scholarly journals A Comparative Study to Evaluate the Outcome of Double Dartos Flap in Tubularized Incised Plate Urethroplasty for Distal Hypospadias Repair

2015 ◽  
Vol 3 (2) ◽  
pp. 65-70
Author(s):  
Abhi Kumar Chakraborty ◽  
Sajal Kumar Majumdar ◽  
Mirza Kamrul Zahid ◽  
Sayed Mahmudur Rahman ◽  
Dipankar Kumar Saha ◽  
...  
Keyword(s):  
Double Layer ◽  
Fistula Formation ◽  
Hypospadias Repair ◽  
Tubularized Incised Plate ◽  
Superficial Skin ◽  
Group A ◽  
Dartos Flap ◽  
Tubularized Incised Plate Urethroplasty ◽  
Distal Hypospadias ◽  
Group B

Background/purpose: The tubularized incised plate urethroplasty (Snodgrass technique) presents the procedure of choice for distal hypospadias repair. Fistula formation is the most common complication with various rates. Avoiding overlap of suture lines in the Snodgrass repair is critical to minimize fistula formation through second-layer coverage of the neourethra. We compared the outcome of double- layer dartos flaps to flapless procedure in the tubularized incised plate urethroplasty for distal hypospadias repair to assess the effectiveness of dartos flap in this method.Methods: Our study included 28 patients aged upto 12 years who were treated with tubularized incised plate urethroplasty for distal hypospadias in Shaheed Suhrawardy Medical College Hospital from April 2010 to December 2011. They were divided into two groups. Group A (14 patients) had double dartos flap coverings. Group B (14 patients) had no dartos flap covering. The dissected dorsal dartos flap was bisected vertically to form two pedicle wings. Each wing was rotated laterally from either side of the glans to cover the neourethra ventrally in a double-layer fashion.Result: Mean follow up period was 9 months. In Group A, one patient (7%) developed fistula and one (7%) superficial skin necrosis. On the other hand three (21%) patients developed fistula and one patient (7%) meatal stenosis in group B, who were treated with Snodgrass procedure without using dartos flap. All successful repaired hypospadias patients of both groups had a cosmetically normal looking circumcised penis with ventrally slit meatus.Conclusions : Double dartos flaps covering of the neourethra is a simple procedure and could be effective for the prevention of urethrocutaneous fistula after tubularized incised plate urethroplasty.J. Paediatr. Surg. Bangladesh 3(2): 65-70, 2012 (July)

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 Comparative Study Between Outcomes of Tubularized Incised Plate Urethroplasty and Modified Tubularized Incised Plate Urethroplasty in the Management of Distal Hypospadias

2020 ◽  
Vol 17 (2) ◽  
pp. 75-81
Author(s):  
Ma Salam ◽  
M Asaduzzaman ◽  
MR Quddus ◽  
Amar Chouudhury ◽  
Md Faisal Islam ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
P 75 ◽  
Stricture Urethra ◽  
Tubularized Incised Plate ◽  
Group A ◽  
Tubularized Incised Plate Urethroplasty ◽  
Distal Hypospadias ◽  
Group 2 ◽  
Group B ◽  
Primary Management

Objective: To compare the outcomes of tubularized incised plate urethroplasty and modified tubularized incised plate urethroplasty in the primary management of distal hypospadias Materials and Methods: Total 70 patients of age group 2 to 10 years with distal hypospadias were selected for this study from January 2008 to December 2010. They were divided into Group-A (n=35) treated by the tubularized incised plate urethroplasty and Group-B (n=35) treated by the modified tubularized incised plate urethroplasty.The modification was performed by using inner preputial skin on the incised plate before tubularization. All patients were followed up immediately and at 4th, 8th and 12th weeks after operation. Results: The satisfactory cosmetic and functional outcomes were observed in 29 patients (82.85%) of Group-A and all families of Group-B were happy with aesthetic and functional outcomes. Urethrocutaneous fistula developed in 5 patients (14.70%) patients of Group- A and 1 (2.94%) patient in Group-B. Three patients (8.82%) in group-A and one patient (2.94%) in group-B were found to develop meatal stenosis. One patient (2.94%) developed stricture urethra in group A but no patient in group-B developed urethral stricture. Overall complications occurred in 10 patients (29.41%) in Group-A and 2 patients (5.88%) in Group-B. Conclusions: This study demonstrates that modified tubularized incised plate urethroplasty had excellent cosmetic and functional outcomes and fewer complications than that of tubularized incised plate urethroplasty in the primary management of distal hypospadias. Bangladesh Journal of Urology, Vol. 17, No. 2, July 2014 p.75-81

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 Hypospadias in toddlers: a multivariable study of prognostic factors in distal to mid-shaft hypospadias and review of literature

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.

scholarly journals A comparative study of two operative procedures in anterior hypospadias repair: limited urethral mobilization and tubularized incised plate urethroplasty.

