scholarly journals Using prepucial mucous to cover neourethra in TIP urethroplasty: 4 years experience in a tertiary paediatric hospital of Bangladesh

2020 ◽  
pp. 37-40
Author(s):  
Sabbir Karim ◽  
◽  
Monoarul Islam Talukder ◽  
Sultana Parvin ◽  
◽  
...  
Keyword(s):  
Conflict Of Interest ◽  
Wide Spectrum ◽  
Urethrocutaneous Fistula ◽  
Urethral Plate ◽  
Paediatric Hospital ◽  
Tubularized Incised Plate ◽  
Dartos Flap ◽  
Key Words Hypospadias ◽  
The Mean ◽  
Different Tissues

Background. Hypospadias has a wide spectrum of penile abnormality requiring surgical correction. Most of the cases are of anterior variety and the surgical technique depends on constructing a neo urethra. Snodgrass or Tubularized Incised Plate (TIP) urethroplasty is one of the most popular techniques of urethroplasty which depends on the existing healthy, adequate and intact urethral plate. Different tissues have been described to cover the neourethra as second layer in literature. In this study we modified the TIP urethroplasty by covering the neourethra with 2 layers of pedicled prepucial mucosa or Dartos flap. Objective. To see the outcome of modified Snodgrass or TIP urethroplasty in anterior mid and proximal penile hypospadias. Materials and method. Total 88 patients were operated by modified Snodgrass technique or modified TIP urethroplasty from January 2012 to July 2016. Coronal, subcoronal, distal penile, mid penile and proximal penile hypospadias were included in the study. Every patient underwent modified TIP urethroplasty and outcomes were assessed. Results. The mean age of the patients were 28.34±14.98 months, ranges from 6.5 to 65 months. 9 (10.2%) patients of our series develop urethrocutaneous fistula, 5 (5.68%) patients develop meatal stenosis and 1 (1.1%) patient developed neourethral stricture. Conclusion. TIP urethroplasty is a versatile method to correct penile hypospadias. Covering of the neourethra with prepucial mucosa secure the neourethral anastomosis. The author declares that there is no conflict of interest. Key words: Hypospadias, TIP urethroplasty, Prepucial mucosa.

Midshaft Hypospadias: Review of Surgical Technique

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

scholarly journals The effect of pre-incision urethral plate width and glanular width on the outcome of Tubularized Incised Urethral plate repair surgery in distal penile Hypospadias, A prospective study

2020 ◽  
Author(s):  
Tarek Abd Elbaky ◽  
Diaa Eldin Taha ◽  
Hossam Nabeeh ◽  
Khaled Zein elabden ◽  
Mohamed Galal
Keyword(s):  
Cosmetic Outcome ◽  
Urethral Plate ◽  
Tubularized Incised Plate ◽  
Significant Difference ◽  
Urinary Stream ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
A Prospective Study ◽  
Plate Width

Abstract Objective:To determine the cosmetic and functional outcomes of hypospadias repair in relation to the width of the urethral plate in addition to granular width and configuration.Materials and methodsThe study was a prospective evaluation of patients operated for hypospadias after approval of ethical committee a formal consent were taken from parents. The urethral plate width (UPW) and glans width (GW) of the patients were measured preoperatively using standard calipers. The width of the urethral plate was correlated to the cosmetic outcome (using hypospadias objective penile evaluation [HOPE]) and functional outcome (using the urinary stream) of hypospadias repair.All patients were managed via the same technique using Snodgrass tubularized incised plate repair (TIP). All operations were performed by a single surgeon. All intaoperative data were recorded. All patients were followed up for 1 year. Success was defined as slit shaped meatus at the tip of the glans with no stenosis, fistula or diverticulum.Results:All 38 patients were evaluated at 6 months and 1 year follow up. The mean age at surgery was 4.5 ± 2.1 years. Overall, the mean ± SD of UPW was 10.92 ± 1.24 mm. a 24 patients (61.5 %) (Group A) had a urethral plate width of less than 8 mm while 14 patients (35.9 %) (group B) had a urethral plate width greater or equal to 8 mm. the mean ± SD of GW was 9.52 ± 1.56 mm. Success was documented in 36/38 patients (94.3%).The only complication was Fistula in two patient (6.7 %), glans dehiscensce in three patients (10%). Success rate was not statistically different in correlation of UPW and GW (p=0.5).The only statistically significant difference between all patients was a longer operative time in the patients with deficient urethral plate compared to others with adequate urethral plate (p= 0.005). The urinary stream was straight in 32 boys and sprayed in 6. Overall, mean ± SD HOPE score was 39.1 ± 8.83. A significant correlation found between the cosmetic outcome of the two groups and HOPE score (p = 0.06).Conclusions:The pre-incision urethral plate width and glanular width was not correlated with the TIP outcome. A better HOPE score is associated with wide urethral plate.

