Our expirience in distal hipospadias and tip urethroplasty

PURPOSE: We began performing the Snodgrass procedure in 2012 /tabularized incised plate urethroplasty, described by Orkiszewski in 1987/ and improved and popularized by Warren Snodgrass in 1994 (1). METHODS: Snodgrass TIP urethroplasty was performed between January 2013- January 2020 for distal hypospadias in 12 boys aged 8 months to 12 years were included, with data on the demography of the patients, type of hypospadias, extent of urethral plate incision, type of flap, used to cover the urethroplasty, the surgical outcome and follow-up for meatal stenosis. RESULTS: We reviewed the boys with hypospadias repair of Snodgrass TIP urethroplasty, who is performed between January 2013-January 2020 in the Pediatric Surgery Department of University hospital–Stara Zagora. Cases of proximal hypospadias with severe chordae and those who had undergone previous urethroplasty were excluded. CONCLUSION: On the basis of our experience we feel that the Snodgrass considered not only for primary but also for reoperative repair of distal hypospadias.

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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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Staged proximal hypospadias repair: Modified thiersch duplay with midline incision in urethral plate followed by Mathieu urethroplasty

Journal of Pediatric Surgery ◽

10.1053/jpsu.2002.29438 ◽

2002 ◽

Vol 37 (1) ◽

pp. 104-107 ◽

Cited By ~ 5

Author(s):

M. Samuel ◽

S. Capps

Keyword(s):

Hypospadias Repair ◽

Midline Incision ◽

Urethral Plate ◽

Proximal Hypospadias

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Pediatric Urology Meatal mobilization (MEMO) technique for distal hypospadias repair: Technique, results and long-term follow-up

Central European Journal of Urology ◽

10.5173/ceju.2010.03.art4 ◽

2010 ◽

Vol 63 ◽

pp. 125-128

Author(s):

Joerg Seibold ◽

Bastian Amend ◽

Saladin H. Alloussi ◽

Daniela Colleselli ◽

Tilman Todenhoefer ◽

...

Keyword(s):

Pediatric Urology ◽

Hypospadias Repair ◽

Repair Technique ◽

Long Term Follow Up ◽

Distal Hypospadias

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DISTAL HYPOSPADIAS REPAIR BY THE MODIFIED THIERSCH-DUPLAY TECHNIQUE WITH OR WITHOUT HINGING THE URETHRAL PLATE

The Journal of Urology ◽

10.1097/00005392-199909000-00071 ◽

1999 ◽

pp. 1156-1158 ◽

Cited By ~ 1

Author(s):

ROSS M. DECTER ◽

DAVID F. FRANZONI

Keyword(s):

Hypospadias Repair ◽

Urethral Plate ◽

Distal Hypospadias

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Straightening Ventral Curvature While Preserving the Urethral Plate in Proximal Hypospadias Repair

The Journal of Urology ◽

10.1016/j.juro.2009.02.084 ◽

2009 ◽

Vol 182 (4S) ◽

pp. 1720-1725 ◽

Cited By ~ 42

Author(s):

Warren Snodgrass ◽

Juan Prieto

Keyword(s):

Hypospadias Repair ◽

Urethral Plate ◽

Proximal Hypospadias

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Challenges in the Diagnosis and Management of Acquired Nontraumatic Urethral Strictures in Boys in Yaoundé, Cameroon

Case Reports in Urology ◽

10.1155/2016/2586458 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

F. F. Mouafo Tambo ◽

G. Fossi kamga ◽

C. Kamadjou ◽

L. Mbouche ◽

A. S. Nwaha Makon ◽

...

Keyword(s):

Surgical Management ◽

Urethral Stricture ◽

Pediatric Surgery ◽

Tertiary Hospital ◽

Internal Urethrotomy ◽

Urethral Catheterization ◽

Diagnosis And Management ◽

Urethral Strictures ◽

Surgery Department

Introduction. Urethral strictures in boys denote narrowing of the urethra which can be congenital or acquired. In case of acquired strictures, the etiology is iatrogenic or traumatic and rarely infectious or inflammatory. The aim of this study was to highlight the diagnostic and therapeutic difficulties of acquired nontraumatic urethral strictures in boys in Yaoundé, Cameroon.Methodology. The authors report five cases of nontraumatic urethral strictures managed at the Pediatric Surgery Department of the YGOPH over a two-year period (November 2012–November 2014). In order to confirm the diagnosis of urethral stricture, all patients were assessed with both cystourethrography and urethrocystoscopy.Results. In all the cases the urethra was inflammatory with either a single or multiple strictures. The surgical management included internal urethrotomy (n=1), urethral dilatation (n=1), vesicostomy (n=2), and urethral catheterization (n=3). With a median follow-up of 8.2 months (4–16 months) all patients remained symptoms-free.Conclusion. The authors report the difficulties encountered in the diagnosis and management of nontraumatic urethral strictures in boys at a tertiary hospital in Yaoundé, Cameroon. The existence of an inflammatory etiology of urethral strictures in boys deserves to be considered.

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Evaluation and Monitoring of the Clinical Pathway for Thyroidectomy

The American Surgeon ◽

10.1177/000313480807400107 ◽

2008 ◽

Vol 74 (1) ◽

pp. 29-36 ◽

Cited By ~ 6

Author(s):

VÍCtor Soria-Aledo ◽

Benito Flores-Pastor ◽

Mari Fe Candel-Arenas ◽

AndrÉS Carrillo-Alcaraz ◽

ÁLvaro Campillo-Soto ◽

...

Keyword(s):

Hospital Stay ◽

Clinical Pathway ◽

Length Of Hospital Stay ◽

University Hospital ◽

Before And After ◽

Clinical Variation ◽

Evaluation And Monitoring ◽

Surgery Department ◽

Mean Cost

The aim of this study is to present the evaluation and monitoring of a clinical pathway for thyroidectomy 1 year after its implementation and after 4 years’ follow up. We compare the results of an evaluation and monitoring indicators series before and after the establishment of the clinical pathway for thyroidectomy in the Surgery Department of Morales Meseguer Hospital, a general university hospital in Murcia, Spain. Implementation of the clinical pathway led to a reduction in length of hospital stay for all the surgery patients (4.8 ± 2.1 and 3.6 ± 1.9 days before and after pathway implementation, respectively; P < 0.001). Implementation of the clinical pathway led to a reduction in cost in all the operated patients (3357 ± 966 and 2695 ± 970 US$ before and after implementing the clinical pathway, respectively; P < 0.001). Evolution of the mean hospital cost according to year of study shows a reduction from 2000 (3400 ± 1056 US$) to 2004 (2404 ± 666 US$) with a slight increase during 2005 (2721 ± 1335 US$) (P < 0.001). Implementation of the clinical pathway for thyroidectomy has successfully reduced clinical variation and therefore the length of hospital stay and mean cost of the process. In subsequent years, no such major improvements have been made with regard to hospital stay, although they are still clearly better than those before pathway implementation.

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