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New insights in congenital penile malformations

(2015)
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Abstract
CPMs encompass a wide spectrum of pathologies. Most of them are still only partly understood. Study 1 intended to search a possible common pathophysiology in CPMs: A prospective observational analysis of DT samples harvested in children undergoing PPS was conducted. The pathologist, blinded for the indication for surgery, confirmed a common pathophysiology in CPMs. Furthermore, it was found that the level of DT architecture disorganisation was strongly correlated with the clinical severity of the malformation. Hypospadias is the most common presentation of CPMs. Review 1 intended to summarize the known aetiologies for hypospadias. The causes are multifactorial, resulting in delicate interactions between the child and his mother through the placenta, modulated by external environmental factors. Many of those causes are still to be unveiled, even if our understanding of the mechanisms leading to hypospadias has clearly risen over the last decade. If the causes of hypospadias are still incompletely understood, the reconstructive techniques are well-described. Review 2 provided an overview of the actual techniques. No technique for reconstruction has ever emerged as a gold-standard, and many techniques are recognized as effective. The reconstruction techniques applied in hypospadias reconstruction rely on a few principles a surgeon needs to be familiar with to be able to apply them when needed. The outcomes of the reconstructive techniques are variable in the literature. Study 2 evaluated the outcome of reconstruction in the Ghent University. A retrospective analysis of a large database of HPR showed that a good result without re-intervention can be achieved in almost 75% of the cases, while 25% of the patients will need a re-intervention. Of those who need a re-intervention, almost the half of them have their complication requiring surgery later than one year after surgery. It illustrates that long-term follow-up is mandatory to detect the real complication rate: the complication rates reported in the literature are sometimes lower, but have often a follow-up limited to 6 or 12 months. As complication rates are quite high, Study 3 tried to find some independent variables associated with re-intervention. Univariate and multivariate logistic analysis regression were applied on a large retrospective database of HPR designed to guarantee long-term follow-up, in order to identify variables associated with re-intervention. The only independent significant predictor for re-intervention is the severity of hypospadias, with proximal hypospadias coming out as statistically significant. In order to lower complication rate, scientific societies wrote guidelines on hypospadias repair. But the available data in the literature are often very limited. Review 3 evaluated the actual level of evidence in hypospadias recommendations. The level of evidence of many recommendations made in the guidelines about hypospadias is dramatically low, ranging from 3 to 5, to almost no data at all. The influence of reconstruction in hypospadias on psychosexual behavior is poorly evaluated in the literature. Review 4 looked at what is known about psycho-sexual outcomes in hypospadias. Patients who underwent hypospadias repair seem to be less satisfied with their micturition pattern in comparison to controls. The extent of those complaints seems related to the severity of hypospadias. Regarding sexual function, a higher prevalence of sexual dissatisfaction and sexual contact avoidance is noted, along with some negative genital appraisal. One of the other CPMs an urologist might encounter is BP. BP is a debated condition for which many reconstruction techniques are described. Study 4 describes the Ghent University Hospital technique and compares it with a classical technique. It concludes that the technique is easy to perform, reproducible and provides satisfactory results according to parents and/or patients. In conclusion, although this thesis provided some answers about the open questions in CPMs, it pointed out many fields that are still to be investigated. Prospective multicentric studies will therefore be necessary.
Keywords
hypospadias, Congenital penile pathologies, buried penis

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Citation

Please use this url to cite or link to this publication:

Chicago
Spinoit, Anne-Françoise. 2015. “New Insights in Congenital Penile Malformations”. Ghent University. Faculty of Medicine and Health Sciences.
APA
Spinoit, A.-F. (2015). New insights in congenital penile malformations. Ghent University. Faculty of Medicine and Health Sciences.
Vancouver
1.
Spinoit A-F. New insights in congenital penile malformations. Ghent University. Faculty of Medicine and Health Sciences; 2015.
MLA
Spinoit, Anne-Françoise. “New Insights in Congenital Penile Malformations.” 2015 : n. pag. Print.
@phdthesis{6932560,
  abstract     = {CPMs encompass a wide spectrum of pathologies.  Most of them are still only partly understood.  
Study 1 intended to search a possible common pathophysiology in CPMs: A prospective observational analysis of DT samples harvested in children undergoing PPS was conducted. The pathologist, blinded for the indication for surgery, confirmed a common pathophysiology in CPMs. Furthermore, it was found that the level of DT architecture disorganisation was strongly correlated with the clinical severity of the malformation. 
Hypospadias is the most common presentation of CPMs.  Review 1 intended to summarize the known aetiologies for hypospadias.  The causes are multifactorial, resulting in delicate interactions between the child and his mother through the placenta, modulated by external environmental factors. Many of those causes are still to be unveiled, even if our understanding of the mechanisms leading to hypospadias has clearly risen over the last decade. 
If the causes of hypospadias are still incompletely understood, the reconstructive techniques are well-described.  Review 2 provided an overview of the actual techniques. No technique for reconstruction has ever emerged as a gold-standard, and many techniques are recognized as effective. The reconstruction techniques applied in hypospadias reconstruction rely on a few principles a surgeon needs to be familiar with to be able to apply them when needed. 
The outcomes of the reconstructive techniques are variable in the literature.  Study 2 evaluated the outcome of reconstruction in the Ghent University. A retrospective analysis of a large database of HPR showed that a good result without re-intervention can be achieved in almost 75% of the cases, while 25% of the patients will need a re-intervention.  Of those who need a re-intervention, almost the half of them have their complication requiring surgery later than one year after surgery.  It illustrates that long-term follow-up is mandatory to detect the real complication rate: the complication rates reported in the literature are sometimes lower, but have often a follow-up limited to 6 or 12 months.
As complication rates are quite high, Study 3 tried to find some independent variables associated with re-intervention. Univariate and multivariate logistic analysis regression were applied on a large retrospective database of HPR designed to guarantee long-term follow-up, in order to identify variables associated with re-intervention.  The only independent significant predictor for re-intervention is the severity of hypospadias, with proximal hypospadias coming out as statistically significant.
In order to lower complication rate, scientific societies wrote guidelines on hypospadias repair.  But the available data in the literature are often very limited.  Review 3 evaluated the actual level of evidence in hypospadias recommendations.   The level of evidence of many recommendations made in the guidelines about hypospadias is dramatically low, ranging from 3 to 5, to almost no data at all. 
The influence of reconstruction in hypospadias on psychosexual behavior is poorly evaluated in the literature. Review 4 looked at what is known about psycho-sexual outcomes in hypospadias.  Patients who underwent hypospadias repair seem to be less satisfied with their micturition pattern in comparison to controls.  The extent of those complaints seems related to the severity of hypospadias. Regarding sexual function, a higher prevalence of sexual dissatisfaction and sexual contact avoidance is noted, along with some negative genital appraisal.
One of the other CPMs an urologist might encounter is BP. BP is a debated condition for which many reconstruction techniques are described.   Study 4 describes the Ghent University Hospital technique and compares it with a classical technique.  It concludes that the technique is easy to perform, reproducible and provides satisfactory results according to parents and/or patients.
In conclusion, although this thesis provided some answers about the open questions in CPMs, it pointed out many fields that are still to be investigated.  Prospective multicentric studies will therefore be necessary.},
  author       = {Spinoit, Anne-Françoise},
  keywords     = {hypospadias,Congenital penile pathologies,buried penis},
  language     = {eng},
  pages        = {200},
  publisher    = {Ghent University. Faculty of Medicine and Health Sciences},
  school       = {Ghent University},
  title        = {New insights in congenital penile malformations},
  year         = {2015},
}