{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T05:35:20Z","timestamp":1791956120167,"version":"4.3.4"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T00:00:00Z","timestamp":1725580800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias. We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) between October 2012 and October 2022. In total, 31 patients underwent the conventional Byars procedure (conventional group), and 45 patients underwent the modified Byars staged procedure (modified group). Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage. Notably, there were no statistically significant differences in the preoperative baseline characteristics, duration of surgery, amount of blood loss, or occurrence of postoperative complications, including urethral fistula, stricture and diverticulum, or penile curvature, between the conventional and modified groups. However, there was a significantly lower incidence of coronal sulcus fistula (0\n                    <jats:italic toggle=\"yes\">vs<\/jats:italic>\n                    16.1%,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.02) and glans dehiscence (0\n                    <jats:italic toggle=\"yes\">vs<\/jats:italic>\n                    12.9%,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.02) in the surgical group than that in the conventional group. In addition, the modified group exhibited a notably greater rate of normotopic urethral opening (100.0%\n                    <jats:italic toggle=\"yes\">vs<\/jats:italic>\n                    83.9%,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.01) and a higher mean score on the Hypospadias Objective Penile Evaluation (HOPE; mean \u00b1 standard error of mean: 8.6 \u00b1 0.2\n                    <jats:italic toggle=\"yes\">vs<\/jats:italic>\n                    7.9 \u00b1 0.3,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.02) than did the conventional group. In conclusion, the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula. Consequently, it offers a promising approach for achieving favorable penile esthetics, thereby providing a reliable therapeutic option for severe hypospadias.\n                  <\/jats:p>","DOI":"10.4103\/aja202470","type":"journal-article","created":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T03:00:07Z","timestamp":1725591607000},"page":"65-71","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Application of the modified Byars staged procedure for severe hypospadias repair"],"prefix":"10.4103","volume":"27","author":[{"given":"Qi-Gen","family":"Xie","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting-Ting","family":"Xue","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Guangzhou Women and Children\u2019s Medical Center, Guangzhou Medical University, Guangzhou 510620, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu-Ren","family":"Chen","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Center, The Key Laboratory for Reproductive Medicine of Guangdong Province, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhao-Ying","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhe","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuo-Qing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Luo","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Center, The Key Laboratory for Reproductive Medicine of Guangdong Province, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,9,6]]},"reference":[{"key":"R1-20250304","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1289\/ehp.011091175","article-title":"Hypospadias and endocrine disruption:is there a connection?","volume":"109","author":"Baskin","year":"2001","journal-title":"Environ Health Perspect"},{"key":"R2-20250304","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.jpurol.2011.08.011","article-title":"A standardized classification of hypospadias","volume":"8","author":"Orkiszewski","year":"2012","journal-title":"J Pediatr Urol"},{"key":"R3-20250304","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1007\/s00431-017-2864-5","article-title":"Hypospadias, all there is to know","volume":"176","author":"van der Horst","year":"2017","journal-title":"Eur J Pediatr"},{"key":"R4-20250304","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.jpurol.2017.03.024","article-title":"Current challenges with proximal hypospadias:we have a long way to go","volume":"13","author":"Gong","year":"2017","journal-title":"J Pediatr Urol"},{"key":"R5-20250304","doi-asserted-by":"crossref","first-page":"354.e1","DOI":"10.1016\/j.jpurol.2017.05.017","article-title":"Early versus late-presenting urethroplasty complications after hypospadias repair:a retrospective analysis of patient follow-up","volume":"13","author":"Faasse","year":"2017","journal-title":"J Pediatr Urol"},{"key":"R6-20250304","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1111\/bju.13771","article-title":"Late surgical correction of hypospadias increases the risk of complications:a series of 501 consecutive patients","volume":"119","author":"Garnier","year":"2017","journal-title":"BJU Int"},{"key":"R7-20250304","doi-asserted-by":"crossref","first-page":"158","DOI":"10.4103\/0971-9261.207627","article-title":"Two stages repair of proximal hypospadias:review of 700 cases","volume":"22","author":"Shukla","year":"2017","journal-title":"J Indian Assoc Pediatr Surg"},{"key":"R8-20250304","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/s00345-021-03829-9","article-title":"Single-stage versus staged interposition urethroplasty for glandular hypospadias with severe penile curvature:15-year experience","volume":"40","author":"Zhou","year":"2022","journal-title":"World J Urol"},{"key":"R9-20250304","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1016\/j.jpurol.2014.05.002","article-title":"Byars two-stage procedure for hypospadias after urethral plate transection","volume":"10","author":"Yang","year":"2014","journal-title":"J Pediatr Urol"},{"key":"R10-20250304","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1038\/nrurol.2013.164","article-title":"Failed hypospadias in paediatric patients","volume":"10","author":"Cimador","year":"2013","journal-title":"Nat Rev Urol"},{"key":"R11-20250304","doi-asserted-by":"crossref","first-page":"237","DOI":"10.5152\/tud.2020.20323","article-title":"Risk