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

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.

Staged buccal mucosa graft Bracka urethroplasty in children with proximal hypospadias

For management of proximal hypospadias in children both one-stage (Hodgson, Ducket), and two-stage (Bracka) technieuqa are used. The staged Bracka repair is preferable because of fewer complications. The objective of the study was to assess and improve the outcomes of treating children with proximal hypospadias by improving the staged buccal mucosa graft Bracka repair. Patients and methods. In the department of uroandrology of the National Children’s Clinical Hospital in the period from 2013 to 2019 126 boys with proximal hypospadias received operative treatment according to the methos of buccal mucosa graft Bracka repair. Depending on whether it was primary surgery or an operation after failed repair, all patients were divided into 2 groups. Results. Both functional and cosmetic outcomes of treatment were assessed in the near and long-term post-operative periods. The assessment of the functional outcomes was based on the following criteria: recovery of free passage of urine with a wide stream (average urinary flow rate) and absence of penile curvature. Cosmetic outcomes were analysed by the HOPE score. Conclusion. Staged buccal mucosa graft urethroplasty permits to obtain positive functional and cosmetic outcomes of treatment in 60% (51% good and 9% satisfactory) of patients in the near and long-term periods. The percentage of complications is 41% and they are mainly presented by urethral fistulae. In patients with a history of failed surgery the risk for developing complications is practically the same as in primary patients. Key words: hypospadias, curvature correction