Augmentation of the urethral plate in the glans penis area and the distal urethra – effective method of fistula correction in children with hypospadias

Background. Important causes of complications of hypospadias repair are the deficit of tissues for plastic surgery, grooveless and small size of glans, obliteration of the urethral platewith varying degrees of scarring. The coronal urethral fistula is the most common complication of urethroplasty. Surgeons continue to search for reliable methods of correction of complications.Materials and methods. Between 2011 and 2019, 85 children aged 2 and 17 years presented with coronal fistula of urethra after hypospadias repair. (TIP) Snodgrass – 78 (91.7 %) and Mathiue – 7 (8.2 %) procedures have been performed them earlier. In our clinic previously operated 28 (32 %) boys, primary surgery of the remaining 57 (67 %) was performed in other medical institutions.Results. All patients (85), conditionally, were divided into two groups. The first group included 39 children (45.8 %), with stitching a fistula, the second group consisted of 46 patients (54.1 %), with augmentation of the urethral plate of the glans and distal urethra with the implantation of a rectangular preputial or oral mucosa free graft. Recurrent urethral fistula after stitching was observed in 10 boys (25.6 %) of the first group, and only in 2 cases (4.3 %) in children with the augmentation of the urethral plate (p <0.05). The decrease of urine flow according to the data of uroflowmetry was observed in 15 patients (52 %) the first group, the children of the second group did not have a decrease in the flow of urine.Discussion. The shape, size of the glans and the condition of the urethral plate affect to the result of urethroplasty. The connection of the wings of the glans in accordance with normal anatomy, avoid obstruction in the distal part of urethra. A wide urethra in the glans and meatal area improves urine flow. Conclusion. The augmentation of the urethral plate of the penile glans and the distal urethra with the implantation of a wide rectangular free flap in to the meatus, in our opinion, an advantage over the implantation of diamond-shaped grafts using the GTIP or TIP graft technique.

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Urethral Plate Quality Assessment and Its Impact on Hypospadias Repair Outcomes: A Systematic Review and Quality Assessment

Journal of Pediatric Urology ◽

10.1016/j.jpurol.2021.02.017 ◽

2021 ◽

Author(s):

Tariq O. Abbas ◽

Luis H. Braga ◽

A.F. Spinoit ◽

JL Pippi Salle

Keyword(s):

Systematic Review ◽

Quality Assessment ◽

Hypospadias Repair ◽

Urethral Plate ◽

Plate Quality

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Is tubularization of the mobilized urethral plate a better alternative to tubularization of an incised urethral plate for hypospadias repair?

Pediatric Surgery International ◽

10.1007/s00383-008-2312-8 ◽

2008 ◽

Vol 25 (2) ◽

pp. 185-190 ◽

Cited By ~ 4

Author(s):

Simmi K. Ratan ◽

John Ratan ◽

Kamal Nain Rattan

Keyword(s):

Hypospadias Repair ◽

Urethral Plate

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Re: Outcome Analysis of Tubularized Incised Urethral Plate Using Dorsal Dartos Flap for Proximal Penile Hypospadias Repair

The Journal of Urology ◽

10.1016/j.juro.2011.09.097 ◽

2012 ◽

Vol 187 (1) ◽

pp. 281-281

Author(s):

Douglas A. Canning

Keyword(s):

Outcome Analysis ◽

Hypospadias Repair ◽

Urethral Plate ◽

Dartos Flap

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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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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

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Role of urethral plate and fossa navicularis biopsies in the detection of balanitis xerotica obliterans in boys undergoing redo hypospadias repair

Arab Journal of Urology ◽

10.1016/j.aju.2017.08.002 ◽

2017 ◽

Vol 15 (4) ◽

pp. 326-330

Author(s):

Mohamed Sultan ◽

Mohamed El-Shazly ◽

Eid Elsherif ◽

Sheren Younes ◽

Mohamed Selim

Keyword(s):

Hypospadias Repair ◽

Urethral Plate ◽

Balanitis Xerotica Obliterans ◽

Fossa Navicularis

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Hypospadias Repair: A Single Centre Experience

Plastic Surgery International ◽

10.1155/2014/453039 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Mansoor Khan ◽

Abdul Majeed ◽

Waqas Hayat ◽

Hidayat Ullah ◽

Shazia Naz ◽

...

Keyword(s):

Social Sciences ◽

Postoperative Complications ◽

Single Stage ◽

Hypospadias Repair ◽

Surgical Skill ◽

Two Stage ◽

Urethral Plate ◽

Single Centre Experience ◽

Male Patients ◽

Hypospadias Surgery

Objectives. To determine the demographics and analyze the management and factors influencing the postoperative complications of hypospadias repair. Settings. Hayatabad Medical Complex Peshawar, Pakistan, from January 2007 to December 2011. Material and Methods. All male patients presenting with hypospadias irrespective of their ages were included in the study. The data were acquired from the hospital’s database and analyzed with Statistical Package for Social Sciences (SPSS). Results. A total of 428 patients with mean age of 8.12 ± 5.04 SD presented for hypospadias repair. Midpenile hypospadias were the most common. Chordee, meatal abnormalities, cryptorchidism, and inguinal hernias were observed in 74.3%, 9.6%, 2.8%, and 2.1% cases, respectively. Two-stage (Bracka) and TIP (tubularized incised urethral plate) repairs were performed in 76.2% and 20.8% of cases, respectively. The most common complications were edema and urethrocutaneous fistula (UCF). The complications were significantly lower in the hands of specialists than residents (P-value = 0.0086). The two-stage hypospadias repair resulted in higher complications frequency than single-stage repair (P value = 0.0001). Conclusion. Hypospadias surgery has a long learning curve because it requires a great deal of temperament, surgical skill and acquaintance with magnifications. Single-stage repair should be encouraged wherever applicable due to its lower postoperative complications.

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