Repair Of Distal Penile Hypospadias Research Articles

The cosmetic outcome of distal penile hypospadias repair using stitch-by-stitch glanuloplasty versus TIP: a non-randomized retrospective study

The cosmetic outcome of distal penile hypospadias repair using stitch-by-stitch glanuloplasty versus TIP: a non-randomized retrospective study

Comparative outcomes among inlay grafted incised plate, onlay preputial flap and tubularized incised plate urethroplasty for the repair of distal penile hypospadias with a narrow urethral plate

PurposeWe conducted this study, comparing the outcomes among Transverse Onlay Island Flap, inlay grafted incised plate and our previous records of tubularized incised plate urethroplasty (TIPU) in patients with narrow urethral plates, aiming to determine which method of repair provides a good outcome.MethodsThis hybrid study included two datasets. The first from a prospective randomized study evaluating outcomes of two treatment modalities; Inlay graft and only flap for distal hypospadias with shallow urethral plate with 80 patients (40 patients in each group) included, the second based on our previous records of TIPU in 40 patients with distal primary hypospadias with narrow urethral plate.ResultsThe success rate in inlay graft urethroplasty group (n = 40) was 87.5%; glandular dehiscence occurred in one case (2.5%), fistulas occurred in 2 cases (5%), and narrow meatus occurred in two cases (5%). Success rate in onlay flap urethroplasty group (n = 40) was 82.5%; glandular dehiscence occurred in two cases (5%), fistulas occurred in two cases (5%), and narrow meatus occurred in three cases (7.5%). TIPU group (n = 40) had success rate of 62.5%; glandular dehiscence occurred in eight cases (20%), fistulas occurred in five cases (12.5%), and narrow meatus occurred in seven cases (17.5%), with five cases exhibiting both narrow meatus with fistula.ConclusionInlay graft and onlay flap urethroplasty for repair of distal penile hypospadias with narrow urethral plate had higher success rate and fewer complications than traditional TIPU. Moreover, operative time was shorter in TIPU.

A comparative study of distal hypospadias repair combined with preputioplasty vs repair using conventional circumcision technique

Background: Hypospadias is one of the most common congenital anomalies characterised by underdevelopment of the ventral anatomical structures of the penis including skin, urethra, corpora spongiosum and prepuce and urethral opening can occur anywhere from the perineum to the ventral aspect of penis. This study evaluated and compared short-term cosmetic and functional outcomes and complications of distal hypospadias repair combined with preputioplasty with the repair using circumcision. Materials & Methods: Patients were divided in two groups with 25 patients in either group. Group A patients underwent urethroplasty with circumcision whereas Group B patients were offered preputioplasty as an additional procedure. Clinical examination included location of the urethral meatus on the ventral aspect of the penis, presence or absence of associated chordee, stretched penile length, penile circumference, glans girth, depth of the navicular fossa or glans groove, urethral plate width, status of the preputial hood and testicular examination. Post-operatively, penis was examined for the location and shape of the neo-meatus, any complications in the form of meatal stenosis, urethrocutaneous fistula, preputial dehiscence and phimosis. Results: Both the groups were comparable with respect to the age at presentation and status of the urinary stream. Distal penile hypospadias predominated in both the groups and it was present in 21 patients in group A and 24 patients in group B. Rest of the babies had sub-coronal hypospadias. Preputial hood and navicular fossa/glans groove were good in either group. Mean stretched penile length in group A was 5.14 cm and it was 4.78 cm in group B children (p value- 0.141). Mean penile circumference of group A and group B patients ware 3.88 cm and 3.68 cm respectively (p value- 0.139). Girth of the glans and mean urethral plate width were also comparable (p values- 0.258 and 0.621 respectively). Final meatal appearance was slit shaped and wide in 22 patients in group A and 21 patients in group B. Urethro-cutaneous fistula was observed in two babies in group A and a single child in group B. One of the children was noted to have preputial dehiscence after two weeks. Prepuce was retracting well in 24 children during the 3rd follow up whereas one patient developed phimosis and thus results of the preputioplasty as an adjunct procedure were found to be satisfactory. Conclusion: Preputioplasty is a safe procedure and should be offered to all children undergoing single-stage distal penile hypospadias repair as it provides a near normal penile appearance at the cost of additional approximately 8% foreskin related complication rate.

