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Patient and surgeon evaluation of outcome in hypospadias repair
ESPU Meeting 2007
S51
RESULTS
CONCLUSIONS
Mean age was 17m (9-91) for TIP and 17.8m (10-58) for ONLAY. Mean follow up was 30m (6-74) and 38.8m (16-80), respectively.
The overall complication rate was similar for long penoscrotal TIP and ONLAY urethroplasties. The TIP-fistula rate was higher vs. ONLAYS, though catheter duration was the same in both groups. While PVRs were not elevated, more flattened flow curves may suggest that TIP-urethroplasty is narrower and thus,
behaves as a relatively ‘‘distal resistance’’ prompting to more proximal fistula formation. Thus, the TIP-fistula rate may benefit from more delayed catheter removal or deeper plate incision. Nevertheless, both techniques appear to be equivalent approaches to correct PSH. Longer follow-up may reveal more divergent outcomes for these 2 approaches.
# S09-7 (PP)
TISSUE ENGINEERING OF SUBCUTANEOUS TUNNELS WITH MINCED SKIN Magdalena FOSSUM, Baraa ZUHAILI, Malte SPIELMANN, Tobias HIRSCH and Elof ERIKSSON Harvard Medical School, Plastic Surgery, Boston, USA
PURPOSE In Pediatric Urology, urethral reconstruction is sometimes challenged by lack of local tissue suitable for the repair. We have used minced, autologous skin, for neoepithelialization of surgically created subcutaneous tunnels, in a large animal model. Eventually, this technique could be added to the repertoire for creation of conduits to the urogenital system or the intestinal canal.
tubes were rolled in fibrin glue and minced skin and placed in subcutaneous tunnels. In the second group, fibrin glue was mixed with a single cell suspension of keratinocytes and fibroblasts after three series of trypzination of the minced skin particles. Finally, serving as controls, a third group included tubes with fibrin glue only. Tubes were extracted after 14, 21, 28 and 35 days for microscopical evaluation.
RESULTS MATERIAL AND METHODS Subcutaneous tunnels were created in the abdominal area on 50- 60 kg Yorkshire pigs. Partial thickness skin grafts were harvested from the back region. The skin was minced to 0,8 x 0,8 x 0,3 mm particles. In the first group, silicone-latex
After 14 days, sections from group one showed epithelial particles directed towards the lumen and some subepithelial cysts containing keratin, by days 28 and 35, all tubes showed a full neoepithelialization and some rete formation. In group two, no epithelium
was formed and only sparse keratinocytes could be detected on day 14, but not days 28 or 35. No epithelial lining was seen in the controls.
CONCLUSIONS In conclusion, a minced skin technique could serve as a potential source for tissue regeneration of tubular conduits for reconstructive purposes of the urethra or for cutaneous stomas for bladder catheterization, or intestinal irrigations. The method would have the advantage of being simple and quick and not requiring in vitro culturing. Tissue Engineering with a minced skin technique could be of mayor importance in various clinical situations in pediatric reconstructive surgery.
# S09-8 (O)
PATIENT AND SURGEON EVALUATION OF OUTCOME IN HYPOSPADIAS REPAIR Ali ZIADA, Selcuk YUCEL, Naveed AHMED* and Warren SNODGRASS UT Southwestern, Urology, Dallas, USA - * UT Southwestern, Dallas, USA
PURPOSE Despite increased emphasis on cosmetic outcomes of hypospadias surgery, few reports objectively determine appearance. Furthermore, prior studies demonstrate patient and surgeon assessments may vary significantly. We used a standardized questionnaire to survey parent and surgeon perception after TIP repair.
MATERIAL AND METHODS A Likert scale questionnaire (responses from 1, very abnormal, to 5, normal) was
developed concerning 6 items: overall penile appearance, cosmesis of meatus and skin, penile size, straightness, and voided stream. Parents and surgeon independently completed surveys 6 weeks after primary TIP repair; similar surveys after circumcision provided normal controls. Maximum score was 30.
