Grafted tubularised incised plate urethroplasty: an excellent option in primary hypospadias with poor urethral plate

Background: Hypospadias represents the most frequent penile anomaly. The most challenging part of hypospadias surgery is urethral reconstruction. We here-in assess the cosmetic and functional outcome with primary single stage dorsal inlay urethroplasty using preputial skin grafts in tubularised incised-plate. We extended this indication to be the standard technique for primary hypospadias repair with poor urethral plate, flat glans and minimal ventral curvature.Methods: Children with a narrow urethral plate, shallow glans and minimal ventral curvature formed the study group. Children having severe chordee needing transection of the urethral plate,having undergone circumcision and failed hypospadias repair was excluded. This prospective study included the surgical experience of 87 cases of primary hypospadias operated upon between 2010 and 2016.Results: A straight penis was achieved in 97.7% of the patients with a 3.4% incidence of urethrocutaneous fistula. Acceptable cosmetic results were achieved in 96.5% of cases. Slit like appearance of neo urethral meatus was achieved in 96.5%, position was on the tip in 81 patients and in 6 it was mid glans. Glans dehiscence was seen in 3 patients. Meatal stenosis in 1, stricture, diverticulum and penile torsion was not seen in this series. Single and straight urinary stream was seen in 91.95%, splaying of urine in 3 patients and a thin stream in 4 patients.Conclusions: Primary dorsal inlay inner preputial graft urethroplasty successfully fulfils all traditional hypospadias repair criteria. It offers a viable option in the management of primary hypospadias with a narrow urethral plate.

Download Full-text

Skin Grafted Tubularized Incised Urethral Plate for Penile Hypospadias Repair

Journal of King Abdulaziz University-Medical Sciences ◽

10.4197/med.22-3.6 ◽

2015 ◽

Vol 22 (3) ◽

pp. 41-45

Author(s):

Mazen O. Kurdi

Keyword(s):

Urinary Tract ◽

Surgical Technique ◽

Skin Grafting ◽

University Hospital ◽

Hypospadias Repair ◽

Urethral Meatus ◽

Cutaneous Fistula ◽

Urethral Plate ◽

Urinary Stream ◽

King Abdulaziz University

Hypospadias is a fairly common congenital defect wherein the urinary tract opening is mispositioned on the ventral aspect of the penis in newborn males. Many techniques have been attempted for the repositioning. Skin grafting of the incised urethral plate was first used in 1998 with encouraging results. This prospective study reports the results of performing this surgical technique at King Abdulaziz University Hospital over the period from January 2010 to December 2014. Thirty patients were enrolled with penile hypospadias, 15 patients had shallow urethral plate, nine patients had small glans and six patients had scarred urethral plate as a result of a previous hypospadias operation. We used continuous suturing (or multiple interrupted stitches) of the proximal end of the skin graft with single stitch fixation of the graft to the depth of the incised urethral plate which helps prevent the separation of the graft by the urinary stream and improve the graft taking. All patients had good caliber of the urethral meatus and the grafted neourethra. Two patients developed urethra-cutaneous fistula without meatal or neourethral stenosis. Grafting of the urethral plate should be considered as an adjunctive method for hypospadias repair especially in patients with small glans, shallow or scarring urethral plate. This grafting resulted in good caliber urethral meatus and neourethra.

Download Full-text

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.

Download Full-text

Dartos flap coverage of the neourethra following repair for primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas: it is a safe approach

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502010000200012 ◽

2010 ◽

Vol 25 (2) ◽

pp. 190-193 ◽

Cited By ~ 3

Author(s):

Hayrettin Ozturk

Keyword(s):

Redo Surgery ◽

Hypospadias Repair ◽

Urethrocutaneous Fistula ◽

Operative Results ◽

Flap Coverage ◽

Distal Shaft ◽

Dartos Flap ◽

Hypospadias Surgery ◽

Safe Approach ◽

Mathieu Procedure

PURPOSE: Urethrocutaneous fistula and neourethral dehiscence are frequently seen complications of hypospadias surgery requiring reoperation. In this study we report the experience of one surgeon with dartos flap coverage in primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas repair. METHODS: A total of 23 patients underwent hypospadias and urethrocutaneous fistulas repair from January 2006 to May 2009. Fourteen patients were operated on for primary hypospadias repair at our institution and 9 patients were admitted for hypospadias complications such as failed hypospadias repair and urethrocutaneous fistula. In all the patients, the dartos flap was dissected and transposed to cover the neourethra. Operative results were recorded. RESULTS: The primary surgical procedure was a one-stage repair in 61% (n = 14); tubularised incised plate (TIP) urethroplasty in 43% (n = 6) and a Mathieu procedure in 57% (n = 8). Urethrocutaneous fistulas complicating the previous initial hypospadias repair were anterior in 33% (n = 2), middle in 33% (n = 2) and proximal in 33% (n = 2). Repair of the fistula was successful on the first attempt in all patients. The reason for redo surgery in 3 patients was complete dehiscence and the patients had distal shaft hypospadias. CONCLUSION: Dartos flap coverage of the neourethra seems to be an effective method of reducing the fistulous complication rate following primary and secondary hypospadias repair.

