Tubularized incised plate urethroplasty with dorsal inlay graft for hypospadias repair in pediatric age: long-term outcomes

Surgical technique for midshaft hypospadias has evolved since the time of Horton and Devine. The most common type of repair that is currently used is the tubularized incised plate urethroplasty, which is a modification of the Thiersch-Duplay hypospadias repair. The authors review the steps of this procedure in detail and discuss troubleshooting for issues that may arise during the repair. Alternatives for chordee correction and skin coverage are reviewed. The authors briefly discuss outcomes and possible complications. In addition, there is a step-by-step video of a midshaft hypospadias repair that highlights the surgical technique. This review contains 9 figures, and 23 references. Key Words: chordee, dartos flap, hypospadias, midshaft hypospadias, surgical technique, tubularized incised plate (TIP), urethrocutaneous fistula, ventral curvature

Download Full-text

Histological and Biochemical Evaluation of Urethral Scar following Three Different Hypospadias Repairs: An Experimental Study in Rabbits

European Journal of Pediatric Surgery ◽

10.1055/s-0037-1605347 ◽

2017 ◽

Vol 28 (05) ◽

pp. 420-425 ◽

Cited By ~ 1

Author(s):

Xiao-Hui Tan ◽

Chun-Lan Long ◽

De-Ying Zhang ◽

Tao Lin ◽

Da-Wei He ◽

...

Keyword(s):

Transforming Growth Factor ◽

Smooth Muscle Actin ◽

White Male ◽

Transforming Growth Factor Β1 ◽

Rational Approach ◽

Hypospadias Repair ◽

Tubularized Incised Plate ◽

Biochemical Evaluation ◽

Tubularized Incised Plate Urethroplasty ◽

Tgf Β1

Introduction Several urethroplasties have been employed in the surgical treatment of hypospadias. Neourethral strictures are among the most common postoperative complications that often require reoperation. Materials and Methods We created a hypospadias model in New Zealand white male rabbits through a hypospadias-like defect and acute repair. A total of 24 animals were randomly allocated into three groups: tubularized incised-plate urethroplasty (TIPU) group (8), perimeatal-based flap urethroplasty (Mathieu) group (8), onlay island flap urethroplasty (onlay) group (8), and corresponding surgical procedures were immediately performed to reconstruct neourethra. The rabbits were killed postoperatively at 5 days, 2 weeks, 6 weeks, and 3 months, respectively. The penile tissue was harvested for histological and biochemical investigations to evaluate the expressions of transforming growth factor β1 (TGF-β1) and α-smooth muscle actin (α-SMactin) in all groups. Results All rabbits were operated on uneventfully. The amount of collagen content was increased in the Mathieu and onlay groups than in the TIPU group (p < 0.05). Biochemical analysis showed that the expression of TGF-β1 in the TIPU group was decreased compared with the two other groups at 2 or 6 weeks postoperatively (p < 0.01). The expression pattern regarding α-SMactin was similar at 6 weeks or 3 months postoperatively (p < 0.01). Conclusion The neourethra repaired by TIPU was practically resumed to normal anatomy and scarring was less apparent than the two other groups. Therefore, TIPU is considered as a relatively rational approach for hypospadias repair. The activity of fibroblasts has been increased in the long term, which may be the pathogenesis of neourethral stricture following hypospadias repair.

Download Full-text

The role of one-stage buccal mucosal graft urethroplasty for secondary anterior urethral strictures following failed primary hypospadias repair: Long-term outcomes from a high volume referral center

European Urology Open Science ◽

10.1016/s2666-1683(20)32799-3 ◽

2020 ◽

Vol 19 ◽

pp. e364 ◽

Cited By ~ 1

Author(s):

M.W. Vetterlein ◽

J. Stahlberg ◽

O. Bahassan ◽

O. Engel ◽

R. Dahlem ◽

...

Keyword(s):

High Volume ◽

Hypospadias Repair ◽

Long Term Outcomes ◽

Referral Center ◽

One Stage ◽

Urethral Strictures ◽

Buccal Mucosal Graft

Download Full-text

Redo hypospadias repair by a single surgeon after failed hypospadias surgeries: Experience from a developing country

10.36811/gju.2020.110010 ◽

2020 ◽

pp. 17-23

Author(s):

Md. Abdullah Al Farooq ◽

MA Mushfiqur Rahman ◽

Tanvir Kabir Chowdhury

Keyword(s):