RESULTS Hypospadias patients comprised 50 distal and 15 midshaft to scrotal TIP repairs. There were 22 circumcision controls. Mean score by parents for hypospadias repair was 28 +/- 3, compared to 27.7 +/- 3
after circumcision. Questions regarding straight erection and voided stream were not answered by the surgeon in all patients, so comparison between parents and surgeon were based on the other 4 parameters with a maximum score of 20. Parents of patients and controls scored 18.3 +/-2 and 17.6 +/- 3, respectively, versus surgeon scores of 18.9 +/- 2 and 18.6 +/-2. Pearson’s test showed statistically significant agreement and the correlation coefficient between parents and surgeon was 0.6 and 0.5 for controls and hypospadias repairs, respectively. There were no differences in evaluations for distal versus proximal hypospadias surgery.
S52
CONCLUSIONS
ESPU Meeting 2007 indistinguishable from normal circumcised penis. Similar surveys
should be performed after alternative repairs.
Parents and surgeon agree TIP results in penile appearance are
# S09-9 (O)
SELF PERCEPTION OF GENITALIA AFTER HYPOSPADIA REPAIR ¨ NBUCHER, Rita GOBET and Markus LANDOLT* Daniel M. WEBER, Verena B. SCHO University Children’s Hospital, Paediatric Urology, Zurich, SWITZERLAND - * University Children’s Hospital, Department of Psychosomatics and Psychiatry, Zurich, SWITZERLAND
PURPOSE A perfect penis cannot be achieved with hypospadia repair and the patients have to cope with cosmetic and eventually functional deficiencies. The aim of this study was to compare the patients’ self perception of their genitals with the perception of the surgeon and the self perception of healthy boys.
straightness and general appearance. All patients were evaluated for the same criteria by several urologists. In addition, self perception of genitalia was also assessed in an age-matched control group of 67 boys after hernia repair. A Genitalia Perception Score (GPS) that ranges from a minimum of 1 to a maximum of 10 was calculated.
RESULTS MATERIAL AND METHODS 64 patients between the age of 6 and 17 years were asked to rate the appearance of their penis with regard to the following criteria: Meatus, glans, penile skin, penile
The patients’ self assessment showed a mean GPS of 7.96 (SD ¼ 1.76). This was almost as high as the GPS of a control group of healthy boys (M ¼ 8.26, SD ¼ 1.66, p ¼ .19) GPS ratings by
urologists were significantly less favourable with a mean GPS of 7.00 (SD ¼ 1.81, p < 0,001).
CONCLUSIONS Boys with corrected hypospadia had a very positive self perception of the cosmetic aspect of their penis that is close to the self assessment of a control group of healthy boys. Urologists were much more critical in evaluating the cosmetic results. Further studies will show, whether the psychosexual development and quality of life of hypospadias patients with a good genital self perception scale is impaired, when compared with healthy boys.
# S09-10 (O)
PSYCHOSEXUAL OUTCOME IN YOUNG ADULTS WHO UNDERWENT HYPOSPADIAS SURGERY WHEN CHILDREN Arianna LESMA, Giovanni PETRALIA, Fabio FABBRI, Aldo BOCCIARDI, Francesco MONTORSI and Patrizio RIGATTI Ospedale San Raffaele, Urology, Milano, ITALY
PURPOSE To assess surgical results and psychosexual adjustment in a group of young adult patients submitted for hypospadias correction in their childhood.
aimed at evaluating social relationships, self body image, urological disorders and sexuality of hypospadiac patients. Agematched healthy male control subjects were mailed with the same questionnaires.
RESULTS
patients were satisfied with their sexual function; 26 patients had concerns about male infertility; all patients were satisfied with the surgical outcome; 27 expressed the need for outpatient follow-up. Instrumental assessment showed a good urinary flow in all patients and penile curvature in 8 patients.
MATERIAL AND METHODS Thirty patients were assessed with International Prostate Symptom Scale (IPSS), International Index of Erectile Function (IIEF), genital examination and instrumental evaluation. Psychosexual outcome was assessed with: Center for Epidemiologic Studies Depression Scale (CES-D), Self-rating Anxiety Scale (SAS), and an original structured questionnaire
On the I-PSS urinary symptoms were found in 24 hypospadiacs and in 7 of the 30 control subjects. On the IIEF all hypospadiacs and all control subjects reported normal erectile function. CES-D and SAS revealed an absence of depression and anxiety traits in both populations. Our original questionnaire found that 16 patients had a partner; 21 patients reported complete sexual activity; all
CONCLUSIONS In contrast with several Authors, we found an overall satisfactory sexual function with good psychosexual adjustment. We recommend routine follow-up during adolescence to resolve patients’ concerns about fertility related to their genital malformation.