Outcomes of Snodgrass (TIP) versus Slit Like Adjusted Mathieu (SLAM) in distal penile hypospadias repair in pediatrics

Outcomes of Snodgrass (TIP) versus Slit Like Adjusted Mathieu (SLAM) in distal penile hypospadias repair in pediatrics

Outcomes of Snodgrass (TIP) versus Slit Like Adjusted Mathieu (SLAM) in distal penile hypospadias repair in pediatrics

Outcomes of Snodgrass (TIP) versus Slit Like Adjusted Mathieu (SLAM) in distal penile hypospadias repair in pediatrics

Reconstructive Techniques of Primary Distal Penile Hypospadias: A Meta-Analysis Study of Last 10 Years

Abstract Background Hypospadias is one of the most common congenital anomalies affecting males worldwide, with distal variants representing up to 70% of all cases. Several surgical techniques are adopted for distal hypospadias repair. However, there is still much controversy about the ideal technique. Objectives The aim of this study is to compare between the most popular reconstructive techniques for distal penile hypospadias repair. Highlighting their effectiveness, in term of success rate as well as the risk of postoperative complications. Methods For this systematic review, PubMed/Medline and ScinceDirect online databases were searched using the keywords ‘distal hypospadias, complications and outcome’. Inclusion criteria were primary repairs; distal hypospadias; pediatric case series and standard techniques. Abstracts of articles identified were reviewed, and then relevant articles were retrieved in full. Papers were only included if data on at least one of the main outcome measures was obtainable, which are postoperative fistula, meatal stenosis and glanular dehiscence. Data were pooled using CMA software, effect sizes were reported as event rates with 95% confidence intervals (CI) been calculated for each outcome. Results A total of 25 studies, which included 4572 patients, met the inclusion criteria. The tubularised incised plate (TIP) was the most commonly adopted procedure followed by the peri-meatal flap (Mathieu). Few studies reported data for other techniques like onlay flap, Thiersch-Duplay, meatal advancement and MAGPI procedures, in addition to urethral mobilization technique. The overall incidence of main complications was 10.5% with comparable results among different techniques. The results are in favor of urethral mobilization and TIP procedures over Mathieu regarding the incidence of both meatal stenosis and post-operative fistula. Overall, the quality of the included studies was determined to be satisfactory. Conclusion Compared with Mathieu technique, urethral mobilization and the TIP procedure for distal penile hypospadias (DPH) reconstruction were associated with a lower risk of overall complications specifically postoperative fistula and meatal stenosis.

Stentless hypospadias repair: The way forward

Background: Stentless repair of hypospadias has been previously described in the literature for distal penile hypospadias repair. This was a prospective non-randomized study with the aim of assessing the efficacy of stentless repair in our health-care system. Methods: A total of 104 patients managed prospectively for hypospadias over a 30-month period who met the inclusion criteria were included in the study and underwent a stentless modified tubularized incised plate (TIP) urethroplasty repair (with a slight modification described subsequently) by three surgeons and were followed up for a minimum period of six months. Results: The median age at surgery was eight months. The site of meatus was glanular in 20 patients, coronal in 36 patients, sub-coronal in 38 patients and mid-penile in 10 patients. The median operative time was 47 minutes (range 32–76 minutes). The median time to first micturition was 140 minutes (range 10–300 minutes). Voiding difficulty was encountered in two patients, requiring catheterization. Three patients had superficial surgical site infections which were conservatively managed. All patients were discharged on the second postoperative day, except for the three patients with surgical site infection. On follow-up, two patients had a fistula. Conclusion: Stentless repair of hypospadias is the future and the new standard of care and should be used in every case where a modified TIP repair is feasible. This decreases complications from urethral stenting and decreases the duration of hospital stay. Both patient and parents are comfortable with this procedure. Level of evidence Level 2.