Developing Country ◽

Complication Rate ◽

Hypospadias Repair ◽

Urethral Plate ◽

Meatal Stenosis ◽

Tubularized Incised Plate ◽

Tubularized Incised Plate Urethroplasty ◽

Principal Author

Background: Hypospadias surgeries are often complicated with fistulas, meatal stenosis and disruptions. We report our series of redo surgeries for failed primary repairs. Methods: We prospectively observed all the redo hypospadias repairs done by the principal author between 2013 and 2017. Thiersch-Duplayurethroplasty was done if the urethral plate was adequately wide and intact; tubularized incised plate (TIP) urethroplasty was performed if the urethral plate was intact but, narrower than 8 mm; 2 stage procedures were done with oral mucosal graft (OMG) if the urethral plate was deficient or scarred with significant chordee. Result: There was a total of 31 patients. Age ranged from 18 months to 15 years (mean 8.05 ±4.27 years). Sixteen (51.61%) patients underwent only one surgery, 10 (32.26%) patients underwent 2 surgeries, 2 patients (6.45%) underwent 3 surgeries, and 3 patients (9.68%) underwent 4 surgeries prior to presenting to us before our redo surgeries.We had performed TIP urethroplasty in 16 (51.61%) patients, meatal based flap urethroplasty in 12 (38.71%), OMG followed by urethroplasty in 2 (6.45%), and repair of urethra-cutaneous (UC) fistula in 1 (3.23%) patient. Ten (32.26%) Complications occurred in 8 (25.80%) patients. Unsuccessful repair was noted in 03 (9.67%) patients (UC fistula 1, glans dehiscence with UC fistula 1, and glans dehiscence 1). Conclusion: Thiersch-Duplay and TIP repair can be successfully performed in redo hypospadiassurgeries with acceptable complication rate. OMG graft can be reserved for cases with gross scarring of the urethral plate. Keywords: Failed hypospadias repair; Tubularized incised plate urethroplasty; Thiersch-Duplay; Outcome

Download Full-text

Modified tubularized incised plate urethroplasty in distal hypospadias repair: Stepwise technique with validated functional and cosmetic outcome

Journal of Pediatric Urology ◽

10.1016/j.jpurol.2016.09.014 ◽

2017 ◽

Vol 13 (1) ◽

pp. 86-87 ◽

Cited By ~ 2

Author(s):

A.-F. Spinoit ◽

A. Radford ◽

J. Ashraf ◽

M. Gopal ◽

R. Subramaniam

Keyword(s):

Cosmetic Outcome ◽

Hypospadias Repair ◽

Tubularized Incised Plate ◽

Tubularized Incised Plate Urethroplasty ◽

Distal Hypospadias

Download Full-text

731 Tubularized incised plate urethroplasty in hypospadias repair

European Urology Supplements ◽

10.1016/s1569-9056(04)90725-7 ◽

2004 ◽

Vol 3 (2) ◽

pp. 185

Author(s):

E. Erkan ◽

U. Ozkuvanci ◽

H. Rodoplu ◽

Y. Berberoglu ◽

A.Y. Muslumanoglu

Keyword(s):

Hypospadias Repair ◽

Tubularized Incised Plate ◽

Tubularized Incised Plate Urethroplasty

Download Full-text

Hypospadias in toddlers: a multivariable study of prognostic factors in distal to mid-shaft hypospadias and review of literature

World Journal of Pediatric Surgery ◽

10.1136/wjps-2020-000225 ◽

2022 ◽

Vol 5 (1) ◽

pp. e000225

Author(s):

M Reza Roshandel ◽

Tannaz Aghaei Badr ◽

Fahimeh Kazemi Rashed ◽

Samantha Salomon ◽

Seyyed Mohammad Ghahestani ◽

...

Keyword(s):

Prognostic Factors ◽

Fistula Formation ◽

Hypospadias Repair ◽

Urethral Plate ◽

Factors Affecting ◽

Tubularized Incised Plate ◽

Multivariable Regression ◽

Tubularized Incised Plate Urethroplasty ◽

Predicting Factor ◽

Hypospadias Surgery

BackgroundTubularized incised plate urethroplasty is the most common hypospadias repair technique. However, there are unanswered questions and debates about the anatomical prognostic factors affecting the repair outcomes. This study tried to address some of the problems in the studies compromising the results of the current body of literature.MethodsA prospective cohort of 101 males aged 1–3 years undergoing primary distal to mid-shaft hypospadias repair were enrolled in the study. Complications including edema, erection, inadvertent removal of the urethral stent, surgical wound infection, bladder spasm, hematoma, and hemorrhage were evaluated. Studies in the current literature were reviewed to achieve a better perspective for future investigations.ResultsPersistent complications were found in 16 cases (15.8%) including fistula formation, the persistence of chordee, meatal stenosis, glans, and urethral dehiscence. The mean follow-up time was 6.6±3.4 months. In the single-variable analysis, the meatal location, the length and width of the urethral plate, and the reversible acute postoperative events were significantly associated with the complications. Furthermore, fistula formation was associated with acute surgical site infection (p<0.001). However, the multivariable regression study revealed the presurgical meatal location to be the only statistically significant factor (p=0.03). Notably, the glans diameter or glanular groove shape, urethral plate dimensions, or presence of mild chordee were not independently associated with the outcomes (p>0.05).ConclusionsOur study on the toddlers with hypospadias surgery revealed that the location of urethral meatal was the main predicting factor in the development of major complications. Furthermore, the fistula formation at the infected surgical site emphasizes the importance of postsurgical care.

Download Full-text