• Archives of Plastic Surgery
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• v.46 no.4
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• pp.381-385
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• 2019

Hypospadias is a congenital malformation of the male genitalia. The reconstructive objectives are to obtain voiding with laminar flow and satisfactory sexual function. Several urethroplasty techniques have been described, but for perineal or revisional cases no single technique has shown robust success. In this study, we describe the expanded use of intestinal flaps for urethral reconstruction and report a peculiar request from a patient to undergo peno-urethral separation after successful hypospadias repair with a free ileum flap. A 51-year-old male patient with perineal hypospadias underwent several urethral reconstructive procedures with poor outcomes. A free ileum flap was attempted as a substitute for the urethra. Following successful reconstruction, separation of the neo-urethra (ileum) from the penile body was performed to address the patient's sexual expectations. A free ileum flap proved to be a reliable urethral substitute in perineal hypospadias reconstruction, with a successful outcome. The peno-urethral separation with the creation of an "accessory penis," however peculiar, optimized the results in terms of both sexual and urinary function. Anatomical restoration of the urethra and patient-reported expectations are the key to successful hypospadias reconstructive procedures. Sexual function outcomes and the patient's perception of success should not be underestimated, even when urinary function has been restored.

• Archives of Plastic Surgery
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• v.36 no.2
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• pp.225-228
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• 2009

Purpose: Urethral reconstruction following failed hypospadias repair is difficult because of a severe shortage of the skin on ventral surface of the penis. We experienced a successful reconstruction of a failed hypospadias repair using the radial forearm free flap. So we present our case. Methods: A 16 - year - old boy had a proximal shaft hypospadias and had been taken a transverse preputial island flap but it completely broke down. There was no spare skin on the shaft of the penis. So we reconstructed a neo - urethra and the ventral skin of the penis with the radial forearm free flap. Results: Postoperatively he made relatively good process. The urethral catheter was maintained for 10 days and self - voiding was started. The suprapubic catheter was removed at the postoperative 30th day after control of cystitis. The postoperative appearance of the penis is acceptable and a straight erection is achieved. Conclusion: In the scarred penis with hypospadias, the radial forearm free flap transfer is a reliable reconstructive method for the neo - urethra and the ventral skin of the penis.

• Archives of Plastic Surgery
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• v.40 no.6
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• pp.766-772
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• 2013

Background Hypospadias is the most common congenital malformation of the male urinary tract, wherein the urethral opening is located proximal to the normal site. Tubularized incised-plate urethroplasty reconstruction, and its efficacy, remains controversial due to the high recurrence rate. This study aimed to evaluate the results of dartos fascia-reinforced flap surgery in hypospadias patients with previous operative complications. Methods Nine patients (mean age, 12 years) who had previous one- or two-stage repair with TIP urethroplasty and suffered from urethrocutaneous fistulas or fissures as complications, underwent dartos fascia-reinforced flap surgery in our clinic between January 2010 and December 2012. The mean postoperative follow-up period was 6 months. Results Among the 9 patients, 7 had complete correction. In all the patients, the maximum uroflow angle was > $45^{\circ}$. No patient complained of an unnatural urinating position. The patients and parents gave very high satisfaction scores (4.7 points) with regard to the appearance of the outer genitalia. Conclusion The dartos fascia-reinforced flap could be a useful and reliable option for complications of hypospadias repair or fissure with the prepuce preserved, given that histological aspects vary and that the possibility of recurrence in the glanular region is high.

• Journal of Veterinary Clinics
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• v.25 no.6
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• pp.557-559
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• 2008

Three calves which were born in a village with similar symptoms that urine ran down along the inner femoral region were referred to Veterinary Medical Teaching Hospital, Kyungpook National University. On physical examination, there were aplasia of the penis, ventrally incomplete sheath and bifid scrotum in common. Blood cell count test and blood biochemistry test were performed and then diagnostic radiography was carried out in a case. Retrograde positive cystograph showed normal urinary bladder and no other urogenital abnormalities. The shape and size of the testes were normal on ultrasonographs, yet intact urethral wall was not detected. These cases were diagnosed as hypospadias.

• Journal of Veterinary Clinics
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• v.29 no.4
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• pp.352-355
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• 2012

Hypospadias is a rare congenital malformation of the urethra reported in cattle. The urethral lumen of male indigenous Korean calf is open along the ventral aspect of the penis in the perineal region. Renal abscess and renal stone formation causing urinary tact infection has not been reported in hypospadia calves. The objective of this study was investigation for renal abscess and renal stone formation through autopsy. Histopathological examination and laboratory tests were performed. At autopsy, the pustules were formed on the right renal cortex, and the renal medulla abscess were formed on right and left part of the renal pelvis. Histopathological finding, this case was diagnosed as severe acute suppurative and necrotizing pyelonephritis, and severe chronic interstitial nephritis with fibrosis and moderate multifocal acute cystitis with edema. Milky exudate of the kidney has been identified as Actinomyces meyeri using the VITEK-2 system for identification of bacteria, and the stone has been identified as carbonate apatite using FT-IR system for quantification analysis. This case report describe the hypospadias complicated with urinary tract infection due to carbonate apatite stones and Actinomyces meyeri.

