Vacuum physiotherapy after first stage buccal mucosa graft (BMG) urethroplasty in children with proximal hypospadias

Bandini, Marco; Sekulovic, Sasha; Spiridonescu, Bogdan; Dangi, Anuj Deep; Krishnappa, Pramod; Briganti, Alberto; Salonia, Andrea; Montorsi, Francesco; Djinovic, Rados

doi:10.1590/S1677-5538.IBJU.2019.0845

Acessibilidade / Reportar erro

Brasil

International braz j urol

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Int. braz j urol 46 (6) • Nov-Dec 2020 • https://doi.org/10.1590/S1677-5538.IBJU.2019.0845 copy

Vacuum physiotherapy after first stage buccal mucosa graft (BMG) urethroplasty in children with proximal hypospadias

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction

To assess the feasibility of vacuum physiotherapy meant to decrease graft contraction and recurrent penile curvature (PC), hence successful tubularization and a straight penis in patients underwent two-stage buccal mucosa graft (BMG) urethroplasty, in proximal hypospadias repair.

Material and methods

Between January 2014 and July 2018, 59 two-stage BMG urethroplasties performed at our referral center, were included in the study. The parents were counseled to use the vacuum device between the two stages. An internal, self-administered, semiquantitative, non-validated questionnaire was designed to record parent and patient adherence to the vacuum physiotherapy and parent satisfaction. Success rate of graft tubularization, curvature correction rates, and status of early (4 months) postoperative urinary stream were evaluated.

Results

Of 45/59 (76.3%) who returned the questionnaire, 77.8% followed the recommended physiotherapy protocol using the vacuum device. 93.3% of parents replied that the use of the vacuum was easy or moderately easy. None of the parents interrupted the physiotherapy because of perceived difficulty or intolerability. 100% of parents would have repeated the physiotherapy, if they had to. Overall, success rate of tubularization was 98.3% (58/59), complete curvature correction was achieved in 88.2% (52/59) of patients, and 79.7% (47/59) of patients showed a straight and powerful early post-operative urinary stream.

Conclusions

Physiotherapy with the vacuum device is safe, easy and practically feasible. Our vacuum physiotherapy protocol had high compliance rate. Vacuum physiotherapy should be considered for further assessment in patients undergoing two stage hypospadias repair using buccal mucosa.

Hypospadias; Mouth Mucosa; Vacuum

Variables		Overall	Patients who did not fulfil the questionnaire (14)	Patients who fulfilled the questionnaire (45)	P values
Age at 1st stage of surgery (months)	Median	20	27	20	0.2
	Range	14-36	18.2-76	14-31	0.2
Age at 2nd stage of surgery (months)	Median	27	34	26	0.1
Age at 2nd stage of surgery (months)	Range	21-43	25.2-83	21-39	0.1
Time between the two stages (months)	Median	6	6	6	0.5
Time between the two stages (months)	Range	6-8	6-7.8	7-8	0.5
Lipectomy	No	11 (18.6)	2 (14.3)	9 (20)	0.9
Lipectomy	Yes	48 (81.4)	12 (85.7)	36 (80)	0.9
Location of the meatus	Proximal	51 (86.4)	12 (85.7)	39 (86.7)	1
Location of the meatus	Proximal-shaft	8 (13.6)	2 (14.3)	6 (13.3)	1
Previously operated for hypospadias	No	46 (78)	10 (71.4)	36 (80)	0.8
Previously operated for hypospadias	Yes	13 (22)	4 (28.6)	9 (20)	0.8
Penile curvature at presentation	None or < 30	1 (1.7)	0 (0)	1 (2.2)	0.6
	>60	50 (84.7)	13 (92.9)	37 (82.2)
	30-60	8 (13.6)	1 (7.1)	7 (15.6)
Penile curvature at second stage of surgery	None or < 30	17 (28.8)	3 (21.4)	14 (31.1)	0.4
	>60	4 (6.8)	2 (14.3)	2 (4.4)
	30-60	38 (64.4)	9 (64.3)	29 (64.4)
DSD	No	48 (81.4)	10 (71.4)	38 (84.4)	0.5
DSD	Yes	11 (18.6)	4 (28.6)	7 (15.6)	0.5
Curvature management at 1° stage	Plication	2 (3.4)	0 (0)	2 (4.4)	1
Curvature management at 1° stage	Chordee release or ventral tunica attenuations	57 (96.6)	14 (100)	43 (95.6)	1
Curvature management at 2° stage	Plication	47 (79.7)	12 (85.7)	35 (77.8)	0.8
Curvature management at 2° stage	None	12 (20.3)	2 (14.3)	10 (22.2)	0.8
Skin reconstruction	Direct ventral closure	46 (78)	12 (85.7)	34 (75.6)	0.7
Skin reconstruction	flaps or grafts from skin, dartos or preputial	13 (22)	2 (14.3)	11 (24.4)	0.7
Fistula	No	32 (54.2)	11 (78.6)	21 (46.7)	0.07
Fistula	Yes	27 (45.8)	3 (21.4)	24 (53.3)	0.07
Any complications	No	28 (47.5)	9 (64.3)	19 (42.2)	0.3

Questions	Answers

Patients who replied to the questionnaire (45/59, 76.3%)
Did you use the vacuum device between the two stages of surgery?	Yes	No
Response rates	45 (100%)	0 (0%)
How many days per week did you use the vacuum device? (Days per week)	7-6	5-3	2-1
Response rates	44 (97.8%)	0	1 (2.2%)
How many times per day did you use the vacuum device?	3	2	1
Response rates	9 (20.0%)	30 (66.7%)	6 (13.3%)
For how long after the first surgery did you use the vacuum device? (Months)	6 (or until the second stage )	3-4	2-1	≤1
Response rates	41 (91.1%)	1 (2.2)	2 (4.5%)	1 (2.2)
Number of patients, who followed our recommended protocol vacuum physiotherapy (at least two times per day, every day, until the second stage of surgery)				35 (77.8%)
Did you have any difficulties in using the vacuum device?	No, it was easy	It was moderately easy	It was challenging	I interrupted because it was too difficult
Response rates	32 (71.1%)	10 (22.2%)	3 (6.7%)	0 (0%)
How was your son reacting to the vacuum device?	He never complained	He was complaining, but only at the beginning	He was complaining at all times	I interrupted because my son could not tolerate the vacuum
Response rates	12 (26.7%)	27 (60.0%)	6 (13.3%)	0 (0%)
Number of parents who found vacuum physiotherapy was easy or moderately easy combined with children who did not complain or complain but just at the beginning				39 (86.7%)
Did you perform the massage of the ventral side of the penis, over the buccal mucosa graft, with the cream?	Yes	No
Response rates	44 (97.8%)	1 (2.2%)
Would you perform physiotherapy with the vacuum device again?	Yes	No
Response rates	45 (100%)	0 (0%)

Sociedade Brasileira de Urologia Rua Bambina, 153, 22251-050 Rio de Janeiro RJ Brazil, Tel. +55 21 2539-6787, Fax: +55 21 2246-4088 - Rio de Janeiro - RJ - Brazil
E-mail: brazjurol@brazjurol.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence address: Marco Bandini, MD Division of Oncology/Unit of Urology URI, IRCCS Ospedale San Raffaele Via Olgettina 60, Milan 20132, MI, Italy Fax: + 39 02 2643-7298 E-mail: bandini.marco@hsr.it