Management of Multiple Failed Repairs of the Phallus Using Tissue Expanders: Long-Term Postpubertal Results

No AccessJournal of UrologyPediatric urology1 May 2007Management of Multiple Failed Repairs of the Phallus Using Tissue Expanders: Long-Term Postpubertal Results Abdol-Mohammad Kajbafzadeh, Alireza Sina, and Seyedmehdi Payabvash Abdol-Mohammad KajbafzadehAbdol-Mohammad Kajbafzadeh , Alireza SinaAlireza Sina , and Seyedmehdi PayabvashSeyedmehdi Payabvash View All Author Informationhttps://doi.org/10.1016/j.juro.2007.01.047AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We present the long-term results of our experience with application of tissue expanders for phallic reconstruction in patients with a history of multiple surgical repairs. Materials and Methods: We retrospectively reviewed the medical records of 16 patients who underwent penile tissue expansion for treatment of failed phallic reconstruction. The patients were 5 to 22 years old (mean age 9.9) at the time of the procedure. The original diagnoses were congenital adrenal hyperplasia (1 patient), partial penile amputation (1), epispadias (3) and proximal hypospadias (11). We used different shapes and numbers of tissue expanders according to the estimated skin augmentation requirement for final reconstructive surgery. The injection port was placed at the suprapubic area lateral to the penile base, with a small incision between the anticipated expander pouch and the reservoir. Penile tissue expanders were inflated by injections after 1 to 2 weeks postoperatively. Definitive reconstructive surgery was then planned and the tissue expander was removed at penile reconstruction at 2 to 11 months (mean 4.6) after implantation. Results: Only 1 tissue expander was removed due to erosion. However, sufficient expanded skin was available for urethral reconstructions and penile skin coverage in all patients (100%). There were 2 cases of overlying penile skin redness, which resolved with temporary balloon deflation. Two patients had urethrocutaneous fistulas, which were successfully repaired later. Two additional patients required meatal dilation/urethromeatoplasty for meatal stenosis. These complications were corrected within 1 year postoperatively. After a long-term followup of 3 to 10 years (mean 6.5) as patients progressed through puberty, only 3 had mild chordee. At the end of followup acceptable cosmetic and functional results were achieved in 13 patients (81%). Conclusions: Tissue expansion is associated with few complications and good cosmetic results for phallic reconstruction in patients with minimal residual skin available for additional reconstructive efforts after repeated surgeries. References 1 : A one-stage repair for hypospadias cripples. Plast Reconstr Surg1970; 45: 425. Google Scholar 2 : Management and outcome of complex hypospadias repairs. J Urol2005; 174: 1540. Link, Google Scholar 3 : Treatment modalities for hypospadias cripples. Plast Reconstr Surg2000; 105: 600. Google Scholar 4 : Tissue expander enhanced onlay island flap in the repair of severe hypospadias. J Urol2003; 169: 606. Link, Google Scholar 5 : Reconstruction of hypospadias and epispadias with buccal mucosa free graft as primary surgery: more than 10 years of experience. J Urol2003; 170: 1600. Link, Google Scholar 6 : Use of bladder mucosal graft for urethral reconstruction. Int J Urol2000; 7: 355. Google Scholar 7 : Tissue expansion for urethral and penile reconstruction. Dialogues Pediatr Urol1995; 18: 4. Google Scholar 8 : Tissue expansion in management of failed phallic reconstruction: initial report of clinical series. Urology2005; 66: 180. Google Scholar 9 : Comparison of flaps versus grafts in proximal hypospadias surgery. J Urol2000; 163: 1286. Link, Google Scholar 10 : Tissue expansions in hypospadias cripple. : 2002. Presented at John W. Duckett Memorial Meeting and Workshop on Hypospadias, Istanbul, Turkey. Google Scholar 11 : Bladder mucosa in urethral reconstructions. J Urol1990; 144: 827. Link, Google Scholar 12 : Initial experience with staged buccal graft (Bracka) hypospadias reoperations. J Urol2004; 172: 1720. Link, Google Scholar 13 : Use of buccal mucosal grafts in hypospadia-crippled adult patients. Ann Plast Surg2003; 50: 382. Google Scholar 14 : Pediatric tissue expansion: indications and complications. J Craniofac Surg2003; 14: 866. Google Scholar 15 : Ureteral tissue expansion for bladder augmentation. J Urol1998; 159: 1665. Link, Google Scholar 16 : Tissue expansion: a promising new trend for reconstruction in urology. J Endourol2000; 14: 93. Google Scholar 17 : The role of tissue expanders in vaginoplasty for congenital malformations of the vagina. Br J Urol1992; 70: 554. Google Scholar 18 : Reconstruction after total penile amputation and emasculation. Ann Plast Surg2003; 50: 321. Google Scholar 19 : Immunohistochemical localization of androgen receptors in the urogenital tracts of human embryos. Reproduction2004; 128: 331. Google Scholar 20 : Expression of the androgen receptor and 5α-reductase type 2 in the developing human penis and urethra. Cell Tissue Res2002; 307: 145. Google Scholar Department of Urology, Pediatric Urology Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran© 2007 by American Urological AssociationFiguresReferencesRelatedDetailsCited byKajbafzadeh A and Nezami B (2018) Detubularized Pedicled Vaginal Onlay Flap Urethroplasty: A New Method for Hypospadias Repair of Ambiguous GenitaliaJournal of Urology, VOL. 180, NO. 5, (2159-2166), Online publication date: 1-Nov-2008.Kajbafzadeh A, Arshadi H, Payabvash S, Salmasi A, Najjaran-Tousi V and Sahebpor A (2018) Proximal Hypospadias With Severe Chordee: Single Stage Repair Using Corporeal Tunica Vaginalis Free GraftJournal of Urology, VOL. 178, NO. 3, (1036-1042), Online publication date: 1-Sep-2007. Volume 177Issue 5May 2007Page: 1872-1877 Advertisement Copyright & Permissions© 2007 by American Urological AssociationKeywordsmalehypospadiastissue expansionpenisepispadiasurologic surgical proceduresMetricsAuthor Information Abdol-Mohammad Kajbafzadeh More articles by this author Alireza Sina More articles by this author Seyedmehdi Payabvash More articles by this author Expand All Advertisement PDF downloadLoading ...