Assessment Study of Glans Approximation (Wingless Glanuloplasty) for Repair of Distal Penile Hypospadias (Pilot Study)

Abstract Background Hypospadias refers to a birth defect of the urethra in the male where the urinary opening is not at the correct location on the head of the penis. It is the second most common birth abnormality in boys, affecting approximately 1 of every 300. Objective To evaluate the outcomes, safety, efficacy, and cosmetic appearance of glans approximation (wingless glanuloplasty) in treatment of distal penile hypospadias (glanular & coronal). Patients and Methods The study was Controlled, Prospective pilot study, conducted on (10) patients with penile hypospadias with different degree (coronal & DPH). This study was done at El- Demerdash University Hospital and take one year. The patients were who fulfill the following inclusion criteria. Results As regards the complication rate in our study, we found that these complications similar between the two groups, with non significant differences. Regarding coronal group, complications were detected in 5 out of the 7 cases (2 cases developed infection, and one case with hematoma, catheter blockage or fistula). Regarding DPH group, complications were found in 2 out of the 3 cases (one case for each of hematoma and fistula). None of the studied cases in the two groups developed catheter slippage, meatal stenosis or glans dehiscence. Conclusion Approximated glanuloplasty has many advantages, lower operative time, lower blood loss, no need for tourniquet and is a simple procedure for the hypospadiologist.

A comparative study between Snodgrass and urethral advancement methods in the repair of distal penile Hypospadias

Background: Numerous original methods have been introduced to repair hypospadias with variable results. Aim of The Work: The aim of this work is to evaluate the two techniques, Snodgrass and anterior urethral advancement for the repair of distal hypospadias. Materials and Methods: A total of, 16 patients with distal hypospadias underwent primary repair in a prospective controlled randomized trial. Eight patients were allocated for a Snodgrass procedure and another 8 patients were allocated for a urethral advancement procedure. A comparative study was conducted, and the outcome was evaluated in terms of satisfactory functional and cosmetic outcomes. The study was done between January 2019 and December 2019. Results: The mean duration of surgery was significantly shorter for the Urethral advancement than for the Snodgrass procedure 56 minutes versus 76 minutes respectively. The cosmetic and functional results were better in the urethral advancement than Snodgrass. All patients healed uneventfully but one of the patients who underwent urethral advancement repair had chordee. One patient had a urethrocutaneous fistula and two patients had a failure of repair that occurred in the Snodgrass group. Conclusion: Urethral advancement is a safer and more reliable modality for the primary repair of distal penile hypospadias. It has many advantages, shorter operative time and better functional and cosmetic results.

Snodgrass vs Snodgraft operation to repair the distal hypospadias in the narrow urethral plate

Using the Snodgraft technique in patients with urethral plate less than 8mm to repair distal hypospadias is still debatable. Some authors assume that augmentation may be beneficial. We aimed to compare the outcomes of the Snodgrass vs Snodgraft procedure in patients with a narrow urethral plate less than 8mm. This prospective randomized study included 60 children who had been treated by the Snodgrass or Snodgraft procedure for repair of distal penile hypospadias with narrow urethral plate from March 2017 to September 2018. They were randomized into two subgroups. Group 1 (30 patients) underwent tubularized incised plate urethroplasty, whereas the second group (30 patients) underwent the Snodgraft procedure by using the inner prepuce. Operative details, postoperative period, and complications were reported and statistically analyzed using IBM SPSS software package version 20.0. The operative time was longer for patients who underwent the Snodgraft procedure: 78 (55-95) and 110 (80-140) minutes in groups 1 and 2, respectively. In group 1, there was one case of meatal stenosis which was resolved by urethral dilation using the local anesthetic cream in the outpatient clinic. In addition, there was another case of distal penile fistula. In group 2, there was a case of complete wound disruption and another of distal penile fistula. There was no significant difference in the complication rate in any group. The operative time was longer in group 2 than in group 1 but with comparable outcomes. The Snodgraft procedure is not superior to the Snodgrass operation in the narrow healthy urethral plate.

