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This study assessed the clinical impact of mindfulness meditation training combined with probiotics on children with hypospadias. A total of 126 children with hypospadias undergoing treatment in Capital Center For Children's Health, Capital Medical University from December 2021 to December 2023 were recruited as the study participants. They were randomly divided into a control group (CG) and a research group (RG) using a random number table method, with 63 in each group. Both groups received psychological nursing based on mindfulness meditation training and early enteral nutrition (EN) support. In contrast, the RG added Bifidobacterium tetravalent live bacteria capsules to enhance nutritional intervention for patients. The results showed that probiotics ameliorated intestinal microecology, enhanced intestinal mucosal barrier function, accelerated gastrointestinal function recovery, elevated nutritional status and mitigated anxiety level. We conclude that psychological nursing based on mindfulness meditation training combined with probiotics can improve gastrointestinal function recovery, strengthen nutritional status, and alleviate negative emotions in children with hypospadias. Cette étude a évalué l'impact clinique d'un entraînement à la méditation de pleine conscience associé à des probiotiques chez des enfants atteints d'hypospadias. Au total, 126 enfants atteints d'hypospadias, traités à l'Institut de pédiatrie de Centre de santé infantile de la capitale, Université médicale de la capitale entre décembre 2021 et décembre 2023, ont été recrutés comme participants à l'étude. Ils ont été répartis aléatoirement en un groupe témoin (GT) et un groupe de recherche (GR) selon la méthode des tables de nombres aléatoires, avec 63 personnes dans chaque groupe. Les deux groupes ont bénéficié d'un suivi psychologique basé sur un entraînement à la méditation de pleine conscience et un soutien à la nutrition entérale précoce (NE). En revanche, le GR a ajouté des capsules de bactéries vivantes tétravalentes Bifidobacterium afin d'améliorer l'intervention nutritionnelle des patients. Les résultats ont montré que les probiotiques amélioraient la microécologie intestinale, renforçaient la fonction de barrière muqueuse intestinale, accéléraient la récupération de la fonction gastro-intestinale, amélioraient l'état nutritionnel et atténuaient le niveau d'anxiété. Nous concluons que le suivi psychologique basé sur un entraînement à la méditation de pleine conscience associé à des probiotiques peut améliorer la récupération de la fonction gastro-intestinale, renforcer l'état nutritionnel et atténuer les émotions négatives chez les enfants atteints d'hypospadias.

Retaining a dressing on the phallus has always been difficult. Newer and innovative techniques are coming up in this regard. One such method is suggested which we find extremely useful. Advantages of this dressing are easy application, stability for long time, and easy and painless removal. Our dressing named as \"Shukla dressing\" is simple, cheap, easily available, and provides comfort to the patient as well as surgeon and caring nursing staff.

IntroductionCaudal block is frequently performed to provide analgesia for hypospadias repair. Literature suggests that pudendal block provides prolonged postoperative analgesia as compared with caudal block in children between 2 and 5 years. We compared the efficacy of pudendal and caudal blocks in children less than 2 years.Methods60 children scheduled for hypospadias repair received standard general anesthesia along with either pudendal or caudal block (groups of 30 each). Variables collected were demographic data, block time, operating room time, intraoperative pain medication need, pain assessment score and medication need in the recovery room and pain assessment at home.ResultGroups were demographically similar. No differences were observed in the following recorded times (minutes): block procedure (caudal: 9.5±4.0, pudendal: 10.6±4.1, p=0.30), anesthesia (caudal: 17.3±5.3, pudendal: 17.7±4.3, p=0.75), total OR (caudal: 171±35, pudendal: 172±41; p=0.95) and postanesthesia care unit (PACU) stay (caudal: 88±37, pudendal: 86±42; p=0.80). Additionally, no differences were observed in rescue pain medication need in the operating room (caudal: 0, pudendal: 2 (p=0.49), in PACU (caudal: 4, pudendal: 4, p=0.99), pain assessed at home, time to pain level 2 (caudal: 13.93±8.9, pudendal: 15.17±8.7), average pain scores (p=0.67) and total pain free epochs (pain level of zero) (p=0.80) in the first 24 hours.DiscussionIn children less than 2 years, both blocks provide comparable intraoperative and postoperative pain relief in the first 24 hours after hypospadias surgery.Trial registration number NCT03145415.

