Actas urologicas espanolas最新文献

Introduction: The goal of hypospadias repair is to optimize urinary and sexual function, improve cosmesis and minimise the psychosocial effects associated with a penile anomaly. However, a lack of clarity exists regarding the role of surgery in milder hypospadias where the anomaly is inconspicuous and there is no anticipated impact on function. The aim of this study was to review the long term functional, cosmetic and psychosocial outcomes in men with uncorrected hypospadias. This information may be helpful for parents who are burdened with deciding the correct treatment for their child's hypospadias.

Methods: A scoping review of PubMed, EMBASE, and CINAHL + databases was performed in adherence with PRISMA guidelines. Eight studies were identified for inclusion in the review.

Results: Men with mild uncorrected hypospadias have similar functional outcomes to those without hypospadias, preferring to void standing and reporting similar IPSS scores. However, those with severe untreated hypospadias experience significant urinary difficulties, higher IPSS scores, and are more likely to sit when voiding. They reported worse SHIM scores, more ventral curvature, and greater difficulty with intercourse. Most men with incidentally identified hypospadias are unaware of their condition and are satisfied with their penile appearance. There was no difference in the attainment of psychosocial milestones between men with uncorrected hypospadias versus no hypospadias.

Conclusion: There is a lack of research regarding the experiences of adult men with uncorrected hypospadias. However, there is some evidence to support the non-operative management of mild hypospadias. Therefore, the decision to defer surgery in infancy should balance parental wishes and physician guidance, particularly in cases where the risk of functional impairment is low.

Introduction: Anterior urethroplasty is the gold standard for treating complex urethral strictures, primarily focusing on restoring urinary function. However, aesthetic complications, including penile curvature, scarring, and meatal deformities, can impact patient satisfaction, self-image, and quality of life. Despite their significance, cosmetic outcomes are underreported in the literature, affecting patient counseling and surgical planning.

Objective: This scoping review aims to assess the prevalence, types, and contributing factors of cosmetic complications after anterior urethroplasty. A photographic collection of these complications is also presented to aid in clinical education.

Materials and methods: A systematic search of PubMed, Scopus, and Web of Science databases was performed, including studies from 2000 onward that report cosmetic outcomes in male adult patients post-urethroplasty. Following PRISMA guidelines, studies focusing on pediatric cases, case reports with fewer than 10 patients, and those lacking specific cosmetic data were excluded.

Results: Of the 493 studies screened, 97 met the inclusion criteria, with only a minority (8 studies) explicitly discussing cosmetic complications. Reported issues varied widely, including penile curvature, skin tethering, hypertrophic scarring, meatal deformities, and penile shortening, underscoring the diversity of aesthetic challenges in urethral reconstruction.

Conclusion: This review highlights the need for incorporating aesthetic considerations into surgical planning and patient counseling for anterior urethroplasty. Standardized metrics for evaluating cosmetic outcomes could improve patient satisfaction and the quality of care in urethral reconstruction.

Introduction: Although failures are undesirable, they offer valuable learning opportunities that drive progress through necessary changes. This concept holds particularly true in the history of urethral reconstruction.

Methods: A comprehensive literature review was conducted using PubMed, focusing on the history of the urethral stricture and current trends based on national and international guidelines for urethral stricture management.

Results: Urethral strictures are among the oldest known urological conditions, with initial treatments centred around dilatation. These palliative measures proved disappointing. The advent of reconstructive urology has transformed this pathology into a treatable condition, notably through Excision and Primary Anastomosis (EPA) and one-stage augmentation urethroplasty using buccal grafts.

Conclusion: Urethroplasty is the gold standard treatment for urethral strictures, and ongoing refinements aim to further reduce morbidity.