Redo hypospadias repair: experience at a tertiary care children’s hospital
Bibliographic record
Abstract
OBJECTIVE: Treatment of patients with failed hypospadias repairs can be challenging. Our study aimed to determine the best type of redo repair depending on the location and size of the urethral meatus, the status of the urethral plate and genital skin, the severity of residual chordee and the amount of scar tissue. METHODS: The Institutional Review Board approved our retrospective chart review of patients who had a redo hypospadias repair at our institution over the past 6 years. We recorded the type and number of previous repair(s), the type and number of redo procedure(s),as well as the complications and functional outcomes. RESULTS: There were 28 patients, aged 1-12 (mean 3.8) years, with failed hypospadias repairs. The initial severity of the hypospadias were as follows: perineal (1), penoscrotal (9), proximal shaft (1), mid-shaft (9), distal shaft (4), coronal (3) and mega-meatus (1). Of all the patients, 24 had 1 repair, 3 had 2 repairs and 1 had 3 repairs. The initial repairs comprised 11 tubularized island flaps (TIFs), 8 Snodgrass tubularized incised plate (TIP) techniques, 5 Mathieu repairs, 1 Meatal Advancement and GlanuloPlasty Incorporated (MAGPI) technique, 1 Pyramid, 1 Arap technique and 1 Thiersch-Duplay repair. Twenty-one of 28 patients had 1 redo operation, 5 had 2 redo operations, 1 had 3 redo operations and 1 had 4 redo operations, for a total of 38 redo operations. Of these, 26 were TIP techniques (68.4%), 3 were Mathieu (7.9%), 3 were TIF repairs (7.9%), 2 were onlay island flaps (5.3%) and 4 were buccal mucosal grafts (10.5%). Follow-up was 1-5 years (mean 3.5 yr). The final locations of urethral meatus included glans (18), corona (6), mid-shaft (3) and penoscrotal (1). Complications after redo surgery comprised 4 urethrocutaneous fistulae, 2 meatal stenoses, 1 urethral stricture and 3 dehiscences. Sixteen patients were followed with yearly uroflow with a Q-mean (mean uroflow) range of 3-14 mL/s (mean 8.1 mL/s). CONCLUSION: The majority of hypospadias failures can be salvaged with one operation. The TIP repair is our procedure of choice in most cases. In the setting of a poor urethral plate, TIF or buccal mucosa may be necessary. Complications are not infrequent in redo procedures.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".