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

ISRN Urology ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
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.

scholarly journals Comparison of Dartos flap and spongioplasty in Snodgrass urethroplasty in distal penile hypospadias

2021 ◽  
Vol 4 (3) ◽  
pp. e000294
Author(s):  
Anju Verma ◽  
Shahid Murtaza ◽  
Vijay Kumar Kundal ◽  
Amita Sen ◽  
Divya Gali
Keyword(s):  
Urethrocutaneous Fistula ◽  
Meatal Stenosis ◽  
Tubularized Incised Plate ◽  
Group A ◽  
Dartos Flap ◽  
The Difference ◽  
Group B ◽  
Good Cosmesis ◽  
Hypospadias Surgery ◽  
Single Technique

BackgroundHypospadias surgery has been continuously evolving, although there is no single technique which can be said to be perfect and suitable for all types of hypospadias. Tubularized incised plate (TIP) urethroplasty (Snodgrass procedure) is presently the most common surgical procedure performed for distal penile hypospadias (DPH). The aim of this study was to compare the outcome of TIP urethroplasty using Dartos flap (DF) and spongioplasty as second layer in DPH.MethodsA total of 30 patients of DPH were repaired using TIP urethroplasty with DF or spongioplasty as second layer from January 2017 to June 2018. Out of 30 patients, TIP with DF was done in 15 patients (group A) and TIP with spongioplasty was done in the remaining 15 patients (group B). Preoperative mean age and weight were comparable in both groups. Postoperative complications, namely, postoperative edema, residual chordee, urethrocutaneous fistula (UCF), meatal stenosis and final cosmesis, were recorded.ResultsIn both groups, complications included postoperative edema (Gp A-1Gp B-1), residual chordee (Gp A-1, Gp B-1), UCF (Gp A-3, Gp B-4), meatal stenosis (Gp A-1, Gp B-5) and poor cosmesis (Gp A-3, Gp B-4). Wound infection was managed with appropriate antibiotics, and meatal stenosis responded to calibration in five patients.Although it seems that DF has a better outcome clinically, the difference between the two techniques was statistically not significant.ConclusionDF as an additional cover to TIP is associated with an acceptable complication and has good cosmesis compared with spongioplasty; however, the difference is not statistically significant.

scholarly journals Short term outcomes of snodgrass urethroplasty in distal and mid penile hypospadias

2018 ◽  
Vol 5 (5) ◽  
pp. 1878
Author(s):  
Pramod S. ◽  
Anukethan J.
Keyword(s):  
Demographic Data ◽  
Urethrocutaneous Fistula ◽  
Short Term ◽  
Urethral Plate ◽  
Duration Of Surgery ◽  
Duration Of Hospitalization ◽  
Congenital Condition ◽  
The Mean ◽  
Complications Rate ◽  
Hypospadias Surgery