Classic Snodgrass Versus Inner Preputial Inlay Grafted Snodgrass in Distal Penile Hypospadias Repair

Assessment of the outcome of G-TIP technique in primary distal hypospadias repair in comparison to TIP repair using HOSE score This study had been performed between June 2018 and June 2019 which included 50 patients all presented to urological outpatient clinic of Benha university hospital -Egypt- with different types of primary distal hypospadias. They were divided into two groups (Group A operated upon using classic Snodgrass TIP urethroplasty and Group B operated upon using G-TIP urethroplasty technique), each group included 25 patients. Circumcised cases or cases with penile chordea more than 30 degree were excluded from the study. Urethral catheter might have been exited set up for particular case week on 10 times. Catch up might have been consistently during 1st, 3rd Also 6th months (3 patients didn't go to the 6th month catch up 2 from one assembly An tip Also particular case starting with the G-TIP assembly B). Mean hose score a t 6th month might have been 15. 7 out about 16 Previously, tip and 15. 5 Previously, G-TIP (P 0. 52 (NS)). In the tip aggregation those score might have been because of difficulties which incorporated an instance for urethrocutaneous fistula and an instance about meatal stenosis with urethrocutaneous fistula same time in the G-tip an instance from claiming glans dehiscence What's more an instance about gentle remaining chordea. Constantly on effects demonstrated no noteworthy measurable distinction between the two bunches but more agent chance 91. 4±6. 2 minutes in the G-TIP assembly contrasted with main 85. 2±6. 3 to tip gathering (P 0. 002 (S)), those time used for harvesting, get ready Also inlaying those graft. We finished up that G-TIP urethroplasty is a great elective procedure of the excellent tip repair shed for tantamount comes about Furthermore Despite there were no noteworthy measurable distinction the middle of those 2 gatherings in regards complications, G-TIP gatherings demonstrated preferred outcomes Concerning illustration view meatal stenosis Also urethrocutaneous fistula yet all the for longer agent run through.

Stented versus Non-Stented Snodgrass Urethroplasty for Distal Hypospadia Repair

Background: Hypospadia is one of the most common congenital anomalies in children. Patients with distal hypospadias can be treated successfully with a tubularized incised plate (TIP) urethroplasty, usually with a postoperative urethral stent to divert urine into the diaper or a urine bag for approximately 1 week. However, these stents have their own morbidity and complications. We therefore tried to determine the safety of distal penile hypospadias repair without the use of a postoperative stent. Patients and Method: Fifty patients with distal penile hypospadias were prospectively assessed from May 2016 to August 2018. All patients underwent Snodgrass urethroplasty by the same surgeon. Half of the patients had a postoperative stent for 1 week. The other half had no stent. Clinical follow-up was over 6 months with an emphasis on possible stent-related complications. Results: Fifty children underwent TIP urethroplasty for distal hypospadia repair. The mean age was 5.9 years (range 2–12). In 25 cases, a stent was removed within 1 week. In the other 25 cases, no postoperative stent was placed. The overall complication rate for the stented group was 48% (n = 12) and for the non-stented group 68% (n = 17), respectively. In the stented group, 1 patient (4%) developed a fistula, whilst there were 2 (8%) in the non-stented group. All fistulas were repaired after 6 months postoperatively. Neourethral stenosis and glans dehiscence occurred in each 1 case (4%) in both groups. Differences were not statistically significant. However, there were significantly more wound infections in the stented group. On the other hand, stents prevented temporary urinary retention which occurred in 2 patients in the non-stented group. Conclusion: Despite the limited number of cases, our study suggests that, all in all, there is no significant difference in severe complication rates regardless whether a postoperative stent is used or not.

