94 / 330
94
28
TH
CONGRESS OF THE ESPU
RESULTS
A total of 5,115 cases were identified, 388 types of medications and 90 pharmacological groups
were evaluated. Alpha-methyldopa and progesterone showed to be potentially risk factors: OR
2,27 (1,17-4,41; p=0,01) and OR 3,88 (1,96-7,70; p value 0,00003) respectively. Ferrous sulfate and
folic acid showed possible protective effect: OR 0.72 (0.60-0.87; p=0.0004) and OR 0.74 (0.56-0.96;
p value 0,02) respectively. Association with different types of hypospadias demonstrate potential
effects depending moment of exposure.
CONCLUSIONS
Potential preventive effects have been demonstrated in the past and this large-scale analysis
confirms a preventive effect of multivitamins in developing countries. Further studies will now focus
on cluster analysis, medication exposure and prevalence rates of hypospadias.
12:17–12:20
S8-8 (PP)
STAGED REPAIR OF PROXIMAL HYPOSPADIAS
WITH PREPUTIAL GRAFT OVER VASCULARISED SPLIT
DARTOS FLAPS
Elizabeth O’CONNOR, Junaid ASHRAF, Alexander TURNER
and Ramnath SUBRAMANIAM
Leeds Teaching hospitals NHS trust, Paediatric Urology, Leeds, UNITED KINGDOM
PURPOSE
To present the outcome of staged repair for proximal hypospadias with preputial graft on the bed of
vascularised split dartos flaps.
MATERIAL AND METHODS
73 boys with proximal hypospadias underwent staged repair over 11 years between March 2006 and
August 2016; 16 mid shaft, 36 proximal penile, 19 penoscrotal and 3 perineal. Chordee was moder-
ate in 24( 33%) and severe in 44 (61%) requiring nesbitts procedure. 7 boys(9.5%) received Local
DHT gel prior to first stage. All of them had preputial graft at the first stage with split vascularised
dartos flaps placed on lateral aspects of the bed. Tubularisation of neourethra was done 6-8 months
later when the graft was supple.The mean age at first stage was 29 months (14-100) and 43 months
at 2
nd
stage(21-116).
RESULTS
Median length of follow up was 23 months post completion of staged repair (2-95 months). We had
a 100% graft take following first stage with no revision of graft. 57 boys had successful repair with
planned two stages. 16 boys had complications (21%). 9 boys developed fistulas (12%). 4 fistulas
were late complications, one developing 26 months after the second stage, 2 developing 3 years
after the second stage and one developing 7 years post second stage. The other 5 developed
between 5 and 19 months after the second stage.
Of the 9 fistulas, 7 succesfully repaired (5 closure of fistula; 2 redourethroplasty). One boy has had
two failed attempts at closure. Another boy is awaiting fistula closure.
4 boys had late presenting meatal stenosis;2 had meatoplasty; 2 awaiting correction. One boy had
a meatal skin tag which was excised and another had penile torsion which was corrected. One boy
had residual overhanging foreskin causing spraying, which was repaired.
CONCLUSIONS
Staged repair with preputial graft over dartos flaps for proximal hypospadias is reliable technique
with minimum morbidity and no graft loss.