURPOSE
We determined efficacy of 3 corporotomies to straighten ventral curvature (VC) 30-135° during the first stage of a 3-stage STAC hypospadias repair in patients verified by artificial erection (AE) at STAC 2 and STAC 3.
MATERIAL AND METHODS
Consecutive males with proximal hypospadias and VC 30° or more measured by goniometry after degloving underwent primary or reoperative STAC repair. Reoperative patients were initially operated elsewhere with dorsal plication, chordee excision or single corporotomy with corporal grafting, and presented with fistulas and dehiscences usually without diagnosis of their curvature. Straightening during STAC 1 involved 3 ventral corporotomies made across the area of bending and extending through the tunica albuginea from 3 to 9 o’clock. AE was then repeated during STAC 2 and 3, and any reoperations for complications. Residual VC at STAC 2 was straightened by 1 dorsal plication. The primary outcome was any VC at STAC 3; secondary outcomes were bleeding requiring intra- or post-operative intervention and any reported adverse change in erections in Tanner 4/5 patients.
RESULTS
There were 237 primary and 163 reoperative STAC repairs from 2019 - 2024, of which 60 were Tanner 4/5. VC averaged 66°. Overall, 75% had more than 45° VC and 25% of primary patients had more than 90°. All had at least 2 AE (mean 2.4; 2-5) after corporotomies, with the final an average of 17 (11.5-58) months later. 81% had no VC at STAC 2. All residual VC was 30° or less, occurring mostly in those with more than 90° initially (p<0.001), and was successfully corrected with 1 dorsal plication in most. 5 still had VC at STAC 3 measuring 30° in 1 and 15° in the others. Therefore, 99% of patients were proven by AE to have successful straightening. There were no bleeding complications. 1 adult reported 15% decrease in erection fullness managed by tadalafil.
CONCLUSIONS
3 corporotomies alone were successful in 81% of our patients, increasing to 99% with 1 dorsal plication in those with residual VC. 1 adult had partial decrease in erections, which has also been reported in adults after dorsal plication (Kusin et al. Sex Med 2017: 5:142-7) and single corporotomy with corporal grafting (Badaway & Morsi. J Urol 2021;180:1842-5).
We observed persistent or recurrent VC after dorsal plications, chordee excision and single corporotomies done elsewhere, and in 19% of our patients following 3 corporotomies. The fact that residual curvature greater than 30° can occur after all straightening methods, and is associated with urethroplasty complications (Snodgrass & Bush. J Ped Urol 2019; 15: 344-6), emphasizes the need for surgeons to repeat AE at the next operation after straightening in staged repairs and during reoperations.
10:01 - 10:04
S29-4 (CP)
Jeffrey HUYNH 1, Rogier SCHROEDER 1, Fred VAN DER TOORN 2, Barbara KORTMANN 3, Josine QUAEDACKERS 4, Piet CALLEWAERT 5, Martijn STEFFENS 6, Eric VAN DER HORST 7, Martje SCHOTMAN 8 and Katja WOLFFENBUTTEL 2
1) Univeristy Medical Centre Utrecht - Wilhelmina Children's Hospital, Pediatric Urology, Utrecht, NETHERLANDS - 2) Erasmus University Medical Center - Sophia Children's Hospital, Pediatric Urology, Rotterdam, NETHERLANDS - 3) Radboud University Medical Center - Amalia Children's Hospital, Pediatric Urology, Nijmegen, NETHERLANDS - 4) University Medical Center Groningen, Urology, Groningen, NETHERLANDS - 5) Maastricht University Medical Center, Urology, Maastricht, NETHERLANDS - 6) Isala Hospital, Urology, Zwolle, NETHERLANDS - 7) Amsterdam University Medical Center, Urology, Amsterdam, NETHERLANDS - 8) Haga Hospital - Juliana Children's Hospital, Pediatric Urology, Den Haag, NETHERLANDS
PURPOSE
High complication rates have been reported after primary proximal hypospadias repair. However, most studies are of limited methodological quality, making it difficult to draw robust conclusions. We aim to evaluate urethroplasty complication (UC) rates in a cohort of proximal hypospadias patients followed up until 5 years of age.
MATERIAL AND METHODS
This study is part of the multicenter prospective Dutch Hypospadias Study. Patients with proximal penile or penoscrotal hypospadias who underwent primary hypospadias repair between 2008 and 2016 were included. Exclusion criteria were: age older than 5 years, previous penile surgery, difference of sex development, or other major congenital disorders. The UC rates were assessed 6 months after surgery and at 5 years of age.
RESULTS
A total of 104 patients were included, 57 with proximal penile and 47 with penoscrotal hypospadias. The median age was 12.0 months (IQR 10–12 months). Sixteen percent of patients were born small for gestational age (SGA), which is 8 times higher than the reported national SGA rate. At 6 months postoperatively, 102 patients were eligible for UC rate analysis. Thirty-eight patients (37%) had a UC, with fistulas and dehiscence being the most frequent complications. At 5 years of age, 94 of the 104 patients were analyzed, of whom 43 (46%) had experienced a UC. Most UC (88%) were diagnosed during the first follow-up visit. Higher UC rates were found after single stage repairs compared to two stage repairs. On average, patients treated with single stage repair underwent 1.3 procedures, whereas those treated with two stage repair required 2.1 procedures to achieve a successful outcome
CONCLUSIONS
Proximal hypospadias repairs remain challenging, with a high UC rate of 46% at 5 years of age. The vast majority of UC, mainly fistulas and dehiscences, were observed at the first follow-up visit 6 months after surgery. An intentional single stage repair needed 1.3, whereas a two stage repair needed 2.1 operations before being successful. Our findings are important for preoperative counseling of parents.
10:04 - 10:09
S29-5 (VP)
Dario Guido MINOLI, Daniele STROPPA, Michele GNECH, Erika DE MARCO, Eduje THOMAS, Arianna ROGGERO, Fabio CIAMARRA, Francesca MITZMAN, Gianantonio MANZONI and Alfredo BERRETTINI
Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Paediatric Urology, Mi, ITALY
PURPOSE
Over the years, Dorsal Inlay Graft (DIG) urethroplasty has gained worldwide acceptance for primary hypospadias repair. However, its safety and effectiveness for revision surgery are yet to be proven.
MATERIAL AND METHODS
We describe the step-by-step technique in re-do hypospadias repair, using a free graft harvested from the inferior lip and sutured onto the incised urethral plate. In this video we highlight:
We carried out a retrospective analysis of data collected from 53 consecutive DIG urethroplasties performed by a single surgeon at our institution. Patients were stratified in primary and redo-urethroplasty.
RESULTS
Out of 53 DIG urethroplasties, 21 (39.6 %) where primary and 32 (60.4 %) were re-do. As expected, the two groups differed for median age at surgery: 20 months for primary and 68.5 months for revision surgery (p < 0.001). Additionally, all primary interventions were performed with preputial graft, whereas among revision 93.8% DIG urethroplasties were buccal. Catheterization time and postoperative complication rates were comparable between primary and revision surgery group, respectively. Forty-two patients underwent uroflowmetry during follow-up.
CONCLUSIONS
Dorsal Inlay Graft urethroplasty has long been known to be safe and effective for primary hypospadias repair while DIG urethroplasty as a salvage surgery after primary repair failure is scarce. Surprisingly, according to our findings, surgical outcomes and complication rates are comparable between primary and revision hypospadias cases. According to our findings, DIG urethroplasty is a safe and effective option to treat revision hypospadias