Background: Hypospadias is common congenital condition. First attempted hypospadias surgery was done during first century A.D. Since then more than 300 techniques have been explained in the surgery for Hypospadias. The goal of surgery is focused on functional and cosmetic outcomes. In 1994 Snodgrass popularized the technique of urethral plate incision, tubularization and secondary dorsal healing for hypospadias repair. Aim of the study was to evaluate the short term outcomes of Snodgrass urethroplasty.Methods: This was a retrospective study conducted by the department of Pediatric Surgery, Kempegowda Institute of medical sciences (KIMS) hospital, Bangalore from 2014 to 2017. Children with mid penile and distal hypospadias who had undergone Snodgrass urethroplasty were enrolled in the study. Children with previous surgery were excluded. The demographic data, duration of surgery, post operative requirement of anticholinergics, duration of catheterization and post operative stay were tabulated. Children were followed up for duration of 6 months to 3 years. Post operative complications were tabulated. Results: 40 children were included in the study. Age ranges of children were between 9 months to 14 years. In most of the children hypospadias was diagnosed at birth. The mean duration of surgery was 97.25 minutes. The mean duration of hospitalization was12.2 day. The overall complications rate was 20%. The most common complication was urethrocutaneous fistula. Out of the 40 children included in the study 4(10%) children required resurgery (urethrocutaneous fistula closure).Conclusions: Snodgrass urethroplasty is a simple and effective technique. It is easy to learn and can be applied as a single stage procedure. The most common complications are urethrocutaneous fistula and meatal stenosis.

scholarly journals Preputial Dartos Reinforced Snodgrass Tubularized Incised Plate Urethroplasties in Distal Hypospadias to Prevent Urethrocutaneous Fistula

2015 ◽  
Vol 3 (1) ◽  
pp. 12-17
Author(s):  
Md Shah Alam Talukder ◽  
Debesh Ch Talukder ◽  
Md Abdullah Al Mahmud ◽  
Mohammed Showkot Ali ◽  
Nadiuzzaman Khan ◽  
...  
Keyword(s):  
Urethrocutaneous Fistula ◽  
Cutaneous Fistula ◽  
Medical College ◽  
Tubularized Incised Plate ◽  
Group A ◽  
Dartos Flap ◽  
Distal Hypospadias ◽  
Group B ◽  
Hypospadias Surgery ◽  
Fistula Prevention

Urethro cutaneous fistula( U-C fistula) is the most common complication of hypospadias surgery. It frequently needs separate surgeries for closure, which bring a great deal of physical and mental agony and monetary involvement of the patient and his family. Many efforts have been invented to prevent the u-c fistula with various degree of success. We would like to see the outcome of “Preputial Dartos Reinforced Snodgrass Tubularized Incised Plate Urethroplasties in Distal Hypospadias to Prevent Urethrocutaneous Fistula”. This interventional study was performed to see the outcome of preputial dartos reinforced Snodgrass tubularized incised plate urethroplasties in distal hypospadias specially urethrocutaneous fistula prevention. For this purpose 40 patients were selected having distal hypospadias age ranging from 6 months to 11 years admitted in the Department of Pediatric Surgery, Mymensingh Medical College & Hospital during the period of January 2010 to March 2011. Out of 40 patients, 20 were in group-A (preputial dartos flap) and another 20 were included in group - B (without flap). All this patients were followed by perioperative and postoperative care. Few patients developed postoperative pyrexia, wound infection, stent blockage which were treated accordingly leaving minimum morbidity. Both groups of patients were followed up for 3 months after surgery. Present study is probably a better technique to prevent fistulaassociated morbidities in distal Snodgrass TIP urethroplasties.J. Paediatr. Surg. Bangladesh 3(1): 12-17, 2012 (January)

scholarly journals Dorsal vertical island flap urethroplasty in children with hypospadias: a single center’s experience 75 patients

2019 ◽  
Vol 2 (1) ◽  
pp. e000021
Author(s):  
Gontumukkala Chalapathi ◽  
Kadiri Sitha Ramaiah ◽  
Javvadi Veeraswamy
Keyword(s):  
Good Alternative ◽  
Urethral Diverticulum ◽  
Vertical Tube ◽  
Island Flap ◽  
Urethrocutaneous Fistula ◽  
Urethral Plate ◽  
Meatal Stenosis ◽  
Cosmetic Appearance ◽  
Good Cosmetic ◽  
The Mean

