AB128. Features of correction hypospadias in the young men

Purpose: Examining the early and late results of adult urethroplasty in the adult patients.

Materials and methods: During the period from January 2006 to December 2013 at the Republican Specialized Center of Urology (training base of Tashkent Medical Academy) urethroplasty using various techniques was performed in 68 men. Mean age was 23.4 ±2.6 years (from 18 to 26 years). All patients have had previously foreskin removing (circumcision). Some form of surgical intervention on the penis was performed in 48 (70%) men formerly. Typically, earlier in childhood, there had been an unsuccessful attempt in urethroplasty in 39 patients, and straightening of the penis (excision of the chord) in seven cases. Dermal urethral fistula in the urethra was formed in 23 (34%) males: in 12 cases the aperture was situated in penoscrotal zone; in eight patients—in the shaft of the penis and in three patients - located in the coronary sulcus. Deformity of the penis due to insufficiently removing of the chord was in three patients. Causes of patients complaints were dissatisfaction with aesthetic appearance of the penis (all patients), the presence of a fistula and the absence of children after marriage (12 men). All the patients underwent routine clinical and laboratory investigations, biochemical analyzes, the investigation of sexual hormones levels, ultrasonography (to avoid abnormalities of the urinary tract) and uroflowmetry (to exclude bladder outlet obstruction). All patients have had an antibacterial therapy before the surgery in the case urinary tract of infection and urethroplasty was performed in the presence of sterile urine. Sine qua non of urethra plastic surgery was the decompression of the lower urinary tract, which was performed by setting a catheter into the bladder cavity via percutaneous suprapubic access. In to the neouretral lumen was performed of a small diameter catheter. Restoration of natural urination occurred 12-15 days after the surgery.

Results: The formation of the neourethra in all patients was completed in several stages. The first stage included the chord excision in seven patients with deformed penile curvature. S. E. Duplay method of urethral plastic surgery was performed in 32 (47%) patients, in 28 cases the meatus was formed at coronal sulcus, whereas in four men using glanduloplasty we managed to form the outer aperture of the urethra at the tip of the penis. After the surgery in 12 (37%) cases, because of purulent urethritis and wound dehiscence, the urinary fistulas were accured. The fistulas self-cured in two of the cases, in the remaining patients this occurred three months after the surgical repair. Due to the scarcity of the skin on the penis in 36 (53%) cases for the technique proposed by Cecil was used in creation of the urethra: the first stage creates the urethra and the skin defect on the penile skin flap is closed using the skin from the scrotum; the second stage (after three months) the uncoupling of the penoscrotal anastomosis was performed. After the Cecil surgery the purulent urethritis occurred in 10 (27%) patients, which caused the formation of urethral urinary fistulas in eight cases. After three months, urethral fistula was successfully eliminated surgically. It should be noted that in all patients in this group the urethral meatus was formed at the coronal sulcus, as the specialized nature of these operations according to Cecil do not provide another option.

Conclusions: Due to the scarcity of the skin on the penis in adult patients (including the lack of foreskin) urethroplasty should be performed in a multi-step process. There is no need to form the outer opening of the urethra on the penis balanus, however the location of the meatus on a physiological level allows for the best aesthetical result. Because of the risk of urethritis in men it is advisable before performing uretroplastic surgery to perform a derivation of urine using cystostomy.

Keywords: Adult urethroplasty; correction hypospadias; surgical intervention