Tubularized incised plate urethroplasty for proximal hypospadias

OBJECTIVES: Numerous surgical procedures have been used to correct distal hypospadias. Among them, the tubularized incised plate urethroplasty (Snodgrass procedure) has become a mainstay for the repair of distal hypospadias. We applied the procedure to proximal hypospadias. METHODS: Three patients with proximal hypospadias underwent a tubularized incised urethral plate urethroplasty. The location of the meatus was proximal penis in one, penoscrotal margin in one and scrotum in one. A perimeatal incision was made and the two paramedian incisions were extended to the tip of the glans. The skin of the penile shaft was dissected free to the penoscrotal junction and bands of fibrous tissue were excised until the corpus spongiosum proximal to the meatus was completely exposed inside the scrotum. The urethral plate was then incised in its midline from the tip of the glans to the hypospadiac meatus and was tubularized without tension. The neourethra was covered with a pedicle of subcutaneous tissue dissected from the dorsal skin or the scrotal skin to avoid fistula formation. RESULTS: The tubularized incised urethral plate urethroplasty was carried out successfully in one stage on three patients with proximal hypospadias. CONCLUSIONS: The Snodgrass procedure is suitable for correcting hypospadias in patients with a healthy urethral plate. It is also suitable in patients with proximal hypospadias.     

Tubularized incised plate urethroplasty for distal hypospadia,using overlapping dorsal subcutaneous flaps

This paper presents a newly developed simple procedure using overlapping vascularized dorsal dartos subcutaneous flaps to cover the neourethra after hypospadias correction. A 3-year old boy with distal hypospadias underwent the tubularized incised plate urethroplasty using this method. Postoperative complications, which include urethrocutaneous fistula, were not observed, but the glans did exhibit a vertical, slit-like meatus. Covering the neourethra with overlapping dorsal dartos flaps is expected to prevent the development of urethrocutaneous fistula in patients with distal hypospadias.     

Tubularized incised-plate urethroplasty for secondary hypospadias surgery

PURPOSE: Reoperation for failed hypospadias has been considered to be seriously bothersome because abundant penile skin does not tend to remain for urethroplasty or for penile shaft skin coverage. In this study, the tubularization of incised urethral plate was employed for those who had no excessive penile skin after failure of hypospadias repair. METHODS: Five patients with hypospadias underwent tubularized incised-plate urethroplasty as salvage surgery. The surgical techniques necessary for the performance of the reoperation were not different from those for the primary repair. The urethral plate was incised sufficiently deeply in its midline from the tip of the glans to the regressed meatus. The incised urethral plate was tubularized without tension over a catheter of an appropriate size. RESULTS: Four of those who underwent secondary tubularized incised-plate urethroplasty were successfully repaired without complications. A urethrocutaneous fistula occurred at the corona in the remaining patient. CONCLUSIONS: The absence of preputial skin in reoperative cases makes tubularized incised-plate urethroplasty the ideal option, although the series was small and postoperative duration is still short. In addition, this procedure can give excellent functional and cosmetic results even in patients who require revisional hypospadias surgery.     

Tubularized incised plate urethroplasty for hypospadias reoperations in 100 patients

