Facebook Twitter YouTube

17242

Outcomes of Reoperations for Glans Dehiscence In Prepubertal Boys with Hypospadias

Saturday, October 20, 2012
Grand Ballroom A/B (Hilton Riverside)
Carlos A. Villanueva, MD, Nicol Corbin Bush, M.D. and Warren T. Snodgrass, M.D., Pediatric Urology, Children's Medical Center, Dallas, TX

Purpose

We recently reported that glans dehiscence (GD), defined as complete separation of the glans wings, occurred in 4% of patients with distal and 15% of proximal TIP hypospadias repairs in prepubertal boys (Snodgrass et al. J Urol 185:1845). Now we present outcomes for reoperative glansplasty among boys with GD.

Methods

Data for all patients undergoing hypospadias surgery was prospectively maintained since 1999, and analyzed for this report. All operations were done by WS, and consecutive prepubertal patients undergoing primary or reoperative glansplasty had the same sutures and suturing techniques, consisting of 1 layer interrupted subepithelial 6-0 polyglactin (3 stitches in most patients), closed independently of the underlying neourethra.

Results

Of 618 primary distal and proximal TIP repairs, 34 (5.5%) had GD, of which 29 underwent reoperative glansplasty. Recurrent GD developed in 7/26 (27%, p=0.0001) with follow up ranging from 1.2-106 months.  Another 100 patients underwent primary hypospadias repair elsewhere complicated by GD, and reoperative glansplasty resulted in recurrent GD in 11/85 (13%, p=0.017 compared to GD after primary repair). GD rates after reoperative glansplasty were similar for those with distal and proximal hypospadias at the time of primary repair (11/67 distal vs. 7/44 proximal, p=0.841). A total of 11 boys had a 3rd attempt at glansplasty, with recurrent GD in 5/8 (63%) with follow up.

Conclusion

Glans dehiscence rates are higher after reoperative glansplasty for GD than after primary repair, occurring in 13-27% of patients undergoing 2nd glansplasty and 63% of patients undergoing a 3rd glansplasty attempt. The etiology of GD remains unknown, with no clear association with suture type or suturing technique. Consequently, we used the same methods for both primary and reoperative glansplasty. From these data, we currently offer reoperation to all patients with GD after their primary hypospadias repair. Boys failing 2 glansplasties are now recommended to postpone additional surgery until reassessment at puberty, when the much larger glans size may decrease risk for recurrent GD.