S51
RESULTS
CONCLUSIONS
Mean age was 17m (9-91) for TIP and 17.8m (10-58) for ONLAY. Mean follow up was 30m (6-74) and 38.8m (16-80), respectively.
The overall complication rate was similar for long penoscrotal TIP and ONLAY urethroplasties. The TIP-fistula rate was higher vs. ONLAYS, though catheter duration was the same in both groups. While PVRs were not elevated, more flattened flow curves may suggest that TIP-urethroplasty is narrower and thus,
behaves as a relatively ‘‘distal resistance’’ prompting to more proximal fistula formation. Thus, the TIP-fistula rate may benefit from more delayed catheter removal or deeper plate incision. Nevertheless, both techniques appear to be equivalent approaches to correct PSH. Longer follow-up may reveal more divergent outcomes for these 2 approaches.
# S09-7 (PP)
TISSUE ENGINEERING OF SUBCUTANEOUS TUNNELS WITH MINCED SKIN Magdalena FOSSUM, Baraa ZUHAILI, Malte SPIELMANN, Tobias HIRSCH and Elof ERIKSSON Harvard Medical School, Plastic Surgery, Boston, USA
PURPOSE In Pediatric Urology, urethral reconstruction is sometimes challenged by lack of local tissue suitable for the repair. We have used minced, autologous skin, for neoepithelialization of surgically created subcutaneous tunnels, in a large animal model. Eventually, this technique could be added to the repertoire for creation of conduits to the urogenital system or the intestinal canal.
tubes were rolled in fibrin glue and minced skin and placed in subcutaneous tunnels. In the second group, fibrin glue was mixed with a single cell suspension of keratinocytes and fibroblasts after three series of trypzination of the minced skin particles. Finally, serving as controls, a third group included tubes with fibrin glue only. Tubes were extracted after 14, 21, 28 and 35 days for microscopical evaluation.
RESULTS MATERIAL AND METHODS Subcutaneous tunnels were created in the abdominal area on 50- 60 kg Yorkshire pigs. Partial thickness skin grafts were harvested from the back region. The skin was minced to 0,8 x 0,8 x 0,3 mm particles. In the first group, silicone-latex
After 14 days, sections from group one showed epithelial particles directed towards the lumen and some subepithelial cysts containing keratin, by days 28 and 35, all tubes showed a full neoepithelialization and some rete formation. In group two, no epithelium
was formed and only sparse keratinocytes could be detected on day 14, but not days 28 or 35. No epithelial lining was seen in the controls.
CONCLUSIONS In conclusion, a minced skin technique could serve as a potential source for tissue regeneration of tubular conduits for reconstructive purposes of the urethra or for cutaneous stomas for bladder catheterization, or intestinal irrigations. The method would have the advantage of being simple and quick and not requiring in vitro culturing. Tissue Engineering with a minced skin technique could be of mayor importance in various clinical situations in pediatric reconstructive surgery.
# S09-8 (O)
PATIENT AND SURGEON EVALUATION OF OUTCOME IN HYPOSPADIAS REPAIR Ali ZIADA, Selcuk YUCEL, Naveed AHMED* and Warren SNODGRASS UT Southwestern, Urology, Dallas, USA - * UT Southwestern, Dallas, USA
PURPOSE Despite increased emphasis on cosmetic outcomes of hypospadias surgery, few reports objectively determine appearance. Furthermore, prior studies demonstrate patient and surgeon assessments may vary significantly. We used a standardized questionnaire to survey parent and surgeon perception after TIP repair.
MATERIAL AND METHODS A Likert scale questionnaire (responses from 1, very abnormal, to 5, normal) was
developed concerning 6 items: overall penile appearance, cosmesis of meatus and skin, penile size, straightness, and voided stream. Parents and surgeon independently completed surveys 6 weeks after primary TIP repair; similar surveys after circumcision provided normal controls. Maximum score was 30.