Tubularized Incised plate(Snodgrass)urethroplasty as the Surgical Technique of Choice for Repair of Distal and Midshaft Hypospadias in Tikrit Teaching Hospital

Background: The Snodgrass technique is a widely accepted method for hypospadias repair. Snodgrass has a urethroplasty of tubularized incised plate (TIP) type for repair of distal penile hypospadias. It was with encouraging results and also applied to hypospadias of proximal type. Objective:To evaluate Conducting surgical techniques performed to repair the submicillator. Patients and Methods: In this study, we follow the patient post operatively within three months after performing this technique and notice its final outcome with respect to postoperative complications and outcome, with emphasis on meatal stenosis, fistula formation, residual chordee and penile torsion. Results: We reviewed the results of 60 cases treated by Snodgrass urethroplasty between March 2012 and February 2014at the urological department in Tikrit Teaching Hospital. In this study, performed Snodgrass technique on 60 cases for primary hypospadias , The boys age at time of operation ranged from 18 months to 14 years. The mean age of the children was 5 years. Complications occurred in 8 patients (13.3%). Aurethrocutaneous fistula occurred in 6 patients (10%). three (5%) of these patients with u.c.fistula associated with meatal stenosis . one patient develop meatal stenosis only and Penile torsion was recorded postoperatively in one patient also. Conclusion: A shorter urethral plate incision, use of a lateral and preputial dartos flap to cover the neourethra and more extensive skin degloving in Snodgrass urethroplasty reduce the rate of complications.

Outcome of Snodgrass Repair of Distal Penile Hypospadias with Stented and Unstented Urethra

Background: Hypospadias is the most common congenital malformation of penile shaft occurring in 1 per 300 male births; it is considered a common clinical problem as it causes not only functional problems but also psychological problems for parents. Objective: The objectives of this study is to review the result of TIP repair of distal penile hypospadias in terms of outcome and complications of stenting and unstenting the urethra. Patients and methods: As a prospective randomized study; this study has included patients with distal penile hypospadias operated with Snodgrass between year 2011-2018 and had divided to (group A) included 40 patients operated upon with stent preservation for a week (group B) was 20 patients with stent removed at the end of the operation. Results: Regarding group (A) the stent of 10 cases had slipped at the first 8 hour postoperative so they have been added to the count of (group B) and considered as unstented repair. It is clear here in our study that meatal stenosis rate were different from Snodgrass rate but were similar to other published studies. Other comparable items as fistula rate, urinary retention and hospital stay, were the same as published studies. Conclusion: It could tell that removing the catheter can reduce bladder spasm , urinary tract infections, and patient discomfort and improve the familiar compliance without increasing acute retention episodes and fistula rate, so that at least in some cases specially in distal types, leaving stent can be avoided.

Outcome of Snodgrass Repair of Distal Penile Hypospadias with Stented and Unstented Urethra

Background: Hypospadias is the most common congenital malformation of penile shaft occurring in 1 per 300 male births; it is considered a common clinical problem as it causes not only functional problems but also psychological problems for parents. Objective: The objectives of this study is to review the result of TIP repair of distal penile hypospadias in terms of outcome and complications of stenting and unstenting the urethra. Patients and methods: As a prospective randomized study; this study has included patients with distal penile hypospadias operated with Snodgrass between year 2011-2018 and had divided to (group A) included 40 patients operated upon with stent preservation for a week (group B) was 20 patients with stent removed at the end of the operation. Results: Regarding group (A) the stent of 10 cases had slipped at the first 8 hour postoperative so they have been added to the count of (group B) and considered as unstented repair. It is clear here in our study that meatal stenosis rate were different from Snodgrass rate but were similar to other published studies. Other comparable items as fistula rate, urinary retention and hospital stay, were the same as published studies. Conclusion: It could tell that removing the catheter can reduce bladder spasm , urinary tract infections, and patient discomfort and improve the familiar compliance without increasing acute retention episodes and fistula rate, so that at least in some cases specially in distal types, leaving stent can be avoided.