Background Hypospadias is a common congenital malformation. The prevalence of hypospadias has a large geographical variation, and recent studies have reported both increasing and decreasing temporal trends. It is unclear whether hypospadias prevalence is associated with maternal age. Aim To analyze the prevalence and trends of total hypospadias, isolated hypospadias, hypospadias with multiple congenital anomalies, hypospadias with a known cause, and hypospadias severity subtypes in Europe over a 10-year period and to investigate whether maternal age is associated with hypospadias. Methods We included all children with hypospadias born from 2001 to 2010 who were registered in 23 EUROCAT registries. Information on the total number of births and maternal age distribution for the registry population was also provided. We analyzed the total prevalence of hypospadias and relative risks by maternal age. Results From 2001 to 2010, 10,929 hypospadias cases were registered in 5,871,855 births, yielding a total prevalence of 18.61 per 10,000 births. Prevalence varied considerably between different registries, probably due to differences in ascertainment of hypospadias cases. No significant temporal trends were observed with the exceptions of an increasing trend for anterior and posterior hypospadias and a decreasing trend for unspecified hypospadias. After adjusting for registry effects, maternal age was not significantly associated with hypospadias. Conclusions Total hypospadias prevalence was stable in 23 EUROCAT registries from 2001 to 2010 and was not significantly influenced by maternal age.

IntroductionProximal hypospadias associated with severe chordee represents a major surgical challenge and the debate over its optimal treatment is ongoing. The objective of this study is to compare the outcome of two-stage Bracka and Byar’s repair in proximal hypospadias.Materials and methodsThis study was conducted from January 2013 to February 2018 in a tertiary care centre. Patients of hypospadias with severe chordee who required urethral plate transection were included in the study. Patients were randomly divided into two groups by simple randomization method. Bracka staged repair was done in Group A and Byar’s staged repair in Group B. Postoperatively complications including graft loss, flap necrosis, fistula formation, meatal stenosis, stricture, diverticula formation, residual chordee were noted in both the groups and compared. p value of < 0.05 was considered statistically significant.ResultsOver a period of 5 years, 74 patients in group A and 68 patients in group B were operated. Fistula occurred in 6.8% and 10.2% in group A and group B, respectively (p value 0.629). Meatal stenosis was seen in 4% in group A and 3% in group B (p value 0.731). Stricture was seen in 1% in each group (p value 0.339). Diverticula formation was seen in 2% in group B and none of the patient in group A (p value 0.960). None of the patient had recurrence of chordee in either group.ConclusionBracka and Byar’s two-stage repair have similar postoperative outcome and the choice between the two depends up on the surgeon’s choice and experience rather than scientific evidence.

Androgen signaling is critical for male sex differentiation and proper penile development. Disruption of this pathway results in congenital malformations of the male external genitalia, such as hypospadias. Hypospadias is a malformation of the penis, where the urethral opening is located along the ventral shaft rather than the tip. Although the molecular link between androgen signaling, penile differentiation, and proper urethra closure has been established for over 70 years, most hypospadias cases do not have a defined etiology. To clarify how the androgen receptor contributes to human hypospadias, we conducted a quantitative meta-analysis comparing androgen receptor expression in hypospadias patients and healthy boys. Due to substantial heterogeneity and imprecision in both mRNA and protein assays, no consistent direction of androgen receptor expression could be demonstrated, suggesting that hypospadias etiology may be more complicated than just the sole expression of the androgen receptor. To contextualize these results, we complemented the meta-analysis with a mini-review summarizing the various mechanisms through which androgen receptors can be regulated in the developing penis. This review aims to provide a framework for future investigations of androgen signaling and urethral closure mechanisms during penile development.

