Snodgrass procedure for distal penile and mid-shaft hypospadias repair in children

Introduction. Hypospadias is one of the most frequent penile malformations in newborn boys. Warren Snodgrass developed the «tubularized incised plate» (TIP) urethroplasty that is the most often procedure used in the surgical treatment of distal hypospadias for the last 20 years. Despite the great popularity of the technique, its no less famous Grafted TIP (GTIP) modification appeared. The technique is aimed at filling the defect in the urethral site with a foreskin free flap followed by tubularized urethroplasty.Purpose of the study. To compare the outcomes of TIP and GTIP procedures in our clinic which have been performed in the last 10 years.Materials and methods. One hundred-fourteen boys with hypospadias (aged 6 mo – 15 years) were operated on using the TIP technique and its modification GTIP during 2010 – 2020 (Sochi Center of Motherhood and Childhood Protection). The patients were: boys up to 1 year – 27 (23.7%), from 1 to 3 years – 57 (50%), 4 – 7 years – 19 (16.7%), from 8 to 14 years – 14 (12.3%). Primary repair was done in 112 cases (98.2%), the second procedure was done in 2 (1.8%) cases. There were 94 (82.5%) boys with distal hypospadias and 20 (17.5%) children with mid-shaft hypospadias. All patients were examined 3 and 12 months after surgery. We assessed the degree of skin scar process on the penile shaft, the location of the meatus and the quality of urination during the examination.Results. We observed 27 (23.7%) complications after urethroplasty out of 114 treated boys. There were 13 (11.4%) cases of urethral fistula, which were secondary repaired 6 months later. Meatal stenosis was observed in 2 (1.8%) cases, which required secondary meatoplasty. Repeat urethroplasty was done in 10 (8.7%) cases due to neourethral suture failure. There were also 2 (1.8%) cases of secondary penile curvature that required repeat surgery. The good cosmetical and functional results were achieved finally in all children.Conclusion. The analysis of our ten-year experience of using TIP-urethroplasty and its GTIP modification did not reveal significant differences in the overall incidence of postoperative complications. Yet, using the TIP procedure is associated with more fistulas. There were more cases of urethral suture failure in children whom the GTIP technique was performed. Our data suggest the need for a selective approach in the formation of indications for using TIP and GTIP procedures, along with research aimed at finding criteria for patient selection.

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The impact of COL1A1 and COL6A1 expression on hypospadias and penile curvature severity

BMC Urology ◽

10.1186/s12894-020-00760-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Prahara Yuri ◽

Gunadi ◽

Rahmadani Puji Lestari ◽

Firly Putri Fardilla ◽

Wiwit Ananda Wahyu Setyaningsih ◽

...

Keyword(s):

Extracellular Matrix ◽

Polymerase Chain Reaction ◽

External Genitalia ◽

Penile Curvature ◽

Moderate Correlation ◽

Chain Reaction ◽

Polymerase Chain ◽

Distal Hypospadias ◽

Male External Genitalia ◽

The Impact

Abstract Background Hypospadias, the most frequent congenital male external genitalia abnormality, is usually associated with curvature of the ventral penis, i.e. chordee. Abnormality of darto tissue has been suggested as the pathophysiology of chordees. Collagen is one of the most abundant fibrous proteins within the extracellular matrix. In this study, we determined the expression of collagen 1 (COL1A1) and COL6A1 in patients with hypospadias and associated them with the severity of penile curvature. Methods We included 60 children < 18 years old, consisting of 20 distal hypospadias, 20 proximal hypospadias patients, and 20 controls in our institution from 2017 – 2020. The expression of COL1A1 and COL6A1 in darto tissue was determined by reverse-transcriptase polymerase chain reaction (qPCR). The penile curvature severity was classified as mild (< 30 degrees), moderate (30–60 degrees), and severe (> 60 degrees). Results qPCR showed that COL1A1 and COL6A1 expression was significantly downregulated in the distal (0.88 (0.38–2.53) and 0.54 (0.16–4.35), respectively) and proximal 0.76 (0.33–2.57) and 0.57 (0.18–1.38), respectively) hypospadias groups compared to controls (1.85 (0.24–4.61) and 0.93 (0.17–4.06), respectively) with p-values of 0.024 and 0.018, respectively. Furthermore, there was a moderate correlation between COL1A1 and COL6A1 expression (r = 0.458, p < 0.0001). Interestingly, COL1A1 and COL6A1 were also significantly downregulated in the moderate and severe chordee groups compared to the mild chordee groups, with p-values of 0.003 and 0.037, respectively. Conclusions Aberrant COL1A1 and COL6A1 expression might affect abnormalities in darto tissue and penile curvature severity in hypospadias patients.