Tubularized incised plate urethroplasty (Snodgrass procedure) for distal penile hypospadias: A regional center experience

Objective: Tubularized incised plate (TIP) urethroplasty has rapidly become the procedure of choice for repair of distal penile hypospadias (DPH) at most of the centers throughout the world. We did some modifications in the original technique to improve the outcome. In this article, the technique of TIP urethroplasty is discussed and literature is reviewed. Materials and Methods: TIP urethroplasty was performed in 250 new cases of DPH from January 2005 to December 2015 in our institute. We included only primary DPH with typical characteristics including stenotic meatus, deep glandular groove, wide urethral plate distally and in middle, and adequate size penis. We did some modification in the original Snodgrass repair to improve our outcome. Neourethra was covered with vascularized pedicled dartos flap from the inner prepuce. Patients were followed up for a mean of 12 months. Results: Age range of the patients varied between 3 and 11 years with majority of them [235 (94%)] below 9 years; 50 (20%) patients had mild-to-moderate chordee, which was corrected by degloving of the penis. We did not require tunica albuginea plication to correct chordee because it was only skin chordee. The mean age of children was 6 years. Mean duration of surgery was 50 min (45–60 min). Postoperative hospital stay was 10 days. Overall complication rate, requiring specific intervention, was 13.2%. Major complications occurred in 30 (13.2%), urethrocutaneous fistula in 15 (6%), meatal stenosis in five (2%), complete dehiscence in three (1.2%), glanular dehiscence in five (2%), and proximal stricture in five (2%) patients. Functional results as judged by the urinary stream were good in 225 (90%) patients. An excellent cosmetic result was seen in 215 (86%) patients. Conclusion: TIP urethroplasty with dartos flap cover is a simple, single-stage procedure for DPH with excellent cosmetic and functional results and is associated with minimal complications. Finally, some of our modifications in the original technique can improve the outcome.

URETHROCUTANEOUS FISTULA FOLLOWING SNODGRASS VERSUS TWO STAGE AIVAR BRACKA REPAIR OF DISTAL PENILE HYPOSPADIAS IN MALE CHILDREN: A RANDOMIZED CONTROL TRIAL

Background: Hypospadias is the most common congenital malformation of the urethra with the prevalence of 1 in 200-300 live male births. The objective of this trial was to compare the frequency of urethrocutaneous fistula between Snodgrass and two staged Aivar Bracka repair of distal penile hypospadias in male children. Material & Methods: This RCT was conducted in Department of Plastic & Reconstructive Surgery, Hayatabad Medical Complex, Peshawar, Pakistan from 1st June 2013 to 31st May 2014. 64 male patients were randomly allocated to two surgical procedures, 32 to experimental (Snodgrass) group and 32 to control (two stage Aivar Bracka) group. Age in years, age groups and presence of urethrocutaneous fistula were variables. Age in years was analyzed by mean, SD and range and other variables by count and percentage. McNemar chi-square test was applied to see the significance of difference between the experimental and control groups in terms of frequency of urethrocutaneous fistula at alpha 0.05. Results: Mean age in experimental (Snodgross) group was 6.74 years±1.26 & in control (Aivar Bracka) group 6.71 years ±1.29. The urethrocutaneous fistula was present in three (9.38%, 80% CI 2.77-15.99%) cases in experimental (Snodgross) group and in six (18.75%, 80% CI 9.91-27.59%) cases in control (Aivar Bracka) group. McNemar chi-square test showed no significant difference between the experimental and control groups in terms of frequency of urethrocutaneous fistula. Conclusion: The results are comparable for Snodgrass repair and two stage Aivar Bracka repair for distal penile hypospadias in male children in terms of frequency of urethrocutaneous fistula in our population.

The Penile Perception Score after distal hypospadias repair with tubularized incised plate and Mathieu