Objectives To determine the key points for a successful redo hypospadias procedure using tubularized incised plate urethroplasty operation. Methods A retrospective chart review of a cohort of 100 patients (Mean age: 4.5 years, range: 2–12) who had undergone a redo tubularized incised plate urethroplasty operation was performed. Fischer exact and Chi square tests were used for statistical analysis. Results The incidence of complications of tubularized incised plate urethroplasty reoperation after failed repairs of meatal advancement and glanuloplasty procedure (n: 14), meatal based flap (n: 36), and tubularized incised plate urethroplasty (n: 50) were 29% (n: 4), 22% (n: 8) and, 28% (n: 14) respectively (P > 0.05). The overall complication rate was 26% (n: 26). Eighteen patients (18%) had fistula, five had meatal stenosis (5%), two had dehiscence (2%) and one had neourethral stenosis (1%). Postoperatively, fistula was closed in 18 patients and 5 underwent meatoplasty. Two patients with dehiscence and one with neourethral stenosis underwent an unsuccessful third redo tubularized incised plate urethroplasty reoperation and they were candidates for a complex hypospadias repair (3%). The ultimate success rate of tubularized incised plate urethroplasty reoperation after treatment of complications was 97%. Conclusion Tubularized incised plate urethroplasty is a safe and efficacious alternative procedure for hypospadias reoperations if the urethral plate has no scars and outcome is favourable if the first failed hypospadias repair is a meatal based flap procedure. The complication rate increases if the urethral plate has been previously incised in the midline and a redo third redo must be avoided.     

Tubularized incised plate urethroplasty: expanded use in primary and repeat surgery for hypospadias

PURPOSE: We evaluated the impact of tubularized incised plate urethroplasty on primary and repeat hypospadias repair. MATERIALS AND METHODS: We retrospectively reviewed the medical records of all boys who underwent hypospadias repair at our institution during a recent 3-year period. The level of the hypospadias defect, technique of repair, primary repair versus reoperation, age at surgery and complications were recorded. RESULTS: A total of 520 hypospadias repairs were done from May 1996 through June 1999. We began to perform tubularized incised plate urethroplasty in November 1996. During the ensuing consecutive 32 months 181 primary and 25 repeat hypospadias repairs were done using this technique. Mean patient age at surgery was 22 months (range 3 months to 30 years). During the 6 months immediately before we began to use this method the Mathieu flip-flap procedure was the most commonly performed technique, accounting for 38% of all hypospadias repairs. In contrast, during the last 6 months reviewed tubularized incised plate urethroplasty accounted for 63% of all repairs, including 41 of 65 primary operations (63%) and 4 of 6 reoperations (67%), while no Mathieu procedures were performed. Postoperative followup was 6 to 38 months for tubularized incised plate repair. Overall meatal stenosis and a urethrocutaneous fistula developed in 1 and 14 boys, respectively (7% complication rate). CONCLUSIONS: Tubularized incised plate urethroplasty has become the preferred technique of primary and repeat hypospadias repair at our institution. The technique has few complications as well as proved success and versatility that continues to expand its applicability and popularity.     

Effect of the depth and width of the urethral plate on tubularized incised plate urethroplasty

PURPOSE: We determined the effect of the depth and width of the urethral groove on tubularized incised plate urethroplasty for distal hypospadias. MATERIALS AND METHODS: We retrospectively reviewed the records of 48 patients who underwent tubularized incised plate urethroplasty for distal hypospadias between September 1996 and December 1998 for whom preoperative evaluation of the depth and width of the urethral groove was available. Patients were examined by an independent clinician a median of 28 months after surgery when the neourethra was calibrated and urinary stream assessed. RESULTS: Of the 48 patients 46 were available for clinical examination. The urinary stream was straight in 40 boys and angled in 8, while none sprayed. Urethral fistula developed in 6 patients with a urethral plate of less than 8 mm. wide (p = 0.001). The urethral groove was deep in 13 cases, moderate in 20 and shallow in 15. There were no differences among these 3 groups in regard to urinary stream direction or fistula rate. Of the boys with a shallow urethral groove 6 (40%) have a neourethral caliber of 6Fr or less versus 3 (15%) with a moderate and 0 with a deep groove. This difference was statistically significant (p = 0.028). Each patient in whom meatal stenosis developed had a shallow urethral groove. CONCLUSIONS: Urethral groove depth appears to influence neourethral caliber after tubularized incised plate urethroplasty. A shallow groove predisposes to a narrower neourethra and meatal stenosis subsequently. We observed no evidence that incising the urethral plate increases the final urethral diameter. Urethral fistula after tubularized incised plate urethroplasty was associated with an initially narrow urethral plate.     