ObjectiveTo assess the results and complications of dorsal vertical island flap (DVIF) urethroplasty.MethodsA total of 175 children were operated on for hypospadias. Out of these, 41 with proximal hypospadias with severe chordee required two-stage urethroplasty. In 18 babies with glanular hypospadias, a meatal advancement and glanuloplasty procedure was done. In 25 babies with mid-penile and distal penile hypospadias, tubularized incised urethral plate (TIP) urethroplasty was the option. 16 babies with unhealthy urethral plate and chordee were chosen for dorsal vertical tube urethroplasty after excision of the urethral plate. The rest of the 75 babies with proximal, mid-penile or distal penile hypospadias with no or minimal chordee after degloving and poor urethral plate were chosen for DVIF urethroplasty. These 75 babies with DVIF were followed up from 3 months to 5 years to assess complications such as urethrocutaneous fistula, meatal stenosis, glans dehiscence, megalourethra or urethral diverticulum, stricture, and penile torsion/rotation.ResultsA total of 75 patients with proximal, mid-penile, or distal penile hypospadias in whom DVIF was used during the study period were included. The mean age was 3.7 years, ranging from 8 months to 14 years. Fourteen patients developed complications (18.6%). The most common complication was urethrocutaneous fistula, which was seen in seven (9.3%) patients. Glans dehiscence was seen in five patients (6.6%), and one had meatal stenosis with diverticulum formation. Skin necrosis was observed in one patient. In 61 patients, stream was good, with no torsion, and good cosmetic appearance was observed.ConclusionsDVIF is a good alternative to TIP in mid-penile and distal penile hypospadias. Our early experience with DVIF urethroplasty showed an acceptable rate of complications and good cosmetic results.

scholarly journals Spongioplasty with Dartos Flap Coverage in the Snodgrass Technique of Hypospadias Repair

2020 ◽  
Vol 38 (2) ◽  
pp. 64-67
Author(s):  
Sahadeb Kumar Das ◽  
Kaniz Hasina ◽  
Md Ashraf Ul Huq ◽  
Syed Abdul Adil ◽  
Md Mahbubul Alam ◽  
...  
Keyword(s):  
Prospective Study ◽  
Fistula Formation ◽  
Hypospadias Repair ◽  
Urethrocutaneous Fistula ◽  
Urethral Plate ◽  
Flap Coverage ◽  
Dartos Flap ◽  
Distal Hypospadias ◽  
A Prospective Study

Objective: The aim of the study is to evaluate the role of spongiosal tissue with dartos flap coverage for preventing Urethrocutaneous Fistula (UCF) formation in the Snodgrass technique. Materials and Methods: It is a prospective study, performed on 35 patients of mid penile and distal hypospadias aged 15 months to 144 months who underwent urethroplasty in the Snodgrass technique using spongiosal tissue and dartos flap for neourethral coverage. Results: Among 35 patients, Age ranged from 15 months to 144 months (mean 85.94 months). Chordee was corrected by penile degloving alone in 11 patients, partial mobilization of urethral plate with spongiosum in 20 patients and 4 patients required dorsal plication. Glans groove was deep in 19 patients, shallow in 13 patients and no groove noticed in 3 patients. Sixteen patients had narrow urethral plate (<8mm) and 19 patients had adequate urethral plate (>8mm). Urethrocutaneous Fistula (UCF) was encountered in five patients (14.28%), meatal stenosis in two patients (5.71%), and partial glanular dehiscence in one patient. Conclusions: Approximation of spongiosal tissue along with dartos flap as the intermediate layer for neourethral coverage reduces fistula formation. J Bangladesh Coll Phys Surg 2020; 38(2): 64-67

scholarly journals The Effect of Pre-Incision Urethral Plate Width and Glanular Width on the Outcome of Tubularized Incised Urethral Plate Repair Surgery in Distal Penile Hypospadias, A Prospective Study

2021 ◽  
Author(s):  
Tarek Abdelbaky ◽  
Diaa El-din Taha ◽  
Hossam Nabeeh ◽  
Khaled Zein elabden ◽  
Mohamed Galal
Keyword(s):  
Cosmetic Outcome ◽  
Urethral Plate ◽  
Tubularized Incised Plate ◽  
Significant Difference ◽  
Urinary Stream ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
A Prospective Study ◽  
Plate Width

