Abstract
Background Over the past two decades, Snodgrass tubularized incised plate (TIP) urethroplasty has become one of the dominant surgical techniques with wide applications and excellent cosmetic results. However, TIP has many limitations. We performed a retrospective study at our department and assessed the outcome of the inlay internal preputial graft for extending the applications of TIP.MethodsBetween January 2009 and December 2013, we performed a retrospective study consisting of approximately 508 primary distal and moderate cases. Patients with primary distal hypospadias who had mild or no chordee and good penile development were divided into the following 3 groups based on their procedures: (1) classic TIP hypospadias repair group (n = 198); (2) inlay buccal mucosa graft group (n = 150); and (3) inlay internal preputial graft group (n = 160). The median age was 1.6 years (range 1–4 years). Our data were analyzed statistically by the Chi square test with P < 0.05 indicating significant differences. ResultsThe mean follow-up period was 18 months (range 6‒24 months). In the classic TIP group, the incidence of urinary fistula and meatal stenosis were both 3.0 % (6/198); in the inlay buccal mucosal graft group, the incidence of urinary fistula was 3.3 % (5/150), and the incidence of stenosis was 2.7 % (4/150); and in the inlay internal preputial graft group, the incidence of urinary fistula was 3.1 % (5/160), and the incidence of meatal stenosis was 4.4 % (7/160). The success rates of each group were as follows: the classic TIP group has a success rate of 93.9 % (186/198); the inlay buccal mucosa graft group had a success rate of 94.0 % (141/150); and the inlay internal preputial graft group had a success rate of 92.5 % (148/160). There were no statistically significant differences between the 3 groups with respect to complication rates.ConclusionsAs the inner foreskin Snodgraft does not appear to be worse than the buccal mucosa graft, it is a good method for hypospadias repair, and this method is not inferior to TIP.
Highlights
Over the past two decades, Snodgrass tubularized incised plate (TIP) urethroplasty has become one of the dominant surgical techniques with wide applications and excellent cosmetic results
Asanuma et al (2007) summarized several reports about the complications that can occur after TIP urethroplasty, and the mean overall complication rate was 10.8 %, with a 5.7 % incidence of fistula and a 4.7 % incidence of meatal stenosis
The inlay buccal mucosa graft urethroplasty was used in failed cases or complex urinary fistula repair and produced satisfactory results (Hayes and Malone 1999; Ye et al 2008)
Summary
Over the past two decades, Snodgrass tubularized incised plate (TIP) urethroplasty has become one of the dominant surgical techniques with wide applications and excellent cosmetic results. In 1994, Snodgrass (1994) first reported the use of a tubularized incised plate (TIP) to repair distal hypospadias. The inlay buccal mucosa graft urethroplasty was used in failed cases or complex urinary fistula repair and produced satisfactory results (Hayes and Malone 1999; Ye et al 2008). Choosing the right method for hypospadias repair, achieving extremely good results for any primary situation, and investigating the efficacy and safety of the internal preputial graft was the focus of this study
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