Tubularized incised-plate urethroplasty for hypospadias reoperation

OBJECTIVE: To review our preliminary results of tubularized incised-plate (TIP) urethroplasty for reoperative hypospadias repair. PATIENTS AND METHODS: The study comprised 15 patients, of whom eight had undergone a previous repair by techniques that included incision into the midline of the urethral plate, while in the remaining seven the midline of the plate had been left undisturbed. The meatus at reoperation was subcoronal or on the distal shaft in all but one boy, who had a midshaft hypospadias. All had previously undergone one attempt at hypospadias repair, except for one patient presenting after two failed 'meatal advancement and glanuloplasty incorporated' procedures. The TIP repair was undertaken as described for primary surgery, except that the dorsal dartos flaps for interposition between the neourethra and skin closure were available less often. RESULTS: TIP resulted in a functional neourethra and a cosmetically normal meatus in 13 of the 15 patients. One boy healed with a slightly rounded meatus and the other had wound dehiscence; fistulae developed in another two boys, giving three patients with complications. The fistulae occurred in boys whose original surgery did not include urethral plate incision, while the dehiscence was in a patient with partial excision of the plate during previous tubularized preputial flap repair. CONCLUSIONS: TIP urethroplasty can potentially be used for hypospadias reoperation. Previous incision of the urethral plate was not a contraindication in these selected cases in which the plate appeared supple. However, TIP repair should be avoided in repeat hypospadias surgery if the plate has been resected or is obviously scarred.     

保留尿道板手术修复尿道下裂术后尿瘘

目的 总结保留尿道板手术修复尿道下裂术后尿瘘的l临床经验.方法 尿道下裂术后尿瘘患儿224例.患儿术后时间均>6个月,尿瘘瘘口直径>1.0 cm.应用尿道板切开卷管尿道成形术(Snodgrass)102例,年龄2～16岁,平均3.7岁;Duplay尿道成形手术86例,年龄2～14岁,平均3.5岁;Onlay岛状包皮瓣尿道成形术修复20例;尿道口基底皮瓣法(Flip-Flap)修复16例.结果 224例术后随访均≥6个月.Snodgrass手术102例,成功86例(84.3%),发生尿道狭窄3例,尿瘘复发13例;Duplay手术86例,成功75例(87.2%),发生尿道狭窄2例,尿瘘复发9例.2组手术疗效比较差异无统计学意义(P>0.05).Onlay手术20例,成功19例,尿瘘复发1例.Flip-Flap手术16例,成功14例,尿瘘复发2例.结论 尿道下裂术后尿瘘修补方法应根据患儿的具体条件选择.Snodgrass尿道成形术成功率与Duplay手术相当,可以更多应用,保证阴茎外观满意.     

Re-operative hypospadias repair using the Snodgrass incised plate urethroplasty

OBJECTIVE: To retrospectively assess the results of tubularized incised plate (Snodgrass) urethroplasty in a series of re-operative hypospadias repairs in children. PATIENTS AND METHODS: The study comprised a follow-up (from 1996 until 2000) of 13 patients (mean age 7.5 years, range 13 months to 27 years) who had at least one previous hypospadias repair and who then underwent a reconstruction using the Snodgrass repair. In all cases the urethroplasty was covered with an additional layer of subcutaneous tissue. The original location, associated complications and results were recorded. In some cases, the long-term follow up was conducted by telephone. RESULTS: Associated complications before the Snodgrass repair included urethral stricture in two, fistula in three and persistent chordee in one patient. The mean (range) follow-up was 22 (9-34) months. The cosmetic results were excellent, with two complications (one patient with a glans dehiscence and a urethrocutaneous fistula, and a second with meatal stenosis). The remaining patients required no further procedures and were voiding normally at the last follow-up. CONCLUSION: Excellent cosmetic and functional results can be obtained using the Snodgrass incised plate urethroplasty for re-operative hypospadias repair. Only one patient in this series had an initial operation in which the urethral plate was previously incised. Therefore, caution should be used when considering an incised plate urethroplasty in these patients.     

