dr. mirgon fuentes quintana urólogo-pediatra tisbu.sbu-filial-cbba.com/archivos/ee-aa_hipospadia...
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Dr. Mirgon Fuentes Quintana
Urólogo-Pediatra TiSBU.
DEFINICION
• Hipospadia, es definida como la hipoplasia
de los tejidos que forman la parte ventral
del pene mas allá de la división del cuerpo
esponjoso con presencia de meato
ectópico ventral.
Keays MA, Dave S. Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes. Can Urol Assoc J. 2017 Jan-
Feb;11(1-2Suppl1):S48-S53.
• Incidencia- 1/250 recién nacidos
• asociado a 3 anomalías.
apertura ventral anormal del meato
uretral
curvatura ventral anormal del pene
distribución anormal del prepucio con capuchón dorsal.
Keays MA, Dave S. Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes. Can Urol Assoc J. 2017 Jan-
Feb;11(1-2Suppl1):S48-S53.
DIAGNOSTICO
• Hipospadia es diagnosticada por el examen físico,
sospechada inicialmente por la disposición del
prepucio y confirmada por la ubicación ventral del
meato.
Keays MA, Dave S. Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes. Can Urol Assoc J. 2017 Jan-
Feb;11(1-2Suppl1):S48-S53.
• Otros hallazgos incluyen
1. Glande hundido
2. Desviación del rafe medio.
3. Curvatura Ventral
4. Escroto bífido
5. transposición penoscrotal
Keays MA, Dave S. Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes. Can Urol Assoc J. 2017 Jan-
Feb;11(1-2Suppl1):S48-S53.
EMBRIOLOGIA
ETIOLOGIA
Factores Geneticos
• Relación familiar en 4% to 10% de los casos de
hipospadia, incluyendo familiares de 1er 2do y 3er
grado.
Mutaciones Geneticas
Estudios en ratones indican los gene Fgf8, Fgf10, y Fgfr2
que participan en los receptores androgénicos como
posibles candidatos en la fisiopatología de la
hipospadia.. Bouty A, Ayers KL, Pask A, Heloury Y, Sinclair AH. The Genetic and Environmental Factors Underlying
Hypospadias. Sex Dev. 2015;9(5):239-259.
ETIOLOGIA
tratamiento con progesterona durante el embarazo aumenta el riesgo
de hipospadia en el neonato.
En la mayoría de los casos este defecto congénito no esta del todo
comprendido.
Bouty A, Ayers KL, Pask A, Heloury Y, Sinclair AH. The Genetic and Environmental Factors Underlying
Hypospadias. Sex Dev. 2015;9(5):239-259.
ANOMALIAS ASOCIADAS
• Criptorquidia
• Utrículo Prostatico
•
• Agenesia Renal
CLASIFICACION
Indicaciones de cirugía
1. meato proximal
2. curvatura ventral acentuada
3. estenosis de meato
indicaciones cosméticas fuertemente ligadas a un buen
desarrollo psicológico del niño:
1. meato de localización anormal
2. glande achatado
3. pene rotado con rafe anormal
4. capuchón prepucial
5. escroto bífido.
cuando operar?
Entre 6 y 12 meses
• El proceso de cicatrización es menor y mas rápido.
• Los lactantes quedan sin secuelas psicológicas del
trauma quirúrgico en esa edad.
Springer A. Assessment of outcome in hypospadias surgery - a review. Front Pediatr. 2014;2:2.
Actualmente existe controversia en el uso de andrógenos pre quirúrgicos en cirugía de hipospadias.
preparacion hormonal prequirugica?
IM testosterona enantato – 2mg/kg/dosis durante 3 a 6
semanas una dosis semanal.
Springer A. Assessment of outcome in hypospadias surgery - a review. Front Pediatr. 2014;2:2.
Serafeddin. tratando estenosis de meato en niños con
hipospadia.
ORTOPLASTIA
• corrección de la curvatura ventral
• tejidos ventrales: piel, dartos, cuerpo
esponjoso, placa uretral , y túnica del cuerpo
cavernoso. todos ellos creando tensión para
producir curvatura ventral.
• ocurre en 11% de hipospadia distal, 30%
medio peneana, 81% en proximal.
• para evaluar la curvatura real el primero paso es tener
el pene en erección total.
• otro requisito es tener el pene liberado del prepucio.
• técnica de Baskin: las
curvaturas mayores de
30º pueden ser resueltas
con plicaturas dorsales
en la línea media.
técnica de Nesbit:
• apertura longitudinal y
cierre transversal
pudiendo ser necesaria la
escisión de piel en el
segmento contralateral a
la curvatura.
• tratamiento de la
parte ventral:
• corporotomia Ventral con
injerto.
• multiple
corporotomia
ventral sin injerto.
• injerto dermico– Devine and Horton.
URETROPLASTIA
hipospadia distal :
• TIP
• otros como MAGPI, Mathieu flip-flap, y avance
utetral.
hispospadia medio peneana:
• TIP
• Onlay con flap prepucial
hipospadia proximal :
• Reparación en dos tiempos como Byers flap o con la
técnica de Bracka .
