Tunneled Tunica Vaginalis Flap for Recurrent Urethrocutaneous Fistulae

The tubularized incised plate (TIP) hypospadias repair is currently the most widely used urethroplasty technique. The most significant post-TIP complication is urethrocutaneous fistula (UCF) development. Tunneled tunica vaginalis flap (TVF) is a well-described technique for the repair of UCF. We retrospectively reviewed all patients undergoing repeat repair of UCF after TIP repair from 2001 to 2005. Twelve boys underwent TVF repair at our institution for recurrent UCF. Fistulae ranged from distal penile to penoscrotal in location. Median surgical time was 45 minutes and no postoperative complications occurred. After a median follow-up of 32 months (range 16–48 months), no patient has yet had a recurrence of UCF. In conclusion, TVF repair is a successful technique for the treatment of UCF after previous failed repair. TVF is technically simple to perform and should be considered for treating UCF following TIP urethroplasty, particularly in a repeat surgical setting.

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Assessment of the outcome of the tubularized incised plate (T.I.P) tech-nique in the management of distal hypospadias; prospective single-centre study

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v10i2.874 ◽

2019 ◽

Vol 10 (2) ◽

pp. 1547-1550

Author(s):

Ahmed Abdulameer Alwan ◽

Ahmed Ali Obaid ◽

Hussain T. Ajeel

Keyword(s):

Surgical Procedure ◽

Hypospadias Repair ◽

Urethrocutaneous Fistula ◽

Single Centre ◽

Tubularized Incised Plate ◽

Single Centre Study ◽

Tubularized Incised Plate Urethroplasty ◽

Male Patients ◽

Distal Hypospadias

To assess the consequence of tubularized incised plate urethroplasty on primary hypospadias repair. Total of 42 male patients underwent hypospadias repair in AL-Diwaniyah Teaching Hospital/Iraq. from April 2016 to April 2018. The levels of the hypospadias defect, age at operation, type of sutures and dressing, type of catheter and time of removal and complications were verified. Tubularized incised plate urethroplasty done for all patients and mean patients age at operation was 4.4 years (range 1 year to 8year). Postoperative follow up was 1 to 3 months. Generally, meatal stenosis, dehiscence due to infection and an urethrocutaneous fistula occurred in 3,2and 6 patients, respectively. T.I.P. urethroplasty has come to be the favourite surgical procedure of distal hypospadias cases at our hospital. The technique has a small number of complications in addition to prove success and adaptability that continue to increase its application.

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Midshaft Hypospadias: Review of Surgical Technique

10.2310/uro.11047 ◽

2019 ◽

Author(s):

Erin R. McNamara ◽

Bryan Sack ◽

Alan B. Retik

Keyword(s):

Surgical Technique ◽

Key Words ◽

Common Type ◽

Hypospadias Repair ◽

Urethrocutaneous Fistula ◽

Tubularized Incised Plate ◽

Dartos Flap ◽

Tubularized Incised Plate Urethroplasty ◽

Skin Coverage

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

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Redo hypospadias repair: experience at a tertiary care children’s hospital

Canadian Urological Association Journal ◽

10.5489/cuaj.39 ◽

2012 ◽

Vol 1 (1) ◽

Author(s):

Ahmed Al-Sayyad ◽

John G. Pike ◽

Michael P. Leonard

Keyword(s):