Objective: The aim of this study was to evaluate the Penile Perception Score (PPS) after repair of distal penile hypospadias using tabularized incised plate (TIP) and Mathieu procedures. Methods: A randomized controlled study was conducted at urology department from October 2013 to May 2014. It included 60 children who were divided into three groups: group A included 20 patients with distal hypospadias corrected using TIP; group B included 20 patients with distal hypospadias corrected using Mathieu; and group C included 20 children with normal male genitalia who were circumcised and considered as a control group. Results: There were no statistically significant differences between group A and group B in urologists’ and parents’ average sum of PPS evaluation, but urologists’ satisfaction was more than parents’ satisfaction. The PPS for TIP was 8.43 and 7.80 for urologists and parents, respectively. The difference was significant. The PPS for Mathieu were 8.04 and 7.89 for urologists and parents, respectively, with no significance. There were no statistically significant differences between group A and group B in the postoperative evaluation by urologists and by parents in meatus, glans, shaft skin, and general appearance. There were complications in 10% of cases from group A in the form of fistula, in 30% of cases from group B in the form of fistula in 25% and meatal stenosis in 5%, and no complication in group C. Conclusion: TIP showed better PPS score compared with Mathieu in hypospadias repair. However, the results of this study were not statistically significant. PPS was a good scale to evaluate hypospadias repair after surgery. Keywords: hypospadias, parents and urology, Penile Perception Score

Management of hypospadias in Saudi Arabia: A national survey.

Introduction:Hypospadias is one of the most common congenital anomalies of the penis. Different methods of hypospadias management are described in the literature. We try in this study to evaluate the national trends and to compare them with international practices.Materials and Methods:A multiple choice survey was distributed among a sample of national practitioners using a weblink between September and December 2017. It included questions about participants demographics, number of cases operated on per year, perioperative care and preferences, long-term follow-up, and complications. Data were analyzed and compared with international practices.Results:Results of 47 practitioners were evaluated and analyzed in this study. The majority of the participants were pediatric urologists (48.9%) and from the central province (44.7%). Most of the participants prefer to operate on patients between the ages of 1 and 2 years (48.9%) and operate at ≥20 cases per year (76.6%). Tubularized incised plate (TIP) is the preferred technique for distal penile hypospadias repair whereas staged repair is preferred for proximal cases. All participants use a form of a second layer and a stent for their repairs. The majority reported an overall complication rate of ≤10% for distal penile hypospadias (76.1%) and >10% for proximal penile cases (59.6%).Conclusion:This study helped us identify national trends in hypospadias management, which were comparable to the international trends. TIP repair is the preferred technique for distal penile hypospadias repair whereas staged repair is preferred for more complex proximal variants. Although data in this study come from reports of personal experience, it can serve as a backbone for the future prospective studies on this topic.

Role of urethral plate and fossa navicularis biopsies in the detection of balanitis xerotica obliterans in boys undergoing redo hypospadias repair

ObjectivesTo evaluate the presence of balanitis xerotica obliterans (BXO), clinically and pathologically, in the urethra of boys with failed previous hypospadias repair and where surgical management was planned. Patients and methodsBetween February 2010 and March 2015, boys with failed distal penile hypospadias repair who were planned for surgical management were evaluated for the presence of clinical and pathological evidence of BXO. Samples were obtained from the urethral plate and fossa navicularis, after obtaining informed consent and ethical approval. The samples were fixed, sectioned, and haematoxylin and eosin stained for light microscopic examination. ResultsIn all, 157 boys were enrolled in our study, with a mean (SD) age of 6.4 (2.8)years. All the boys had a history of failed hypospadias repair surgeries (once or more). The presentation was fistula in 34 boys (21.7%), meatal stenosis in 45 (28.7%), urethral stricture in 28 (17.8%), and total dehiscence in 50 (31.8%). BXO was detected clinically in 46 boys (29.3%). The total number of biopsies taken was 314, of which 124 (39.5%) were pathologically BXO-positive samples. Of the 157 boys, BXO-positive cases were clinically associated with fistula in seven boys (4.5%), meatal stenosis in 18 (10.8%), urethral stricture in seven (4.5%), and total dehiscence in 15 (9.6%). Of the 314 pathological samples, pathologically BXO-positive samples were associated with fistula in 20 samples (6.4%), meatal stenosis in 40 (12.7%), urethral stricture in 22 (7%), and total dehiscence in 42 (13.4%). ConclusionsIn failed hypospadias cases BXO should be considered, especially for cases with multiple failures, meatal stenosis, and total dehiscence. Urethral plate and fossa navicularis biopsies are important in planning a proper approach for subsequent repair.