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Foreskin reconstruction vs circumcision in distal hypospadias

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Abstract

Purpose

The purpose of the study was to determine if there were differences in the complication rates between foreskin reconstruction (FR) and circumcision (CIRC) in distal hypospadias repairs. The primary outcomes were urethrocutaneous fistula (UF) and dehiscence.

Methods

The data of distal hypospadias operated between 2005 and 2013 were retrospectively reviewed. The inclusion criteria were any distal hypospadias repair that required an urethroplasty. The exclusion criteria were follow-up <1 year, redo procedures, chordee greater than 20°, and incomplete data. Univariate and multivariate analysis was performed on the results.

Results

213 patients were included (95 FR and 118 CIRC). The 2 groups were comparable for age at surgery 19.32 months in FR and 14.25 months in CIRC. Mathieu repair was more common in FR (47/95–49.47%) than in CIRC (45/118–38.14%). The total subsequent procedures required were 23 in FR and 57 in CIRC. The incidence of UF was 6.3% (6/95) in FR and 27.1% (32/118) in CIRC (p < 0.001, OR 5.52, 95% CI 2.2–13.9). Complete dehiscence rates were 3.16% (3/95) FR vs 11.02% (13/118) for CIRC (p = 0.037, OR 3.8, 95% CI 1.05–13.74). The incidence of patients requiring reoperation was 18.9% (18/95) in FR versus 45.8% (54/118) in CIRC (p < 0.001, OR 3.61, 95% CI 1.93–6.76).

Conclusions

Foreskin Reconstruction conferred a significantly lower rate of complications, particularly the UF rate, dehiscence rate, and number of patients that required reoperation. Our rate of complications in the CIRC group is much higher than other published data.

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Authors and Affiliations

  1. Department of Paediatric Urology, The Royal Children’s Hospital Melbourne, 50 Flemington Road, Parkville, VIC, 3052, Australia

    Rajay Rampersad, Yoke Lin Nyo, John Hutson, Mike O’Brien & Yves Heloury

  2. Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia

    John Hutson

  3. Murdoch Children’s Research Institute, Parkville, VIC, Australia

    Yves Heloury

Authors
  1. Rajay Rampersad
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  2. Yoke Lin Nyo
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  3. John Hutson
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  4. Mike O’Brien
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  5. Yves Heloury
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Corresponding author

Correspondence to Rajay Rampersad.

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The authors declare that they have no conflict of interest

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Rampersad, R., Nyo, Y.L., Hutson, J. et al. Foreskin reconstruction vs circumcision in distal hypospadias. Pediatr Surg Int 33, 1131–1137 (2017). https://doi.org/10.1007/s00383-017-4151-y

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  • DOI: https://doi.org/10.1007/s00383-017-4151-y

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