Tubularized-incised urethral plate urethroplasty: is regular dilatation necessary for success?

OBJECTIVES: To report the results of the tubularized-incised urethral plate repair of hypospadias. PATIENTS AND METHODS: Twenty-seven patients (mean age 8 years, range 6-18) had their hypospadias corrected using the tubularized-incised urethral plate technique. Five patients had glanular, 16 had coronal, and two had recurrent hypospadias after a failed Mathieu repair, and four patients required a second-stage repair. The urethral plate was incised in the midline and tubularized over a suitably sized stent. In patients who required second-stage repair a Thiersch-Duplay neourethra was constructed from the hypospadiac orifice to the corona and the glanular urethra was constructed by tubularization of the incised urethral plate. RESULTS: The functional and cosmetic results were excellent. Of the first seven patients, four had a small fistula associated with meatal stenosis. By regular dilatation of the glanular urethra, all fistulae resolved spontaneously. Dilatation was instituted in all the remaining patients and no fistula or meatal stenosis occurred. Other complications included haematoma formation in one patient, urinary tract infection in another and frequent bladder spasm in two. CONCLUSIONS: The tubularized-incised urethral plate urethroplasty is a simple and versatile technique that provides an excellent cosmetic appearance of the glans. It can be applied not only for the primary repair of distal hypospadias, but also for re-operation of recurrent hypospadias. The technique is ideal for constructing a glanular urethra when the Thiersch-Duplay operation is used to repair posterior hypospadias. Regular urethral dilatation is important in preventing adhesions between both sides of the incised plate, which can result in meatal stenosis and fistula.     

Tubularized incised plate repair: functional outcome after intermediate followup

PURPOSE: We describe the functional outcome following tubularized incised plate repair of hypospadias in toilet trained children after an intermediate followup. MATERIALS AND METHODS: Children were included in this study only if they were toilet trained and had flow rate data not less than 6 months after primary tubularized incised plate hypospadias repair or 2 months after any secondary procedure to correct complications. Uroflow data (peak flow, voided volume and post-void residuals) were analyzed and plotted on previously determined age-volume dependent nomograms. RESULTS: Of the 48 boys 39 required no secondary procedures, while 9 secondary fistula closures were performed in 2, meatotomy in 2 and dilation in 5. After either primary (26) or secondary (7) procedures 33 of the 48 patients (68.7%) had normal peak flow rate and 15 (31.3%) had low peak flow rate. Of the 48 patients 46 had post-void residual urine less than 10% of voided volume. CONCLUSIONS: Most children will void efficiently with no straining and no post-void residual (1/2) to 4 years after tubularized incised plate hypospadias repair. Of our patients 68.7% have normal peak flow rate. Intermediate followup of larger series and followup at puberty are recommended to resolve the debate concerning the long-term functional outcome of tubularized incised plate hypospadias repair.     

Treatment of proximal hypospadias with a tubularized island flap urethroplasty and the onlay technique: a comparative study