• TIP
• Onlay con flap prepucial
HIPOSPADIA PROXIMAL
Snodgrass technique for hypospadias repair WARREN T. SNODGRASS Department of Paediatric Urology, Children's Medical Center of Dallas and University of Texas South-western Medical Center at Dallas, TX, USA
Snodgrass technique for hypospadias repair WARREN T. SNODGRASS Department of Paediatric Urology, Children's Medical Center of Dallas and University of Texas South-western Medical Center at Dallas, TX, USA
Snodgrass technique for hypospadias repair WARREN T. SNODGRASS Department of Paediatric Urology, Children's Medical Center of Dallas and University of Texas South-western Medical Center at Dallas, TX, USA
Snodgrass technique for hypospadias repair WARREN T. SNODGRASS Department of Paediatric Urology, Children's Medical Center of Dallas and University of Texas South-western Medical Center at Dallas, TX, USA
Snodgrass technique for hypospadias repair WARREN T. SNODGRASS Department of Paediatric Urology, Children's Medical Center of Dallas and University of Texas South-western Medical Center at Dallas, TX, USA
Snodgrass technique for hypospadias repair WARREN T. SNODGRASS Department of Paediatric Urology, Children's Medical Center of Dallas and University of Texas South-western Medical Center at Dallas, TX, USA
HIPOSPADIA MEDIO PENEANA
Snodgrass technique for hypospadias repair WARREN T. SNODGRASS Department of Paediatric Urology, Children's Medical Center of Dallas and University of Texas South-western Medical Center at Dallas, TX, USA
Snodgrass technique for hypospadias repair WARREN T. SNODGRASS Department of Paediatric Urology, Children's Medical Center of Dallas and University of Texas South-western Medical Center at Dallas, TX, USA
Snodgrass technique for hypospadias repair WARREN T. SNODGRASS Department of Paediatric Urology, Children's Medical Center of Dallas and University of Texas South-western Medical Center at Dallas, TX, USA
HIPOSPADIA PROXIMAL
COMPLICACIONES
• Sangrado, Hematoma
• Estenosis de meato
• Fistula
• Estenosis de uretra,
• Divertículo Uretral
• Infección
• Dehiscencia de glande
• cirugía de hipospadia fundamentada.
estandarización de abordaje
Platinum Priority – Pediatric UrologyEditorial by Antonella Giannantoni on pp. 1190–1191 of this issue
Trends in Hypospadias Surgery: Results of a Wor ldwide Survey
Alexander Springer *, Wilfr ied Krois, Ernst Horcher
Department of Paediatric Surgery, Medical University of Vienna, Austria
1. Introduct ion
Hypospadias is the most common malformation of the
penis, and literally countless techniques for its repair have
been described [1]. In large, systematic reviews of various
types of hypospadias correction, no urethroplasty tech-
nique appears to be definit ively superior. Moreover,
comparison between series in the literature is challenging
because of a lack of reliability in reporting outcome, which
complicates creation of universal recommendations [2–4] .
In 2009, the European Association of Urology published
guidelines for the treatment of hypospadias, with a level of
evidence between case series and systematic reviews of
cohort studies with or without homogeneity [5]. In clinical
practice, many factors influence the choice of surgical
technique, including ‘‘personal taste, upbringing, situation-
al preference, training, experience and personal success’’
[6]. For that reason, we sought to determine which
EU RO PEA N U ROL OGY 6 0 ( 2 0 1 1 ) 1 1 8 4 – 1 1 8 9
av ai l ab l e at w w w .sc i en ced i r ect .co m
j o u r n al h o m ep ag e: w w w .eu r o p ean u r o l o g y .co m
Art icle info
Article history:
Accepted August 11, 2011
Published online ahead of
print on August 22, 2011
Keywords:
Chordee
Hypospadias
Questionnaire
Survey
TIP
Two stage repair
Abstract
Background: Hypospadias is a challenging field of urogenital reconstructive surgery,
w ith different techniques currently being used.
Objective: Evaluate international trends in hypospadias surgery.
Design, sett ing, and part icipants: Paediatric urologists, paediatric surgeons, urologists,
and plastic surgeons worldwide were invited to part icipate an anonymous online
questionnaire (http://www.hypospadias-center.info).
Measurements: General epidemiologic data, preferred technique in the correction of
hypospadias, and preferred technique in the correction of penile curvature were
gathered.
Results and limitat ions: Three hundred seventy-seven part icipants from 68 countries
returned completed questionnaires. In distal hypospadias (subcoronal to midshaft), the
tubularised incised plate (TIP) repair is preferred by 52.9–71.0% of the part icipants.
Meatal advancement and glanuloplasty (MAGPI) is stil l a preferred method in glandular
hypospadias. In the repair of proximal hypospadias, the two-stage repair is preferred by
43.3–76.6%. TIP repair in proximal hypospadias is used by 0.9–16.7%. Onlay flaps and
tubes are used by 11.3–29.5%of the study group. Simple plication and Nesbit ’s proce-
dure are the techniques of choice in curvature up to 308; urethral division and ventral
incision of the tunica albuginea with graft ing is performed by about 20% of the
part icipants in severe chordee. The frequency of hypospadias repairs does not influence
the choice of technique.
Conclusions: In this study, we ident ified current international trends in the management
of hypospadias. In distal hypospadias, theTIPrepair is thepreferred technique. In proximal
hypospadias, the two-stage repair is most commonly used. A variety of techniques are
used for chordee correction. This study contains data on the basis of personal experience.
However, future research must focus on prospective controlled trials.
# 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.
* Corresponding author. Department of Paediatric Urology, Leeds Teaching Hospitals, Leeds, UK.
Tel. +44 7412 690107.
E-mail address: alexander.springer@meduniw ien.ac.at (A. Springer).
0302-2838 /$ – see back matter # 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.eururo.2011.08.031
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