末吉　亮
   Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine
   Position   Assistant Professor
Article types Original article
Language English
Peer review Peer reviewed
Title Reinforcing the ventral penile shaft with pedicled fat/connective tissues before urethroplasty lowers the risk for post-urethroplasty complications in hypospadias.
Journal Formal name：Journal of pediatric surgery
Abbreviation：J Pediatr Surg
ISSN code：15315037/00223468
Domestic / ForeginForegin
Volume, Issue, Page 51(12),pp.2021-2024
Author and coauthor Sueyoshi Ryo†, Seo Shogo, Ochi Takanori, Murakami Hiroshi, Yazaki Yuta, Takeda Masahiro, Nakamura Hiroki, Lane Geoffrey J, Yamataka Atsuyuki
Publication date 2016/12
Summary PURPOSE:CHARGE is our technique for reinforcing the ventral penile shaft with pedicled pericordal/scrotal fat, pedicled perimeatal connective tissue, or a combination of these at the time of initial hypospadias surgery. Such pedicled grafts "charge" poorly developed urethral plates and thin ventral foreskin prior to urethroplasty to improve compromised vascular perfusion that could prevent post-urethroplasty complications (post-UPC).METHODS:We reviewed post-UPC in 179 staged hypospadias repair patients (1997-2015). CHARGE, adopted routinely in 2010 was used in 39 patients (C-group), not indicated in 7 because ventral connective tissue was thick, and not used in 133 (NC-group). Initial hypospadias surgery included foreskin degloving with or without chordectomy, dorsal plication, tunica albuginea incision, or a combination of these.RESULTS:Subject demographics were similar. NC had significantly more post-UPC than C (25 versus 0; p<.01) comprising stenosis (n=14), fistula (n=7), diverticulum (n=2), and wound infection (n=2) that developed after a mean of 0.7±0.2years (range: 1day-2.8years). Extra time taken for CHARGE was less than 15minutes in all cases. Mean follow-up after urethroplasty (years) was significantly shorter in C (1.5±1.0 versus 5.7±3.8) (p<.01), but almost double the time taken to develop post-UPC.CONCLUSION:CHARGE would appear to prevent post-UPC.LEVEL OF EVIDENCE:Retrospective Comparative Study - Level III.
DOI 10.1016/j.jpedsurg.2016.09.031
PMID 27686484