BACKGROUND/PURPOSE: The onlay island flap urethroplasty was first described in the repair of mid and distal penile hypospadias. Since then, this technique has been increasingly used in more severe cases of hypospadias, because of the complications of tubularized flaps, mainly megaurethra and proximal anastomotic strictures. The aim of this study was to compare the morbidity of these 2 techniques. METHODS: Between April 1994 and December 1998, 80 patients underwent surgical treatment for hypospadias. A tubularized island flap (Ducketttechnique) was performed in 42 cases, and the onlay island flap technique was used in 38 patients. The authors retrospectively compared the complication rate and type of these 2 procedures. RESULTS: Altogether, fistula was the most frequent complication without any significant difference between the 2 groups (21.4% for Duckett technique and 18.4% for onlay repair; P > .05). However, the anastomotic stricture was much more common in the tubularized flap group (7.14% v 2.63%; P < .05). Moreover, a megaurethra was found only in the Duckett technique group (4.7%). There was no case of chordee recurrence, but 6 patients (15.7%) treated with the onlay technique required urethrolysis including dissection of the chord behind the urethral plate, and in the other 3 patients of the same group (7.9%), a dorsal Nesbit plication also was necessary. In all these cases, the urethroplasty included an island cutaneous flap to provide ventral coverage to the neourethra. CONCLUSIONS: The authors conclude that both techniques present similar complications. However, proximal strictures and megaurethra are more common after the Duckett technique. This procedure is of choice in patients with scrotal hypospadias. Conversely, the onlay repair should be completed with other procedures (urethrolysis, dorsal Nesbit plication) to obtain good results in patients with severe degree of chordee.     

Tubularized incised-plate urethroplasty for proximal hypospadias

OBJECTIVE: To report the experience of one surgeon using tubularized incised-plate (TIP) urethroplasty to repair proximal hypospadias in a consecutive series of boys. PATIENTS AND METHODS: The records of 33 consecutive patients with midshaft to scrotal hypospadias undergoing TIP repair by one surgeon were reviewed. Dorsal plication was used as necessary for penile straightening, to preserve the urethral plate. Standard TIP urethroplasty was undertaken, and the follow-up included the selective use of neourethral calibration and urethroscopy. RESULTS: Plication was necessary in 18 (55%) patients. The incised plate had a supple appearance in all but two boys. The mean (range) follow-up was 9 (1-48) months and included calibration in 16 (48%) and urethroscopy in 13 (39%) patients. Complications were noted in 11 (33%) boys, of whom seven (21%) developed small fistulae. The two patients in whom the incised plate appeared unhealthy had dehiscence of the repair and contracture of the neourethra with recurrent penile curvature, respectively. There was one meatal stenosis and one short neourethral stricture. CONCLUSIONS: TIP urethroplasty can be used to repair proximal hypospadias in the absence of severe penile curvature, and if the incised urethral plate has a supple appearance. As with distal hypospadias repair, the procedure creates a normal-appearing penis with a slit-like meatus.     

One-stage repair of moderately severe hypospadias using a transverse preputial tubularized island flap

BACKGROUND: Transverse preputial tubularized island flap (TPTIF) urethroplasty has been used for the repair of moderately severe hypospadias since Duckett described the procedure in 1980. In spite of the excellent results reported by Duckett, subsequent studies showed high complication rates. A TPTIF procedure modified to reduce the complication rate is presented. METHODS: Between 1996 and 1997, 13 boys with moderately severe hypospadias were repaired with the TPTIF procedure. Patient age ranged from 10 months to 3 years with an average age of 23 months. To prevent urethrocutaneous fistula, the neourethra was constructed with a two-layer closure and the portion of anastomosis was wrapped between the native urethra and the neourethra with the tissue of the corpus spongiosum. RESULTS: The moderately severe hypospadias was repaired without complication in 12 of 13 patients. A urethrocutaneous fistula developed at the midshaft of the penis in one patient. No meatal stenosis, urethral stricture or diverticulum developed. CONCLUSION: Transverse preputial tubularized island flap urethroplasty provided excellent cosmetic and functional results for moderately severe hypospadias, and postoperative complications could be decreased by the two-layer closure of the neourethra and application of the wrapping technique of the proximal anastomosed portion with corpus spongiosum tissue.     