Background This study aimed to evaluate the effects of caudal block anesthesia with hydromorphone-ropivacaine compared to ropivacaine alone on postoperative immune function and pain management in children undergoing hypospadias surgery. Methods A total of 100 pediatric patients were randomly assigned to two groups: the Hydromorphone-Ropivacaine (HR) group and the Ropivacaine (R) group for caudal block anesthesia, with 50 patients in each group. The R group received 0.25% ropivacaine at a dose of 1 ml/kg, while the HR group received 0.25% ropivacaine (1 ml/kg) combined with hydromorphone (10 µg/kg). The maximum dose for both groups was capped at 30 ml (1 ml/kg). Anesthesia induction included intravenous administration of pentobarbital (0.01 mg/kg) and dexamethasone (0.15 mg/kg), followed by sevoflurane inhalation. All patients underwent ultrasound-guided caudal block anesthesia administered by the same anesthetist. Primary outcomes included the distribution of T lymphocyte subsets (CD3+, CD4+, CD8+, and CD4+/CD8 + ratios) measured at five time points: pre-anesthesia (T0), end of surgery (T1), 24 h postoperatively (T2), 48 h postoperatively (T3), and 72 h postoperatively (T4). Secondary outcomes included postoperative pain scores assessed using the Modified Children’s Hospital of Eastern Ontario Pain Scale (M-CHEOPS) at 1, 6, 12, 18, and 24 h postoperatively, sedation levels evaluated using the Ramsay sedation scale at the same time points, and the incidence of postoperative adverse events. Results The HR group exhibited significant reductions in CD3 + , CD4 + , and CD4 + /CD8 + ratios at T1, T2, and T3 compared to baseline (T0) ( p  < 0.001). At all postoperative time points (T1, T2, T3, T4), the HR group demonstrated significantly higher levels of CD3 + , CD4 + , and CD4 + /CD8 + ratios compared to the R group ( p  < 0.001). By T4 (72 h postoperatively), immune markers in the HR group had largely normalized to baseline levels, whereas those in the R group remained significantly lower ( p  < 0.001). Postoperative pain, assessed using the Modified Children’s Hospital of Eastern Ontario Pain Scale (M-CHEOPS), was significantly lower in the HR group at 6, 12, and 18 h postoperatively compared to the R group ( p  < 0.001). The HR group also exhibited a longer duration of analgesia and required fewer doses of rescue analgesia within the first 24 h postoperatively ( p  = 0.046). Sedation levels, evaluated using the Ramsay sedation scale, showed significant differences between the groups at 1 h ( p  = 0.0087) and 6 h ( p  < 0.0001) postoperatively, with higher sedation scores observed in the HR group. There were no significant differences in heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, or oxygen saturation between the groups at any time point ( p  > 0.05). No significant differences were observed between the two groups in terms of postoperative adverse reactions (all p  > 0.05). Conclusion Caudal block anesthesia with hydromorphone-ropivacaine offers enhanced postoperative pain relief and a lesser impact on immune function compared to ropivacaine alone in children undergoing hypospadias surgery. Further studies are warranted to explore the long-term effects on immune function.

PurposeWe conducted this study, comparing the outcomes among Transverse Onlay Island Flap, inlay grafted incised plate and our previous records of tubularized incised plate urethroplasty (TIPU) in patients with narrow urethral plates, aiming to determine which method of repair provides a good outcome.MethodsThis hybrid study included two datasets. The first from a prospective randomized study evaluating outcomes of two treatment modalities; Inlay graft and only flap for distal hypospadias with shallow urethral plate with 80 patients (40 patients in each group) included, the second based on our previous records of TIPU in 40 patients with distal primary hypospadias with narrow urethral plate.ResultsThe success rate in inlay graft urethroplasty group (n = 40) was 87.5%; glandular dehiscence occurred in one case (2.5%), fistulas occurred in 2 cases (5%), and narrow meatus occurred in two cases (5%). Success rate in onlay flap urethroplasty group (n = 40) was 82.5%; glandular dehiscence occurred in two cases (5%), fistulas occurred in two cases (5%), and narrow meatus occurred in three cases (7.5%). TIPU group (n = 40) had success rate of 62.5%; glandular dehiscence occurred in eight cases (20%), fistulas occurred in five cases (12.5%), and narrow meatus occurred in seven cases (17.5%), with five cases exhibiting both narrow meatus with fistula.ConclusionInlay graft and onlay flap urethroplasty for repair of distal penile hypospadias with narrow urethral plate had higher success rate and fewer complications than traditional TIPU. Moreover, operative time was shorter in TIPU.

Background: Hypospadias is a common congenital condition in male infants, characterised by incomplete development of the underside of the penile shaft. Genetic factors play a major role in its development. Therefore, studying genetic contributions, especially in familial cases, can enhance our understanding of disease causes and guide targeted interventions. Materials and Methods: Through a structured biobank for hypospadias, we collected blood samples from individuals with familial hypospadias and their relatives. Whole-genome sequencing (WGS) was performed on 27 individuals across seven families to identify potential genetic causes. Bioinformatics analysis, including the GEMINI tool, was used to assess inheritance patterns of single-nucleotide variants (SNVs) within families and identify potential causative SNVs. Results: We identified three likely pathogenic variants in genes not previously associated with hypospadias in EIF2B5, INO80, and ACADVL genes, in three index patients. These variants co-segregated with the condition within the families. Additionally, we detected variants of uncertain significance in hypospadias-related gene families (DNAH12 and LHFP) and in other genes, such as COL6A3, which may cause the phenotype. No potential causative variants were found in two of the seven studied families, indicating the need for further analysis, including the assessment of copy number variants (CNVs). Functional studies will be crucial to establish the role of the identified variants in the development of hypospadias. Conclusions: This study underscores the importance of disease biobanking and genetic analysis in identifying potential underlying causes of congenital conditions, such as hypospadias. The identified variants provide new opportunities for functional research and may enhance our understanding of hypospadias pathophysiology. These findings broaden the genetic landscape of hypospadias and lay the groundwork for functional validation, improved risk assessment, and personalised medicine strategies.