Prevalence and surgical management of pubic hypertrophy in hypospadias patients: results from a high-volume surgeon

Vol. 45 (x): 2019 Setember 9.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2019.0267


ORIGINAL ARTICLE

Marco Bandini 1, 2, Sasha Sekulovic 1, Nikola Stanojevic 1, Bogdan Spiridonescu 1, 3, Vladislav Pesic 1, Salvatore Sansalone 4, Milan Slavkovic 1, Alberto Briganti 2, Andrea Salonia 2, Francesco Montorsi 2, Rados Djinovic 1
1 Sava Perovic Foundation, Center for Genito-Urinary Reconstructive Surgery, BelMedic General Hospital, Belgrade, Serbia; 2 Division of Oncology and Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita- Salute San Raffaele University, Milan, Italy; 3 Clinical Institute Fundeni, Center for Uronephrology and Renal Transplantation, Bucharest, Romania; 4 Department of Experimental Medicine and Surgery, University of Tor Vergata, Rome, Italy

ABSTRACT

Introduction: Pubic hypertrophy, defined as an abnormal and abundant round mass of fatty tissue located over the pubic symphysis, is frequently underestimated in patients with hypospadias. We examined the prevalence of this condition, as well as the out­comes associated with its surgical treatment.
Material and methods: Within 266 hypospadias patients treated at our clinic, we as­sessed the prevalence of pubic hypertrophy, and we schematically described the surgi­cal steps of pubic lipectomy. Multivariable logistic regression (MLR) tested for predic­tors of pubic hypertrophy. Finally, separate MLRs tested for predictors of fistula and any complications after pubic lipectomy.
Results: Of 266 hypospadias patients, 100 (37.6%) presented pubic hypertrophy and underwent pubic lipectomy. Patients with pubic hypertrophy more frequently had proximal hypospadias (44 vs. 7.8%), disorders of sex development (DSD) (10 vs. 0.6%), cryptorchidism (12 vs. 2.4%), and moderate (30°-60°) or severe (>60°) penile curvature (33 vs. 4.2%). In MLR, the location of urethral meatus (proximal, Odds ratio [OR]: 10.1, p<0.001) was the only significant predictor of pubic hypertrophy. Finally, pubic lipectomy was not associated with increased risk of fistula (OR: 1.12, p=0.7) or any complications (OR: 1.37, 95% CI: 0.64-2.88, p=0.4) after multivariable adjustment.
Conclusions: One out of three hypospadias patients, referred to our center, presented pubic hypertrophy and received pubic lipectomy. This rate was higher in patients with proximal hypospadias suggesting a correlation between pubic hypertrophy and sever­ity of hypospadias. Noteworthy, pubic lipectomy was not associated with increased risk of fistula or any complications.

Keywords: Lipectomy; Pediatrics; Hypospadias; Hypertrophy

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