Tubularized incised plate urethroplasty for proximal hypospadias

OBJECTIVE: To review our experience of using the tubularized incised plate (TIP) urethroplasty (useful in the treatment of distal hypospadias) to treat proximal hypospadias. MATERIALS AND METHODS: From March 1997 to March 2000 primary repairs were carried out on 40 boys (mean age 4.5 years) with proximal hypospadias. After degloving the penile skin the meatus was at the mid-shaft in 10 boys, at the proximal penile shaft in 11, at the penoscrotal junction in 16, at the scrotum in two and at the perineum in one. The 21 patients with a mid or proximal shaft meatus were categorized as having mid-shaft and the other 19 as having posterior hypospadias. Tunica albuginea plication (TAP) was used to correct residual ventral curvature. The method of urethroplasty was adapted from that described by Snodgrass. The key step of the TIP repair is a midline incision of the urethral plate; a subcutaneous tissue flap dissected from the inner prepuce is used to cover the neourethra. An 8 or 10 F nasogastric tube is used as a urethral stent and removed 7 or 8 days after surgery. Follow-up endoscopy and urethral sounding were carried out in 17 of the patients aged < 6 years; the mean follow-up was 12.5 months. RESULTS: TAP was used to correct penile curvature in nine (23%) of the patients. Excluding stenosis, the TIP repair was successful in 20 (90%) of those with mid-shaft and in 16 of the 19 with posterior hypospadias; for all complications the respective rates were 19 of 22 and 15 of 19. The overall success rate was 88% for all 40 patients with proximal hypospadias; a urethrocutaneous fistula occurred in two of those with mid-shaft and three of those with posterior hypospadias. Urethral meatal stenosis occurred in four (12%) of the patients (two in each group); two were associated with a fistula and the other two had only mild meatal stenosis. The overall complication rate was 17.5% (three and four in the mid and the posterior hypospadias groups, respectively). The meatal stenosis was managed by simple dilatation in three and meatoplasty in one patient. Endoscopically, the mucosa of neourethra was pink and smooth in all 17 patients assessed. The calibre of all 17 neourethra was > or = 8 F and in 13 was > or = 10 F. CONCLUSION: TIP repair is a reliable method for treating both mid-shaft and posterior hypospadias.     

Radical bulbar dissection to correct severe chordee and proximal hypospadias

PURPOSE: We describe a technique of proximal hypospadias correction that involves freeing the proximal normal bulbar urethra from perineal attachments to lengthen the ventral penis and decrease chordee. MATERIALS AND METHODS: Correction was performed in 9 patients with a mean age of 11.5 months who had proximal hypospadias and severe chordee that was perineal in 2, mid scrotal in 6 and penoscrotal in 1. After the penis was degloved the bulbar urethra was detethered to or beyond the perineal body without lifting the urethra from the corpora cavernosa. Any remaining penile chordee was corrected and the urethral plate was transected only when chordee persisted. When the urethral plate was intact and the penis straight, tubularized incised plate urethroplasty was done to correct hypospadias in 1 stage. Otherwise 2-stage repair was performed. RESULTS: Using this maneuver penile straightening was achieved in 2 of the 9 patients, resulting in a glanular urethral or penoscrotal meatus. Dorsal plication sutures required in 4 cases resulted in a mid shaft and penoscrotal meatus in 1 and 3, respectively. Residual chordee in the remaining 3 patients necessitated division of the urethral plate and 2-stage repair despite aggressive mobilization of the proximal urethra. Simultaneous tubularized incised plate urethroplasty was then performed in the 4 penoscrotal and 1 mid shaft meatus. All 6 patients who underwent a successful 1-stage procedure have excellent cosmetic results, while 1 required meatotomy. No fistula or chordee was present at a mean of 13.8 months of followup (range 3.9 to 27.1). CONCLUSIONS: This safe, rapid technique may compensate for significant penile tethering and chordee in a subpopulation of patients with proximal hypospadias, such as 6 of the 9 in our study. It also allows successful tubularized incised plate urethroplasty to be done simultaneously.     