Tertiary Care ◽

Institutional Review Board ◽

Hypospadias Repair ◽

Urethral Plate ◽

Institutional Review ◽

Tubularized Incised Plate ◽

Distal Shaft ◽

The Status ◽

Initial Severity

Objective: Treatment of patients with failed hypospadias repairs can be challenging.Our study aimed to determine the best type of redo repair dependingon the location and size of the urethral meatus, the status of the urethralplate and genital skin, the severity of residual chordee and the amount ofscar tissue.Methods: The Institutional Review Board approved our retrospective chart reviewof patients who had a redo hypospadias repair at our institution over the past6 years. We recorded the type and number of previous repair(s), the type andnumber of redo procedure(s),as well as the complications and functional outcomes.Results: There were 28 patients, aged 1–12 (mean 3.8) years, with failed hypospadiasrepairs. The initial severity of the hypospadias were as follows: perineal(1), penoscrotal (9), proximal shaft (1), mid-shaft (9), distal shaft (4), coronal(3) and mega-meatus (1). Of all the patients, 24 had 1 repair, 3 had 2 repairsand 1 had 3 repairs. The initial repairs comprised 11 tubularized island flaps(TIFs), 8 Snodgrass tubularized incised plate (TIP) techniques, 5 Mathieu repairs,1 Meatal Advancement and GlanuloPlasty Incorporated (MAGPI) technique,1 Pyramid, 1 Arap technique and 1 Thiersch-Duplay repair. Twenty-one of 28 patients had 1 redo operation, 5 had 2 redo operations, 1 had 3 redo operationsand 1 had 4 redo operations, for a total of 38 redo operations. Of these,26 were TIP techniques (68.4%), 3 were Mathieu (7.9%), 3 were TIF repairs(7.9%), 2 were onlay island flaps (5.3%) and 4 were buccal mucosal grafts(10.5%). Follow-up was 1–5 years (mean 3.5 yr). The final locations of urethralmeatus included glans (18), corona (6), mid-shaft (3) and penoscrotal (1).Complications after redo surgery comprised 4 urethrocutaneous fistulae, 2 meatalstenoses, 1 urethral stricture and 3 dehiscences. Sixteen patients were followedwith yearly uroflow with a Q-mean (mean uroflow) range of 3–14 mL/s (mean8.1 mL/s).Conclusion: The majority of hypospadias failures can be salvaged with one operation.The TIP repair is our procedure of choice in most cases. In the settingof a poor urethral plate, TIF or buccal mucosa may be necessary. Complicationsare not infrequent in redo procedures.

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Stentless hypospadias repair: The way forward

Journal of Clinical Urology ◽

10.1177/2051415820931266 ◽

2020 ◽

pp. 205141582093126

Author(s):

Gursev Sandlas ◽

Charu Tiwari ◽

Jyoti Bothra ◽

Bhushan Jadhav ◽

Hemanshi Shah

Keyword(s):

Randomized Study ◽

Surgical Site Infections ◽

Slight Modification ◽

Standard Of Care ◽

Hypospadias Repair ◽

Level Of Evidence ◽

Tubularized Incised Plate ◽

Age At Surgery ◽

Level 2

Background: Stentless repair of hypospadias has been previously described in the literature for distal penile hypospadias repair. This was a prospective non-randomized study with the aim of assessing the efficacy of stentless repair in our health-care system. Methods: A total of 104 patients managed prospectively for hypospadias over a 30-month period who met the inclusion criteria were included in the study and underwent a stentless modified tubularized incised plate (TIP) urethroplasty repair (with a slight modification described subsequently) by three surgeons and were followed up for a minimum period of six months. Results: The median age at surgery was eight months. The site of meatus was glanular in 20 patients, coronal in 36 patients, sub-coronal in 38 patients and mid-penile in 10 patients. The median operative time was 47 minutes (range 32–76 minutes). The median time to first micturition was 140 minutes (range 10–300 minutes). Voiding difficulty was encountered in two patients, requiring catheterization. Three patients had superficial surgical site infections which were conservatively managed. All patients were discharged on the second postoperative day, except for the three patients with surgical site infection. On follow-up, two patients had a fistula. Conclusion: Stentless repair of hypospadias is the future and the new standard of care and should be used in every case where a modified TIP repair is feasible. This decreases complications from urethral stenting and decreases the duration of hospital stay. Both patient and parents are comfortable with this procedure. Level of evidence Level 2.

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Reconstructing forked corpus spongiosum to correct glans droop in distal/midshaft hypospadias repair

Journal of International Medical Research ◽

10.1177/0300060520925698 ◽

2020 ◽

Vol 48 (5) ◽

pp. 030006052092569

Author(s):

Bin Zhang ◽

Yunli Bi ◽

Shuangsui Ruan

Keyword(s):