2021 ◽  
Vol 28 (11) ◽  
pp. 1578-1584
Author(s):  
Shafiq ur Rehman ◽  
Fareena Ishtiaq ◽  
Zarlish Fazal ◽  
Muhammad Anwar ◽  
Saad Fazal
Keyword(s):  
Hospital Stay ◽  
Functional Outcomes ◽  
Operative Time ◽  
Operation Time ◽  
Cosmetic Appearance ◽  
Tubularized Incised Plate ◽  
Group A ◽  
Tubularized Incised Plate Urethroplasty ◽  
The Mean ◽  
Group B

Objectives: This study is aimed to compare the results of limited urethral mobilization and tubularized incised plate urethroplasty in the management of anterior hypospadias, in terms of cosmetic and functional outcomes, complication rate, operative time, and hospital stay. Study Design: Prospective Randomized Controlled study. Settings: Department of Pediatric Surgery, DHQ Teaching Hospital Sahiwal. Period: January 2019 to December 2020. Material and Methods: A total of 89 patients with anterior hypospadias were included. Patients were divided randomly into two groups. In group A, limited urethral mobilization was performed and in group B, tubularized incised plate urethroplasty was carried out. A self-structured performa was used to collect the data of all patients. Both groups were compared in terms of the operation time, hospital stay, postoperative complications, cosmetic appearance, and functional outcomes. Results: Forty-five patients were included in group A, age ranged from 2.5 to 12 years (mean 4.83years). Forty-four patients were included in group B and their ages ranged from 3.5 to 11years (mean 4.76 years). The operation time was significantly less for group A than for group B. In group A, it ranged from 54 to 69 min with an average time of 60.51 min and in group B from 70 to 88 min, with an average of 79.34 min. The mean hospital stay period in group A was 7.37 days, ranged from 7 to 9 days, and in group B was 11.04 days, ranging from 10 to 13 days. The mean follow-up period in both groups was 7.45 months, ranging from 3 months to 12 months. Meatal stenosis was the most common complication in group A, which developed in 6.66% (n=3) patients. Urethrocutaneous fistula was the most common complication in group B, which developed in 6.81% (n=3) patients. Cosmetic appearance and functional outcome were good and comparable in both groups. Conclusion: Although both techniques, tubularized incised plate and limited urethral mobilization urethroplasty are acceptable modalities for the management of anterior hypospadias. But limited urethral mobilization urethroplasty seems to be a good option due to its simplicity, short hospital stay, significant shorter operative time, low fistula formation rate, and good cosmetic and functional outcomes.

scholarly journals What is the best choice for repair of distal penile hypospadias: The tubularized incised plate urethroplasty or anterior urethral advancement technique?

2007 ◽  
Vol 40 (02) ◽  
pp. 182-188
Author(s):  
Mohamed M.S Awad ◽  
Adel M Tolba ◽  
Khaled M Saad ◽  
Zaghlol R Mahmoud ◽  
Ahmed Ezzat Rozigque ◽  
...  
Keyword(s):  
Operative Time ◽  
Good Choice ◽  
Short Operative Time ◽  
Tubularized Incised Plate ◽  
Significant Difference ◽  
Good Cosmetic ◽  
Group A ◽  
Tubularized Incised Plate Urethroplasty ◽  
Fistula Rate ◽  
Group B

ABSTRACT Background and Aim: Numerous ingenious methods have been introduced to repair hypospadias with variable results. we tried to evaluate the two techniques, tubularized incised plate urethroplasty (tip) and anterior urethral advancement (aua) for repair of distal hypospadias and choose the best method to treat the distal type of penile hypospadias with the least complications.Materials and methods :A total of 140 boys with distal penile hypospadias were divided into two groups. group a (68 patients) was treated with tip and group b (72 patients) was treated with aua. all the patients had an average age of three years (2-19) with variable meatal sites coronal (44) sub coronal (53) and anterior penile hypospadias (43). there was no significant difference between both groups with respect to the age and meatal sites.Results: The fistula rate in group a was 8.8% versus 1.3% in group b. there was no urethral stricture in both procedures. wound dehiscence did not occur in group a versus one case in group b (1.3%). in group a, 26 cases (38.3%) had mild glanular torsion and five (7.3%) had moderate glanular torsion versus none in group b postoperatively. no postoperative chordee or binding in group a, versus four patients (5.5%) in group b. no significant difference was observed in both groups with respect to meatal stenosis (7.3% versus 5.5% respectively). there was a significant difference between both groups with regard to the operative time in favour of group b. good cosmetic appearance of the glans was achieved in both techniques.Conclusion: Both techniques can treat this anomaly with a high success rate but the modified aua technique appears to be a good choice due to its simplicity, short operative time and less fistula rate with good cosmetic results.

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