Abstract Background: To determine the outcomes of hypospadias repair according to the width of the urethral plate & glanular width. Materials and methods A prospective evaluation of patients operated for hypospadias. The urethral plate width (UPW) & glans width (GW) of the patients were measured preoperatively using standard calipers. The urethral plate width was correlated to the cosmetic outcome (using hypospadias objective penile evaluation [HOPE]) and functional outcome (using the urinary stream) of repair. All patients were managed via the same technique using Snodgrass tubularized incised plate repair (TIP). All intraoperative data were recorded. All patients were followed up for 1 year. Success was defined as slit shaped meatus at the tip of the glans without stenosis, fistula or diverticulum. Results: All 38 patients were evaluated at 6 months and 1 year follow up. The mean age at surgery was 4.5 ± 2.1 years. We categorized the patients into two groups:- (Group A) had a urethral plate width of less than 8 mm, they were 24 patients (63.15 %). (Group B) had a urethral plate width greater or equal to 8 mm. (group B) had a urethral plate width greater or equal to 8 mm, they are 14 patients (36.8 %) Overall, the mean ± of UPW was 10.92 ± 1.24 mm while the mean ± SD of GW was 9.52 ± 1.56 mm. Success was documented in 36/38 patients (94.7%). The documented complication was Fistula in two patient (5.2 %), glans dehiscensce in three patients (7.9%). Success rate was not statistically different in correlation of UPW and GW (p=0.5). The urinary stream was straight in 32 boys and sprayed in 6. Overall, mean ± SD HOPE score was 39.1 ± 8.83. The only statistically significant difference between all patients was a longer operative time in the patients with deficient urethral plate compared to others with adequate urethral plate (p= 0.005). A significant correlation found between the cosmetic outcome of the two groups and HOPE score (p = 0.06). Conclusions: The pre-incision urethral plate width and glanular width was not correlated with the TIP outcome. A better HOPE score is associated with wide urethral plate.

scholarly journals Role of the urethral plate characters in the success of tubularized incised plate urethroplasty

2014 ◽  
Vol 47 (02) ◽  
pp. 221-237 ◽  
Author(s):  
Hamdy Aboutaleb
Keyword(s):  
Fistula Formation ◽  
Success Rates ◽  
Flat Plates ◽  
Urethral Plate ◽  
Tubularized Incised Plate ◽  
Plate Shape ◽  
Fistula Rate ◽  
Universal Applicability ◽  
Complications Rate ◽  
Plate Width

ABSTRACT Background: Today, tubularized incised plate (TIP) urethroplasty is the most commonly performed operation for distal and mid-penile hypospadias. Reports from different centers worldwide confirm its nearly universal applicability and low complications rate. Aim: Evaluation of the urethral plate characters and its effect on the outcome of TIP urethroplasty. Materials and Methods: Between 2010 and 2013, 100 children with primary distal penile hypospadias underwent TIP urethroplasty. Urethral plates were categorized as flat, cleft, and deeply grooved. Postoperatively, patients were followed-up for evaluation of meatal stenosis, fistula formation, and glandular dehiscence at 1 st , 3 rd and 6 th months. Patients were followed-up for urethral calibration by urethral sound 8 Fr at 3 rd and 6 months follow-up. Data were statistically analysed using Epi info program to correlate between the width, plate shape, and complications. Results: Mean age at surgery was 4.3 years. Patients were followed-up for an average period of 6.4 months. Pre-operative location of the meatus was reported as coronal in 46, subcoronal in 50 and anterior penile in 4 cases. Urethral plate characters were flat in 26 cases, cleft in 52, and deeply grooved in 22. Urethral plate width was >8 mm in 74 cases and <8 mm in 26. Patients with urethral plate <8 mm had a statistically significant higher fistula rate (P = 0.004) and failed 8 Fr calibrations in 26.9% (P = 0.01) compared with the patients with urethral plate >8 mm. In addition, we also founds higher fistula rate and failed 8 Fr calibrations in flat urethral plate. Conclusions: An adequate urethral plate width (>8 mm) is essential for successful TIP repair. Lower success rates with flat plates may need buccal mucosal augmentation to improve the results.

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