factors for fistula recurrence after urethrocutaneous fistulectomy in children with hypospadias","volume":"47","author":"Abdullaev","year":"2021","journal-title":"Turk J Urol"},{"key":"R12-20250304","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/j.bjps.2004.12.026","article-title":"Hypospadias repair:Byar's two stage operation revisited","volume":"58","author":"Arshad","year":"2005","journal-title":"Br J Plast Surg"},{"key":"R13-20250304","first-page":"239","article-title":"Morphology of hypospadias","volume":"14","author":"Avell\u00e1n","year":"1980","journal-title":"J Pediatr Urol"},{"key":"R14-20250304","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/j.jpurol.2013.01.015","article-title":"Introducing the HOPE (Hypospadias Objective Penile Evaluation)-score:a validation study of an objective scoring system for evaluating cosmetic appearance in hypospadias patients","volume":"9","author":"van der Toorn","year":"2013","journal-title":"J Pediatr Urol"},{"key":"R15-20250304","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1177\/0009922816684613","article-title":"What is hypospadias?","volume":"56","author":"Baskin","year":"2017","journal-title":"Clin Pediatr (Phila)"},{"key":"R16-20250304","first-page":"e27544","article-title":"Hypospadias:a comprehensive review including its embryology, etiology and surgical techniques","volume":"14","author":"Halaseh","year":"2022","journal-title":"Cureus"},{"key":"R17-20250304","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.jpurol.2009.12.005","article-title":"Long-term outcome of severe hypospadias","volume":"6","author":"Aulagne","year":"2010","journal-title":"J Pediatr Urol"},{"key":"R18-20250304","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s11255-010-9775-y","article-title":"Long-term outcome of penile appearance and sexual function after hypospadias repairs:situation and relation","volume":"43","author":"Jiao","year":"2011","journal-title":"Int Urol Nephrol"},{"key":"R19-20250304","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1002\/j.1939-4640.2005.tb01078.x","article-title":"Hypospadias:psychosocial, sexual, and reproductive consequences in adult life","volume":"26","author":"Mieusset","year":"2005","journal-title":"J Androl"},{"key":"R20-20250304","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.1016\/j.jsxm.2020.04.002","article-title":"Psychosexual outcome, sexual function, and long-term satisfaction of adolescent and young adult men after childhood hypospadias repair","volume":"17","author":"Tack","year":"2020","journal-title":"J Sex Med"},{"key":"R21-20250304","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.eururo.2006.01.002","article-title":"The two-stage repair for severe primary hypospadias","volume":"50","author":"Johal","year":"2006","journal-title":"Eur Urol"},{"key":"R22-20250304","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1111\/j.1464-410X.2012.11783.x","article-title":"Quantitative measurement of the androgen receptor in prepuces of boys with and without hypospadias","volume":"112","author":"Baskin","year":"2013","journal-title":"BJU Int"},{"key":"R23-20250304","first-page":"110","article-title":"Expression of androgen, estrogen, and progesterone hormone receptors in the penile tissues of children with different types of hypospadias","volume":"6","author":"Celayir","year":"2019","journal-title":"North Clin Istanb"},{"key":"R24-20250304","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.jpurol.2016.07.018","article-title":"Preputial reconstruction in hypospadias repair","volume":"13","author":"Castagnetti","year":"2017","journal-title":"J Pediatr Urol"},{"key":"R25-20250304","doi-asserted-by":"crossref","first-page":"226","DOI":"10.4103\/0970-1591.40620","article-title":"Two-stage repair in hypospadias","volume":"24","author":"Haxhirexha","year":"2008","journal-title":"Indian J Urol"},{"key":"R26-20250304","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1016\/S0039-6109(16)33135-8","article-title":"Surgical repair of hypospadias","volume":"30","author":"Byars","year":"1950","journal-title":"Surg Clin North Am"},{"key":"R27-20250304","doi-asserted-by":"crossref","first-page":"211","DOI":"10.3892\/etm.2023.11910","article-title":"Current perspectives in hypospadias research:a scoping review of articles published in 2021 (review)","volume":"25","author":"Gozar","year":"2023","journal-title":"Exp Ther Med"},{"key":"R28-20250304","doi-asserted-by":"crossref","first-page":"229","DOI":"10.5152\/tud.2021.20421","article-title":"Choosing an ideal second layer cover in snodgrass repair for various types of hypospadias","volume":"47","author":"Sengol","year":"2021","journal-title":"Turk J Urol"},{"key":"R29-20250304","first-page":"e9108","article-title":"The success level of hypospadias repair in adults","volume":"12","author":"Ullah","year":"2020","journal-title":"Cureus"},{"key":"R30-20250304","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1186\/s12887-023-04339-w","article-title":"Risk factors for postoperative complications following one-stage proximal hypospadias repair involving the disconnection of the urethral plate:a retrospective study","volume":"23","author":"Hu","year":"2023","journal-title":"BMC Pediatr"},{"key":"R31-20250304","doi-asserted-by":"crossref","first-page":"311","DOI":"10.4103\/aja202163","article-title":"Application of the Mathieu combined tunnel technique for repairing glans dehiscence after failed hypospadias repair","volume":"24","author":"Xie","year":"2022","journal-title":"Asian J Androl"}],"container-title":["Asian Journal of Andrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aja202470","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:34:37Z","timestamp":1787772877000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aja202470"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,6]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/aja202470","relation":{},"ISSN":["1745-7262","1008-682X"],"issn-type":[{"value":"1745-7262","type":"print"},{"value":"1008-682X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,6]]},"assertion":[{"value":"2024-01-22","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-01","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}