• Journal of Veterinary Clinics
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• v.31 no.5
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• pp.454-456
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• 2014

A 9-month-old intact male Persian cat (3.2 kg of body weight) was referred with primary complaint of constipation. Diagnostic studies found severe constipation and megacolon. After immediate medical treatment (e.g. enema), the physical examination was performed and revealed that the unusual urethral opening was found approximately 0.5 cm ventral to the tip of the penis where a 3.5 fr tomcat catheter was easily advanced into the bladder. The case was diagnosed as hypospadias. The cat was treated with castration and medical therapy for constipation. To our best knowledge, this case is the first case report for feline hypospadias complicated with chronic constipation in Korea.

• Journal of Veterinary Clinics
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• v.24 no.2
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• pp.288-291
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• 2007

Hypospadias is a malformation in which the urethra open on the ventral side of the penis and its frequency is about from 0.3% to 0.5% male birth in human. It is considered a disorder both genetic and environmental factors involves in pathogenesis. A KNC(Korean native calf) showing symptoms of fusion defect of the male ventral urethra, penile defect, bifid scrotum and low body weigh was born. To prevent an ascending urinary tract infection, dermatitis and loss of hair, surgical operation was performed to make a genitals like a female. After the operation, the KNC got a regenerative hair and normal urination. However the KNC became anorexia, loss in weight and weak. Seventy days after birth, the KNC died. The view of autopsy was a yellowish hepatomegaly, hydronephrosis, closed ureter and complex disorder in interanl organ. The symptoms of hepatomegaly and hydronephrosis could be due to a fluid therapy as a consequence of ureter obstruction. The normal urination of the KNC before it got sick, suggested that ureter obstruction in the case of this KNC was formed at its postnatal growth stage.

• Archives of Plastic Surgery
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• v.32 no.1
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• pp.110-116
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• 2005

Male pseudohermaphroditism is individuals with Y chromosome whose external appearances fail to develop as expected as a normal male. Cytogenetic form of male pseudohermaphroditism was 46XY but external genital forms were variable. We reviewed data from 7 patients with male pseudohermaphroditism operated in Dong-A University Hospital from January 1996 to August 2002. They all had severe form of hypospadias (pseudovaginal perineoscrotal type). Only 1 of 7 cases was operated urethroplasty by one stage method, and all others by two stage method. Patients with mild chordee were operated by one stage method and patients with severe chordee were operated by two stage method. Complete chordee release was done by Z-plasty or FTSG on the first stage and posterior urethroplasty was done at level of mid-dorsum of shaft at the same time. Anterior urethroplasty was done completely on the second stage. Results were good from the viewpoint of shape and urination. Urethral fistula occurred in two cases, but other complications (infection, urethral stricture, etc.) didn't occur. In conclusion, two stage method was compatible to correct hypospadias in male pseudohermaphroditism, because hypospadias in male pseudohermaphroditism is in severe form.

• Advances in pediatric surgery
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• v.13 no.2
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• pp.222-227
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• 2007

A differential diagnosis between the true hermaphroditism (TH) and mixed gonadal dysgenesis (MGD) has important clinical implications for gender assignment and the decision for early gonadectomy; however, variable clinical and histological features frequently lead to the confusion of TH with MGD. A 17-month-old boy was presented with proximal hypospadias with chordee and right non-palpable testis in his scrotum. He also had right auricular anomaly including a separated tragus with skin tag. Left testis was well palpable in his left scrotum. Diagnostic right inguinal exploration showed Mullerian structures such as a gonad like an ovary and a fallopian tube with a uterus, which were removed. Repair of hypospadias and right auricular anomaly was also done. Following ultrasonography (USG) showed a normal looking testis in left scrotum. His chromosome was 45, XO/46, XY. We report a difficult case of mixed gonadal dysgenesis mimicking true hermaphroditism which combines ipsilateral congenital auricular anomaly.

• Clinical and Experimental Reproductive Medicine
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• v.13 no.2
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• pp.161-174
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• 1986

A chromosomal study was performed in a total of 162 urological patients during past 2$2{\frac{1}{2}}$ years (Feb. 1984 - Aug. 1986). Of these 78(48%) patients had abnormal chromosome complements. Among all patients with chromosome abnormalities, 88% (69/78) had aberrations of chromosome number, 8% (6/78) had aberrations of chromosome structure and 4% (3/78) had aberrations of both. 90% (65/72) of numerical abnormality was Klinefelter's syndrome and the structural abnormality rate (5.6%, 9/162) was less than that (6.99%) of general population. The chromosomal study was mandatory for the detection of intersex in small testes or hypospadias with cryptorchism or clitoromegaly or bilateral cryptorchism. But unilateral cryptochism or hypospadias with normal scrotal testes was not thought to be indication of the chromosomal study if the external genitalia are otherwise quite normal.