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

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.

Download Full-text

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

International Surgery Journal ◽

10.18203/2349-2902.isj20181601 ◽

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.

Download Full-text

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

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v38i2.45629 ◽

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

Download Full-text

THE RELATION OF HYPOSPADIAS TYPES, AGES, AND SURGICAL TECHNIQUES FOR URETHROCUTANEOUS FISTULA COMPLICATION IN CHILD HYPOSPADIAS CASES

Indonesian Journal of Urology ◽

10.32421/juri.v26i2.451 ◽

2019 ◽

Vol 26 (2) ◽

Author(s):

Desy Pratiwi Widjajana ◽

Septa Surya Wahyudi ◽

Ika Rahmwati Sutejo

Keyword(s):

Surgical Technique ◽

Significant Relationship ◽

Surgical Techniques ◽

The Other ◽

Hypospadias Repair ◽

Urethrocutaneous Fistula ◽

Cross Sectional ◽

Surgery Technique ◽

Hypospadias Surgery ◽

Onlay Island Flap

Objective: To find correlation between hypospadias type, age, and surgical technique for urethrocutaneous fistula in child hypospadias cases. Material & Method: This research was an observational analytic research with cross sectional approach. It was conducted at Bina Sehat Jember Hospital, Paru Jember Hospital, and Bhayangkara Bondowoso Hospital. The research samples were hypospadias patients who had done hypospadias repair with susceptible age from 0 months until 16 years. Result: In this study, was found correlation between type of hypospadias with urethrocutaneous fistula (p=0.03 and r=0.43). And the other hand, this research did not find relationship between age at hypospadias surgery with urethrocutaneous fistula complication (p=0.34 and r=0.3). The results of this study indicate that the incidence of urethrocutanoeus fistula complications in the surgery using TIP technique was greater than Onlay Island Flap technique, but in this study, there was no association between hypospadias surgery technique used with complications of uretrocutanoeus fistula (p=0.3 and r=0.22). Conclusion: In this study, there was a significant relationship between hypospadias type with urethrocutaneous fistula complication with statistically moderate strength and positive correlation direction. This study did not show any significant relationship between age and hypospadias surgery technique with complications of urethrocutanoeous fistula.

Download Full-text

Role of tubularization of urethral plate in development of urethrocutaneous fistula post hypospadias repair

Urology Annals ◽

10.4103/ua.ua_152_16 ◽

2017 ◽

Vol 9 (2) ◽

pp. 141

Author(s):

AbdullahK Mohammedkhalil ◽

BasimS Alsaywid ◽

AbdullahA Mesawa ◽

SaifY Alzahrani ◽

AseelH Askar ◽

...

Keyword(s):

Hypospadias Repair ◽

Urethrocutaneous Fistula ◽

Urethral Plate

Download Full-text

Urethral reconstruction in severe hypospadias using buccal mucosa graft and penile skin flap

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1110631m ◽

2011 ◽

Vol 139 (9-10) ◽

pp. 631-637

Author(s):

Marko Majstorovic ◽

Marta Bizic ◽

Vladimir Kojovic ◽

Borko Stojanovic ◽

Zoran Krstic ◽

...

Keyword(s):

Buccal Mucosa ◽

Skin Flap ◽

Urethral Reconstruction ◽

Penile Curvature ◽

Hypospadias Repair ◽

Penile Skin ◽

Local Skin ◽

Urethral Plate ◽

Advantages And Disadvantages ◽

Buccal Mucosa Graft

Introduction. Hypospadias represents the most frequent penile anomaly. The most challenging part of hypospadias surgery is urethral reconstruction. Many various tissues are used (local skin flaps, bladder mucosa grafts, buccal mucosa grafts etc.) for the reconstruction of the neourethra. Objective. Our aim was to evaluate advantages and disadvantages of combined buccal mucosa graft and penile skin flap in urethral reconstruction in severe hypospadias repair. Methods. Between December 2005 and August 2009, 48 patients with severe hypospadias, aged from nine months to 12 years (mean age 23 months) underwent surgery. Thirty-four (71%) had penoscrotal and 14 (29%) scrotal hypospadias. Ventral penile curvature was present in all cases, and was corrected by incision of the short urethral plate. Urethroplasty was performed using a buccal mucosa graft combined with dorsal penile skin flap. Results. Mean follow-up was 22 months (range from 9 months to 3 years). Satisfactory functional and aesthetic results were achieved in 40 (83%) patients. Fistula was noted in six cases and was solved by minor revision. Urethral stenosis in two cases was resolved by simple dilatation. Conclusion. Urethral reconstruction using the buccal mucosa graft and dorsal penile skin flap in severe hypospadias repair could be the method of choice. Using this technique, single stage urethral reconstruction is possible with satisfactory esthetical and functional results.

Download Full-text