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Postoperative outcomes in distal hypospadias: a meta-analysis of the Mathieu and tubularized incised plate repair methods for development of urethrocutaneous fistula and urethral stricture

Pediatric Surgery International ◽

10.1007/s00383-019-04523-z ◽

2019 ◽

Vol 35 (11) ◽

pp. 1301-1308 ◽

Cited By ~ 4

Author(s):

Hans Winberg ◽

Einar Arnbjörnsson ◽

Magnus Anderberg ◽

Pernilla Stenström

Keyword(s):

Urethral Stricture ◽

Meta Analysis ◽

Statistical Significance ◽

Urethrocutaneous Fistula ◽

Levels Of Evidence ◽

Tubularized Incised Plate ◽

Postoperative Fistula ◽

Distal Hypospadias ◽

Based Medicine

Abstract Purpose To compare the two major complications, namely postoperative urethrocutaneous fistula and urethral stricture, between the Mathieu and tubularized incised plate (TIP) repair methods for distal hypospadias. Methods In this meta-analysis, electronic databases were searched for comparative studies on the two techniques. The Oxford Centre for Evidence-based Medicine Levels of Evidence was used to evaluate the included studies. The main outcome measure was the frequency of postoperative fistula and urethral stricture. RevMan 5.3 was used for statistical analyses, with P < 0.05 indicating statistical significance. Results A total of 17 studies, which included 1572 patients, met the inclusion criteria. The frequency of urethrocutaneous fistula did not differ between the Mathieu [115 (13%)] and TIP [90 (13%)] methods [odds ratio (OR) 1.1, 95% confidence intervals (CI) 0.6–1.9; P = 0.73)]. Urethral stricture was less frequent after the Mathieu [15 (2%)] method than after the TIP [37 (5%)] method (OR 0.5, 95% CI 0.3–0.8; P < 0.01), even after the subgroup analysis of eight randomized controlled trials was included. Overall, the quality of the included studies was determined to be satisfactory. The levels of evidence on which this review was based ranged from 1b to 2b using the CEBM Levels of Evidence. Conclusion Compared with TIP repair, Mathieu repair for hypospadias had a significantly lower risk for urethral stricture; however, the risk for urethrocutaneous fistula was similar.

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Comparison of meatal-based flap (Mathieu) and tubularized incised-plate (TIP) urethroplasties for primary distal hypospadias: A systematic review and meta-analysis

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2020.03.013 ◽

2020 ◽

Vol 55 (12) ◽

pp. 2718-2727

Author(s):

Yuanfeng Zhang ◽

Zeren Shen ◽

Xinye Zhou ◽

Zepai Chi ◽

Xuwei Hong ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Tubularized Incised Plate ◽

Distal Hypospadias

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Achieving a natural glanular meatus for distal hypospadias with a narrow and shallow plate: Tubularized incised plate versus modified Barcat repair

International Journal of Urology ◽

10.1111/j.1442-2042.2008.02063.x ◽

2008 ◽

Vol 15 (7) ◽

pp. 616-620 ◽

Cited By ~ 3

Author(s):

Yutaro Hayashi ◽

Yoshiyuki Kojima ◽

Kentaro Mizuno ◽

Satoshi Kurokawa ◽

Akihiro Nakane ◽

...

Keyword(s):

Plate Versus ◽

Tubularized Incised Plate ◽

Distal Hypospadias

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A New Fibrin Seal: Functional Evaluation of Sensory Regeneration Following Primary Repair of Peripheral Nerves

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(94)90179-1 ◽

1994 ◽

Vol 19 (2) ◽

pp. 250-254 ◽

Cited By ~ 12

Author(s):

B. POVLSEN

Keyword(s):

Peripheral Nerves ◽

Primary Repair ◽

Functional Results ◽

Relevant Information ◽

Functional Evaluation ◽

Sprague Dawley ◽

Morphological Examination ◽

Sprague Dawley Rats ◽

Low Threshold ◽

Fibrin Seal

A new fibrin seal has recently been evaluated in terms of axonal regeneration; however morphological examination of the fibre composition of regenerated nerves may not necessarily provide functionally relevant information. This study therefore aims to evaluate the functional regenerated sensation, following peripheral nerve transection treated with fibrin seal (Tisseel-Duo, Immuno; Austria). The sural nerve-innervated skin of the rat hindfoot served as the target organ. Previously published results from animals following transection and suture served as controls. Ten 3-month-old female Sprague-Dawley rats were used. The sciatic nerve was divided and rejoined with fibrin seal. The rats were allowed unrestricted movement directly after surgery and allowed to survive for 3 months. Our observations show that the functional results of regenerated polymodal nociceptors and low-threshold mecanoreceptors show no statistical difference when compared with microsuture. This strengthens the early positive morphological impression of this new product. Further prospective studies in man are anticipated.

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