RESULTS Hypospadias patients comprised 50 distal and 15 midshaft to scrotal TIP repairs. There were 22 circumcision controls. Mean score by parents for hypospadias repair was 28 +/- 3, compared to 27.7 +/- 3
after circumcision. Questions regarding straight erection and voided stream were not answered by the surgeon in all patients, so comparison between parents and surgeon were based on the other 4 parameters with a maximum score of 20. Parents of patients and controls scored 18.3 +/-2 and 17.6 +/- 3, respectively, versus surgeon scores of 18.9 +/- 2 and 18.6 +/-2. Pearson’s test showed statistically significant agreement and the correlation coefficient between parents and surgeon was 0.6 and 0.5 for controls and hypospadias repairs, respectively. There were no differences in evaluations for distal versus proximal hypospadias surgery.
S52
CONCLUSIONS
ESPU Meeting 2007 indistinguishable from normal circumcised penis. Similar surveys
should be performed after alternative repairs.
Parents and surgeon agree TIP results in penile appearance are
# S09-9 (O)
SELF PERCEPTION OF GENITALIA AFTER HYPOSPADIA REPAIR ¨ NBUCHER, Rita GOBET and Markus LANDOLT* Daniel M. WEBER, Verena B. SCHO University Children’s Hospital, Paediatric Urology, Zurich, SWITZERLAND - * University Children’s Hospital, Department of Psychosomatics and Psychiatry, Zurich, SWITZERLAND
PURPOSE A perfect penis cannot be achieved with hypospadia repair and the patients have to cope with cosmetic and eventually functional deficiencies. The aim of this study was to compare the patients’ self perception of their genitals with the perception of the surgeon and the self perception of healthy boys.
straightness and general appearance. All patients were evaluated for the same criteria by several urologists. In addition, self perception of genitalia was also assessed in an age-matched control group of 67 boys after hernia repair. A Genitalia Perception Score (GPS) that ranges from a minimum of 1 to a maximum of 10 was calculated.
RESULTS MATERIAL AND METHODS 64 patients between the age of 6 and 17 years were asked to rate the appearance of their penis with regard to the following criteria: Meatus, glans, penile skin, penile
The patients’ self assessment showed a mean GPS of 7.96 (SD ¼ 1.76). This was almost as high as the GPS of a control group of healthy boys (M ¼ 8.26, SD ¼ 1.66, p ¼ .19) GPS ratings by
urologists were significantly less favourable with a mean GPS of 7.00 (SD ¼ 1.81, p < 0,001).
CONCLUSIONS Boys with corrected hypospadia had a very positive self perception of the cosmetic aspect of their penis that is close to the self assessment of a control group of healthy boys. Urologists were much more critical in evaluating the cosmetic results. Further studies will show, whether the psychosexual development and quality of life of hypospadias patients with a good genital self perception scale is impaired, when compared with healthy boys.
# S09-10 (O)
PSYCHOSEXUAL OUTCOME IN YOUNG ADULTS WHO UNDERWENT HYPOSPADIAS SURGERY WHEN CHILDREN Arianna LESMA, Giovanni PETRALIA, Fabio FABBRI, Aldo BOCCIARDI, Francesco MONTORSI and Patrizio RIGATTI Ospedale San Raffaele, Urology, Milano, ITALY
PURPOSE To assess surgical results and psychosexual adjustment in a group of young adult patients submitted for hypospadias correction in their childhood.
aimed at evaluating social relationships, self body image, urological disorders and sexuality of hypospadiac patients. Agematched healthy male control subjects were mailed with the same questionnaires.
RESULTS
patients were satisfied with their sexual function; 26 patients had concerns about male infertility; all patients were satisfied with the surgical outcome; 27 expressed the need for outpatient follow-up. Instrumental assessment showed a good urinary flow in all patients and penile curvature in 8 patients.
MATERIAL AND METHODS Thirty patients were assessed with International Prostate Symptom Scale (IPSS), International Index of Erectile Function (IIEF), genital examination and instrumental evaluation. Psychosexual outcome was assessed with: Center for Epidemiologic Studies Depression Scale (CES-D), Self-rating Anxiety Scale (SAS), and an original structured questionnaire
On the I-PSS urinary symptoms were found in 24 hypospadiacs and in 7 of the 30 control subjects. On the IIEF all hypospadiacs and all control subjects reported normal erectile function. CES-D and SAS revealed an absence of depression and anxiety traits in both populations. Our original questionnaire found that 16 patients had a partner; 21 patients reported complete sexual activity; all
CONCLUSIONS In contrast with several Authors, we found an overall satisfactory sexual function with good psychosexual adjustment. We recommend routine follow-up during adolescence to resolve patients’ concerns about fertility related to their genital malformation.