Postoperative Complications ◽

Urethral Stricture ◽

Urethral Diverticulum ◽

Mometasone Furoate ◽

Corpus Spongiosum ◽

Hypospadias Repair ◽

Postoperative Residual

Purpose We reviewed our experience and efficacy of reconstruction of a forked corpus spongiosum (FCS) to correct glans droop in distal/midshaft hypospadias repair. Methods Eighty-five consecutive patients who underwent distal/midshaft hypospadias repair by the same surgeon in our center from October 2015 to June 2018 were retrospectively analyzed. All cases were accompanied by different degrees of glans droop, which we corrected by cutting off and reconstructing the FCS along the plate. We recorded the degrees of glans droop, development of the FCS, and postoperative complications including residual chordee, fistula, diverticulum, glans dehiscence, meatus stenosis, and urethral stricture. Results The follow-up period ranged from 5 to 37 months (mean, 19.7 months). Two patients (2.3%) developed a coronal fistula and underwent a second repair. Two patients (2.3%) developed a mild urethral diverticulum and underwent continued observation. One patient (1.2%) developed a meatus stenosis that resolved after 1 month of meatus expansion combined with external mometasone furoate. No patients developed postoperative residual chordee or urethral stricture. Conclusions The degree of glans droop is closely associated with the development of an FCS. Reconstructing the FCS to correct the glans droop can yield satisfactory outcomes and should be popularized in distal/midshaft hypospadias repair.

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Comparison of effect between dartos fascia and tunica vaginalis fascia in TIP urethroplasty: a meta-analysis of comparative studies

BMC Urology ◽

10.1186/s12894-020-00737-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Hao Yang ◽

Xiao-xiao Xuan ◽

Dong-lai Hu ◽

Hang Zhang ◽

Qiang Shu ◽

...

Keyword(s):

Postoperative Complications ◽

Postoperative Complication ◽

Comparative Studies ◽

Meta Analysis ◽

Relevant Information ◽

Cochrane Library ◽

Urethrocutaneous Fistula ◽

Tunica Vaginalis ◽

Cosmetic Outcomes ◽

Secondary Outcomes

Abstract Background Tubularized incised plate (TIP) urethroplasty is the most commonly performed procedure for hypospadias. Several flap procedures have been recommended to decrease the postoperative complication rate in TIP repair, but no single flap procedure is ideal. This study aimed to compare the outcomes of dartos fascia (DF) and tunica vaginalis fascia (TVF) as intermediate layers in TIP urethroplasty. Methods We searched PubMed, EMBASE, the Cochrane Library, Web of Science, clinicaltrials.gov, and other sources for comparative studies up to April 16, 2020. Studies were selected by the predesigned inclusion criteria. The primary outcomes were postoperative complications. The secondary outcomes were functional and cosmetic outcomes. Results The pooled RR with 95% CI were calculated. We extracted the relevant information from the included studies. Only 6 comparative studies were included. No secondary outcomes were reported. The RR of the total complications rate for DF was 2.41 (95% CI 1.42–4.07, P = 0.0001) compared with TVF in TIP repair. For each postoperative complication, the RRs were 6.48 (2.20–19.12, P = 0.0007), 5.95 (1.13–31.30, P = 0.04), 0.62 (0.25–1.52, P = 0.29), and 0.75 (0.23–2.46, P = 0.64) for urethrocutaneous fistula, prepuce-related complications, meatal/urethral stenosis, and wound-related complications, respectively. Conclusions This meta-analysis reveals that compared to DF, TVF is a better option in TIP repair in terms of decreasing the incidence of the total postoperative complications, urethrocutaneous fistula, and prepuce-related complications. However there is limited evidence for functional and cosmetic outcomes. Overall, larger prospective studies and long-term follow-up data are required to further demonstrate the superiority of TVF over DF. Trial registration PROSPERO CRD42019148554.

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OUTCOME OF TUNICA VAGINALIS FLAP FOR REPAIR OF URETHROCUTANEOUS FISTULA AFTER HYPOSPADIAS REPAIR

10.36106/gjra/5205428 ◽

2021 ◽

pp. 27-28

Author(s):

Aniket Patil ◽

Ajay Naik

Keyword(s):