Tubularized incised plate for mid shaft and proximal hypospadias repair

PURPOSE: We report outcomes from tubularized incised plate repair of mid shaft and proximal hypospadias by a single surgeon. MATERIALS AND METHODS: Chart review of all patients undergoing mid shaft and proximal hypospadias was performed. Those with tubularized incised plate were divided into 2 groups for mid shaft and proximal repairs. Group 1 underwent single layer urethroplasty using chromic catgut suture, while group 2 underwent 2-layer polyglactin subepithelial closure. All patients had a dartos barrier flap, while spongioplasty was also done in group 2 when possible. RESULTS: A total of 30 patients underwent mid shaft repairs, while 35 had more proximal defects. Complication rates for mid shaft repairs did not differ between the 2 groups, and averaged 13%. However, complications in mid shaft vs proximal repairs (37%) were significantly different (p = 0.04). Overall complications (53% vs 25%) and incidence of fistulas (33% vs 10%) decreased in proximal repairs from group 1 to 2. CONCLUSIONS: Tubularized incised plate repair was applicable for all mid shaft hypospadias cases and for those more proximal cases when ventral curvature could be straightened without plate transection and the incised plate was grossly supple. Outcomes were improved using 2-layer subepithelial tubularization of the neourethra. Results of mid shaft vs proximal hypospadias repairs are significantly different and should be reported separately.     

Tubularized incised plate urethroplasty for distal and mid-penile hypospadias

Tubularized incised plate urethroplasty was performed to repair 20 distal and 5 mid-penile hypospadias cases. In distal hypospadias repair meatal stenosis occurred in 1 patient and urethral fistula in another. The overall complication rate in this group was thus 10%. Among midpenile hypospadias cases meatal stenosis was observed in 1 (20%) patient. As a conclusion, tubularized incised plate urethroplasty was found to be a successful method for treating distal hypospadias and encouraging results were obtained in mid-penile hypospadias cases.     

尿道板纵切卷管尿道成形术治疗尿道下裂

目的探讨尿道板纵切卷管尿道成形术（Snodgrass手术）治疗尿道下裂的临床效果。方法对采用尿道板纵切卷管尿道成形术治疗31例尿道下裂患者进行同颐性分析。,尿道下裂患者31例,年龄1～14岁,其中阴茎头型5例、阴茎体型14例、阴茎阴囊型4例,二期尿道成形术8例。结果本组31例患者,一次性治愈26例,术后出现尿瘘2例,均已修补成功。尿道口狭窄3例,经尿道扩张后治愈.结论尿道板纵切卷管尿道成形术可应用于多种类型的尿道下裂治疗。手术操作简便易行,手术成功率高。     

Tubularized incised plate urethroplasty: 5 years' experience

OBJECTIVE: To evaluate the results of tubularized incised plate (TIP) urethroplasty in a series of primary hypospadias repairs. PATIENTS AND METHOD: The medical records of 360 children (Mean age: 4.3 years, range: 2-14 years) with primary hypospadias undergoing TIP urethroplasty repair and treatment of complications were reviewed. A good result is a direct urinary steam through a slit and vertically oriented meatus and mild angled urinary stream through a slightly regressed meatus is a satisfactory result. RESULTS: The sum of good (74%) and satisfactory results (3%) was the overall success rate (77%) which was increased to 95% after a second surgical procedure for the treatment of complications. In 30 patients with single fistula (8%), fistula healed spontaneously in 2 patients and 20 patients had successful fistula closure. Redo TIP urethroplasty (n = 30) was performed for dehiscence (n = 15, 3%), neourethral stricture (n = 3, 1%) and multiple fistula with meatal stenosis (n = 12, 3%). The complication rate after redo TIP urethroplasty is 30%. Twenty-four (7%) patients underwent meatoplasty for meatal stenosis. CONCLUSION: TIP urethroplasty can be used to repair primary hypospadias. After a learning curve and attention to surgical details, cosmetic and functional outcome become excellent. Redo TIP urethroplasty can be performed in the treatment of complications.