One-stage lingual augmented urethroplasty in repair of distal penile hypospadias

E Elsayed,T Dawod,M Abdalla,M Teleb,A Teelab,M Omran,A Eliwa,A Sakr,W Shabana,S Khalil,L Elbendary

doi:10.1016/j.afju.2014.09.001

Abstract

ObjectivesTo evaluate the outcome of augmentation of shallow urethral plate by lingual graft in repair of distal penile hypospadias. Patients and methodsBetween June 2008 and May 2011, the procedure was performed on 23 patients with mean age 2.3 years (range 1–3). All patients had distal penile hypospadias; 11 sub coronal and 12 coronal. The urethral plate was less than 8mm in all patients and 3 of them had history of previous hypospadias surgery. All procedures were carried out under general anesthesia using 4× magnifying loupe. After penile degloving and dorsal incision of the urethral plate, the lingual graft was harvested and sutured to the edges of the incised urethral plate from the hypospadias opening to the tip of the penis. The neourethra was closed and an intervening flap was fixed over the neourethra as a barrier against fistula formation. ResultsSuccess rate was 87% as 20/23 patients were cured without any permanent complication throughout the follow up period. None of patients suffered meatal stenosis or required regular urethral dilatation. Three patients developed urethrocutaneous fistula, of which two closed spontaneously and one required surgical repair 6 months later. Two patients had failed procedures and delayed re-intervention was performed due to complete loss of the graft in one of them and repair disruption following infection in the other. Two patients had post-operative pain in the graft harvesting site which disappeared within days. ConclusionThe one-stage lingual augmented urethral plate urethroplasty offers promising outcomes for repair of distal penile hypospadias with narrow urethral plate.

Highlights

Introduction and objectivesBeing reported in about 0.7% of all live male births, hypospadias is one of the most common pediatric urologic anomalies [1]
In 1989, Rich et al were the first to introduce the principle of incising the urethral plate in the midline [4], this technique was advanced in 1994 by Snodgrass who described tubularized incised plate urethroplasty (TIP) which has become a popular technique in the management of distal hypospadias [5]
The aim of the present study is to evaluate the outcome of augmenting a shallow urethral plate, using a lingual mucosal graft, for the repair of distal penile hypospadias

Summary

Introduction

Introduction and objectivesBeing reported in about 0.7% of all live male births, hypospadias is one of the most common pediatric urologic anomalies [1]. The main goal of surgical repair is to achieve a good functional, outcome with respect both to urination and sexual activity, as well as good cosmetic results. These should include straightening of the chordee (orthoplasty), transferring the meatus to the tip of the glans (meatoplasty), reconfiguration of the glans itself (glanuloplasty) and revising the abnormal prepuce [2]. The use of oral mucosa in urethral reconstruction was initiated many decades ago, and it was reproduced again by Burger and associates in 1992 [10] It has shown acceptable results, especially in complex cases with deficient local skin, poor plate characteristics or excessive scaring, and in staged procedures [11]. The aim of the present study is to evaluate the outcome of augmenting a shallow urethral plate, using a lingual mucosal graft, for the repair of distal penile hypospadias

Objectives

Methods

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Conclusion