Suture Material ◽

Surgical Techniques ◽

Absorbable Suture ◽

Hypospadias Repair ◽

Urethrocutaneous Fistula ◽

Tunica Vaginalis ◽

Basic Principles ◽

Urethral Closure ◽

Distal Obstruction ◽

Hypospadias Surgery

The commonest complication following hypospadias repair is occurrence of urethro-cutaneous stula(UCF) with a reported incidence of 4-25% 1. The expected stula rate is between 10% to 15% for onestage hypospadias surgery. UCF after hypospadias repair remains a signicant challenge for paediatric surgeons despite the advances in surgical techniques. Our aim is to assess the outcome of tunica vaginalis ap repair in cases of urethro-cutaneous stula. Our study included 23 patients who underwent UCF repair using TVF. Successful repair of these UCF depends on several basic principles, which are the avoidance of procedures on inamed tissue, correction of distal obstruction, a tension-free urethral closure with absorbable suture material, and covering of the urethral repair with well-vascularized tissue. From our study we feel that many complications mainly recurrent stula can be avoided using the above principles.

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An Intrapericardial Technique for PDA Ligation: Surgical Description and Clinical Outcome in 35 Dogs

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-5838 ◽

2013 ◽

Vol 49 (1) ◽

pp. 31-40 ◽

Cited By ~ 2

Author(s):

Laura E. Selmic ◽

David A. Nelson ◽

Ashley B. Saunders ◽

H. Phil Hobson ◽

W. Brian Saunders

Keyword(s):

Postoperative Complications ◽

Clinical Outcome ◽

Medical Records ◽

Clinical Signs ◽

Surgical Techniques ◽

Residual Flow ◽

Surgical Time ◽

Ductal Closure ◽

Echocardiographic Findings

A number of surgical techniques have been reported for dissection and ligation of patent ductus arteriosi (PDAs) in dogs. The objectives of this study were to provide a detailed description of an intrapericardial technique for PDA dissection and ligation and to report the clinical outcome of that technique in dogs. Medical records of 35 dogs were retrospectively reviewed for signalment, clinical signs, echocardiographic findings, surgical time, intra- and postoperative complications, and completeness of ductal closure. Median surgery time was 60 min (range, 35–125 min). Neither intraoperative nor postoperative complications occurred. Within 48 hr of surgery, the continuous left basilar heart murmur was absent in all dogs, and complete echocardiographic closure was confirmed in 29 of 32 dogs. Residual flow was identified echocardiographically in three dogs within 48 hr of surgery. Residual flow was decreased in one dog at 1 mo, which resolved within 33 mo. One dog had mild residual flow postoperatively but did not return for follow-up. The intrapericardial technique was successful for PDA dissection and ligation and had a lower rate (6%) of echocardiographic residual flow compared with previously reported techniques.

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Comparative Study of Snodgrass and Mathieu’s Procedure for Primary Hypospadias Repair

ISRN Urology ◽

10.1155/2014/249765 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Raashid Hamid ◽

Aejaz A. Baba ◽

Altaf H. Shera

Keyword(s):

Operative Time ◽

Stricture Formation ◽

Urethrocutaneous Fistula ◽

Cutaneous Fistula ◽

Cosmetic Appearance ◽

Tubularized Incised Plate ◽

Urinary Stream ◽

The Mean ◽

Local Examination

Objective. Present study was undertaken to compare the results of two single stage hypospadias repairs, namely, Tubularized Incised Plate (TIP) repair and Mathieu’s repair. Methods. The study included 100 patients of distal penile hypospadias, from January, 2008 to January, 2013. After a detailed history, local examination was performed with reference to the site of meatus, shape of glans, and presence of chordee. TIP repair was performed in 52 patients and Mathieu’s repair in 48 patients. On follow-up, the patients were examined for the position of meatus, shape of meatus, urinary stream, urethrocutaneous fistula, and stricture formation. Results. The mean age of presentation was 6.2 ± 3.2 years (range 1.5–15years). The mean operative time was 63.7 ± 14.3 (45–90) minutes and 95.0 ± 19.1 (70–125) minutes in TIP and Mathieu’s repair, respectively.Complications after surgery were urethero cutaneous fistula in 3(5.76%) and 7 (14.5%), meatal stenosis in 3(5.33%) and 4(8.33%), wound infection in 19.2% and 8.3% cases in TIP repair and Mathieu repair, respectively. The shape of meatus was slit-like and vertically oriented in 48(92.3%) patients who had undergone TIP repair. Conclusion. The Snodgrass repair is significantly faster, with more natural cosmetic appearance of the meatus than the Mathieu’s repair.

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