RESULTS OF URETHRAL RECONSTRUCTION IN ADULTS AFTER MULTIPLE HYPOSPADIAS REPAIRS


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Abstract

Aim To improve treatment results in patients after multiple hypospadias repairs by optimizing the postoperative management. Materials and methods Eighty-two patients (mean age 48.1±15.3 years) with urethral strictures secondary to failed hypospadias repairs underwent staged graft urethroplasty using oral mucosa (cheek, lip, tongue) as a grafting material. In 62 patients, at the end of surgery the bladder was drained with a standard Foley catheter. In twenty patients the bladder was drained with a modified silicone urethral catheter, which had an additional channel for delivering drugs and removing the urethral wound effluent, and a second additional channel for inflating a balloon fixed to the catheter tube at different parts of the catheter. Results The mean length of the stricture was 5.4±1.2 cm (from 1 to 16 cm). Twenty-eight patients had postoperative complications. Using the modified catheter resulted in statistically significantly (p<0.05) smaller percentage of complications (10% vs 41.9%) compared to standard Foley catheter. Urinalysis and sperm test on the follow up examination at 12 months showed that only 9 (10.9%) patients had signs of the inflammatory process. Seventy-five patients (91.5%) rated the appearance of the penis as «good»; only 5 (6.1%) and 2 (2.4%) patients considered the result as «satisfactory» and «unsatisfactory», respectively. Eighty patient (97.6%) regarded the treatment result as «good» for the quality of urination and only two (2.4%) considered it «satisfactory». When assessing the strength of urinary stream, 64 (78.1%), 13 (15.8%) and 5 (6.1%) patients rated it as «good», «satisfactory», and «unsatisfactory”, respectively. Conclusion The study findings shows that staged urethroplasty using the oral mucosa restores the urethral patency, reduces the severity of the inflammatory process, thus improving the quality of life of patients after failed hypospadias repair. The proposed modification of the catheter ensures the timely delivery of drugs to the surgical site, evacuation the wound effluent from the urethra and helps prevent strictures by periodically inflating the adjustable balloon-dilator.

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About the authors

S. I Gamidov

V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia; I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia

Email: s_gamidov@oparina4.ru
Dr.Med.Sci. , Prof. at the Department of Obstetrics, Gynecology, Perinatology and Reproductology; Head of the Department of Andrology and Urology Moscow, Russia

M. G Shneiderman

V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia

Researcher at the Professor B.V. Leonov Department for Assisted Technologies in Infertility Treatment Moscow, Russia

D. Yu Pushkar

A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia

Corr.-Member of the RAS, Dr.Med.Sci., Prof., Chief Urologist of Minzdrav of Russia, Honored Scientist of the RF, Honored Physician of the RF, Head of the Department of Urology Moscow, Russia

A. O Vasil’ev

A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia

Email: alexvasilyev@me.com
PhD, Teaching Assistant at the Department of Urology Moscow, Russia

A. V Govorov

A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia

Email: dr.govorov@gmail.com
Ph.D., Associate Professor at the Department of Urology Moscow, Russia

R. I Ovchinnikov

V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia

Email: r_ovchinnikov@oparina4.ru
Ph.D., Head of the Department of Andrology and Urology, Clinic Moscow, Russia

A. Yu Popova

V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia; I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia

Email: a_popova@oparina4.ru
Ph.D., Senior Researcher at the Department of Andrology and Urology Moscow, Russia

R. D Dusmukhamedov

N.I. Pirogov Russian National Research Medical University of Minzdrav of Russia

Email: runisdusmuhamedov@mail.ru
Ph.D. Student at the Department of Urology and Andrology Moscow, Russia

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