PTU - Polskie Towarzystwo Urologiczne
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CODE: 16.2 - Treatment of penile cripples after hypospadias operations
Article published in Urologia Polska 2006/59/Suplement 1.


Wojciech Perdzyński, Marek Adamek
Zespół Chirurgii Rekonstrukcyjnej Męskich Narządów Moczowo-Płciowych Szpitala Damiana w Warszawie


Introduction. Failure of the treatment of severe forms of hypospadias may lead to the origin of penile cripple. It consists of anatomical (i.e. stenosis of urethra, curvature of penis) and functional (urinary and sexual dysfunction) disorders, which need to be cured. In most of these patients emotional problems, sometimes depression, arise.
Objectives. The goal of that paper was presentation of the way of treatment as well as the results achieved in these patients.
Materials and methods. From 2003 to 2005 the authors treated 12 patients with penile cripple who were earlier many times operated on in the other departments due to hypospadias. Criterion for inclusion was to present at least three from the complications listed below: stenosis of urethra (in 7 patients), curvature of penis or/and glans tilt (in 9), extensive scarring (in 8), urethro-cutaneous fistulas (in 7), position of urethral meatus on penile body or on the scrotum (in 9), underdevelopment of penis (in 3), iatrogenic covered penis (in 1). In urethral stenosis dorsal incision modo Snodgrass and tubularization (in 4), dorsal "onlay" flap on its mesentery (in 2), urethral cutting and excision of scarred its parts with formation of proximal urethrostomy on the scrotum and distal one below coronal groove, joining both meatuses by buccal mucosal graft (in 2, Ist stage of reconstruction) were done. In abdominal curvatures, on dorsal penile surface Nesbit operation (in 6) and Yachia operation (in 1) were done. In one patient with curvature and penile underdevelopment 2 colagenous grafts were sutured on the abdominal surface into the incisions in tunica albuginea. Urethro-cutaneous fistulas were sutured in many layers. In one patient 5 fistulas were joined together cutting skin bridges among them and then reconstruction of that part of urethra was done.
Results. In all patients with urethral stenosis good urine outflow was detected, which was confirmed by urethral flow examination. In all patients with penile curvature its straightening was achieved. In 6 patients urethro-cutaneous fistulas were sutured with good results, in one patient fistula recurred and reoperation was done. In 6 patients urethral meatus was positioned on the top of glans. Two patients are after the Ist stage of reconstruction of urethra (including a patient with iatrogenic covered penis which was totally exposed).
Conclusions. 1. Patients with penile cripple after the operations due to hypospadias should be treated in centers where up-to-date methods of genito-urinary reconstructive surgery are used. 2. One-stage treatment should be preferable in cases of penile cripple caused by scarring, penile curvature, in patients with position of meatus in distal or central part of penile trunc and with urethro-cutaneous fistulas. 3. The most difficult to treat is postoperative stenosis and shortening of urethra associated with big scarring and penile curvature. Such a patient often needs two-stage treatment.