Using Buck's Fascia as an Integral Covering in Urethroplasty to Restore the Anatomical Structure of the Penis in One-Stage Hypospadias Repair: A Multicenter Chinese Study Comprising 1,386 Surgeries

Yin Zhang; Min Chao; Wei-Ping Zhang; Yun-Man Tang; Hai-Chen Chen; Kai-Ping Zhang; Ru-Gang Lu; Xian-Sheng Zhang; Dong-Hua Lou

doi:10.3389/fped.2021.695912

Using Buck's Fascia as an Integral Covering in Urethroplasty to Restore the Anatomical Structure of the Penis in One-Stage Hypospadias Repair: A Multicenter Chinese Study Comprising 1,386 Surgeries

Front Pediatr. 2021 Aug 9:9:695912. doi: 10.3389/fped.2021.695912. eCollection 2021.

Authors

Yin Zhang¹, Min Chao¹, Wei-Ping Zhang², Yun-Man Tang³, Hai-Chen Chen⁴, Kai-Ping Zhang¹, Ru-Gang Lu⁵, Xian-Sheng Zhang⁶, Dong-Hua Lou⁷

Affiliations

¹ Department of Urology, Anhui Provincial Children's Hospital/Children's Hospital of Fudan University (Affiliated Anhui Branch), Hefei, China.
² Department of Pediatric Urology, Beijing Children's Hospital, Affiliated to the Capital Medical University, Beijing, China.
³ Department of Pediatric Surgery of Children's Medical Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Affiliated Hospital of the University of Electronic Science and Technology of China, Chengdu, China.
⁴ Department of Pediatric Surgery, Xiamen Maternal and Children's Health Hospital, Xiamen, China.
⁵ Department of Urology, Nanjing Children's Hospital, Children's Hospital of Nanjing Medical University, Nanjing, China.
⁶ Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
⁷ Department of Biostatistics, Nanjing Medical University, Nanjing, China.

Abstract

Objectives: The objective of the study is to investigate the feasibility and efficacy of urethroplasty with a Buck's fascia integral-covering technique (BFIC) to wrap and restore the normal anatomical structure of the penis in one-stage hypospadias surgery. Methods: One-stage surgeries for hypospadias management were performed using BFIC from January 2016 to September 2020 at four high-volume medical centers in China. The technique integrates Buck's fascia with glans wings to mobilize and wrap the urethra and restore penile anatomical relationships. The clinical data, postoperative follow-up data, and complications were recorded, and the results were analyzed. Results: A total of 1,386 patients were included in the study: 1,260 cases of primary hypospadias and 126 cases of re-operations; distal in 382 cases (27.6%), mid-shaft in 639 (46.1%), proximal in 365 (26.3%); tubularized incised plate (TIP) in 748 cases, inlay-graft in 124, onlay-graft in 49, Mathieu in 28, free-tube graft urethroplasty in 406, and 31 of hybrid procedures. One thousand one hundred forty-two patients (82.4%) were found to have penile curvature (>10°) after artificial erection and all corrected by dorsal plication/s or transection of the urethra plate (UP) simultaneously. The median followed-up time was 27 months (6-62). A total of 143 (10.3%) complications were recorded: 114 (9.0%) in the primary operations and 29 (23%) in the re-operations, 15 (3.9%) in distal hypospadias, 61 (9.5%) in mid-shaft, and 67 (18.4%) in proximal. The complication rate in UP preservation and transection was 10.1 and 10.8%, respectively. Of all case complications, there were 73 (5.2%) of fistula, 10 (0.6%) of dehiscence, 22 (1.6%) of meatal stenosis, 21 (1.5%) of stricture, 6 (0.7%) of diverticulum, and resident curvature in 11 cases (1.2%). The overall complication rate in TIP and free-tube procedure was 9.8 and 9.9%, respectively, and fistula occurred in primary TIP of 33 cases (4.9%). Conclusions: Buck's fascia with the glans can be used as an integral covering technique in one-stage distal to proximal hypospadias and primary or re-operative hypospadias repair. It is safe, feasible, and effective for the repair of hypospadias.

Keywords: Buck's fascia; hypospadias; multicenter study; penile anatomical structure; postoperative complications; reconstructive surgical procedure.