Incised Plate Urethroplasty Research Articles

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

Tubularized 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. A 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. Persistent 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). Our 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.

THE OUTCOME OF DOUBLE DARTOS VERSUS SINGLE LAYER FLAP IN SNODGRASS URETHROPLASTY FOR DISTAL HYPOSPADIAS REPAIR IN BASRA TRAINING CENTER OF UROLOGY

Hypospadias, a nomination of medical term which was derived from the Greek terms: hypo (under) and spadon (rent, fissure). It is one of the congenital abnormalities of the genitourinary tract. There are about 400 different procedures described for correction of this type of anomaly, but Tubularized Incised Plate (TIP) Urethroplasty is considered the most popular one, and there are multiple variations in this procedure to get high success rate and decrease the complications. In this study, we compare between single layer dartos flap versus double layer dorsal flaps in TIP urethroplasty. This is to assess the outcomes of double dartos flaps versus single layer flap in TIP urethroplasty for primary distal hypospadias repair in Basrah Teaching Center regarding the success rate, and to investigate the importance of double flaps in preventing possible complications in particular, urethral fistula. A cross sectional prospective study was done in Basra Teaching Hospital, between January 2018 to March 2020. A total of 50 boys, 2 to 10 year- old with coronal and sub coronal primary Hypospadias were treated with TIP urethroplasty (Snodgrass procedure) by one surgical team, who were referred to Basrah Teaching Hospital from private and outpatient clinics. Patients were divided into 2 groups: (group I: 25 patients) single layer Dartos flap & (group II: 25 patients) double layers of Dartos flaps. Six patients were missing during follow up, coincidentally 3 patients in each group. The mean age was 4.55 and 4.86 year for groups I, II respectively, the mean operative time was 88.81 and 91.86 minutes for group I & group II respectively. The success rate was (81%) and (86%) for group I, II respectively, with exception of complications which need re-do surgery. Urethrocutaneous fistula (UF) was developed in (22.7%) in group I, and in (4.5%) in group II. Bleeding was happened in 2 cases (9.1%) in group I and 3 cases (13.6%) in group II. Meatal stenosis was diagnosed in (9.1%) in group I and (13.6%) in group II. Glans dehiscence was seen in 1 case (4.5%) for each group. There was a significant difference between the two groups in the occurrence of UF (P = 0.001). According to our evidence in this study, double dartos flaps is easy to be harvested, safe procedure, and represents very good choice for UF prevention. Although the number of complicated patients regarding bleeding and meatal stenosis are higher in group II than group I but they were statistically insignificant. Keywords: Hypospadias, Urethroplasty, Tubularized Incised Plate (TIP), urethral fistula, dartos flaps.

Cosmetic outcomes of grafted tubularized incised plate urethroplasty in primary distal penile hypospadias: prospective comparative study with the classic Snodgrass repair

BackgroundTo compare the outcomes between classic tubularized incised plate (C-TIP), known as Snodgrass urethroplasty, and grafted TIP (G-TIP) in the repair of primary distal penile hypospadias.MethodsParents of all children presented to our tertiary care institution with primary distal penile hypospadias were asked to participate in this study. Patients were equally randomized using closed envelope method into two groups; Group A underwent repair using G-TIP and Group B underwent repair using the C-TIP. Circumcised cases and/or cases with penile chordee > 30 degrees were excluded from this study. Urethral catheter was kept for 7 to 10 days after surgery. The success rate and cosmetic outcomes assessed by HOSE score were evaluated at 6-month postoperatively.ResultsA total of 55 patients were recruited in each group. One hundred and seven patients of the 110 patients (54 and 53 in groups A and B, respectively) were evaluated at 6-month postoperatively using HOSE score. All preoperative data were comparable in both groups. Success was documented in 49/54 patients (90.7%) in group A. The five failures were secondary to two cases of glans dehiscence and three cases of residual postoperative chordee. Whereas, success was documented in 48/53 patients (90.5%) in group B. Complications were: a case of meatal stenosis, three cases of fistula, and a case of combined meatal stenosis and fistula. The HOSE score was comparable between the two groups (15.4 ± 1.09 vs. 15.6 ± 0.55; p = 0.29). However, the operative time was statistically longer in the G-TIP compared with the C-TIP (91.4 ± 6.2 min vs. 85.2 ± 6.3 min; p < 0.001), respectively.ConclusionThe G-TIP urethroplasty provided comparable results with C-TIP in terms of cosmoses, success rate, and complications. However, G-TIP was accompanied with significantly longer operative time.

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

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.

The Histopathological Effect of Aloe Vera on the Wound Healing Process in a Surgically Created Tubularized Incised Plate Urethroplasty Model on Rats

Background Hypospadias is a common congenital anomaly which is determined as an abnormal urethral opening on the ventral face of penis. The purpose of this rat model study was to research the effect of topically applied Aloe vera after a tubularized incised plate urethroplasty (TIPU). Methods The TIPU model was applied to male Wistar albino rats. A total of 30 rats were randomly grouped into 3 groups of 10. Group I was assigned as the control group, treated with 0.9% saline only twice a day for 15 days. Group II received topical Aloe vera gel once a day and Group III received Aloe vera gel twice a day. Spongiofibrosis was graded as 0: none, 1+:≤10% tissues involved, 2+:10%-49% tissues involved, 3+: ≥ 50% tissues involved. Results A higher degree of fibrosis and inflammation was determined in the Group I subjects than in Groups II and III. Fibrosis of grade 3+ was observed in 33% of the control group and not in any of the two Aloe groups (p = 0.043). Inflammation of grade 3+ was seen in 66.7% of the control group, in 10% of Group II, and in 33% of Group III (p = 0.02). Conclusions The topical application of Aloe vera to a surgically created tubularized incised plate urethroplasty model decreased inflammation and fibrosis that may affect the success rates of this operation.

SC123 - Tubularized incised plate urethroplasty with dorsal inlay graft for hypospadias repair in pediatric age: long-term outcomes

SC123 - Tubularized incised plate urethroplasty with dorsal inlay graft for hypospadias repair in pediatric age: long-term outcomes

Assessment of the Educational Value of Distal Hypospadias Repair Videos on YouTube

ObjectiveTo evaluate the quality of YouTube videos depicting distal hypospadias repair. MethodsThe search terms “distal hypospadias repair” were used to identify surgical videos on YouTube. Videos were sorted by view count and the top 34 videos were reviewed for baseline video characteristics, key surgical steps covered, and conformity to a modified LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) checklist. All videos were reviewed and discussed for conformity by 2 attending pediatric urologists and a urology resident. ResultsOf the 34 videos reviewed, 16 videos were excluded due to content. The median length of videos was 9.94 minutes (range, 2.57-99.12 minutes). Video quality was deemed of high quality in only 39% of videos. The most common type of hypospadias procedures described were tubularized incised plate urethroplasty (n = 13) and meatal advancement and glanuloplasty incorporated (n = 2). The median view count was 7828.5 (range, 1,133-58,619 views). Only 1 video met all modified LAP-VEGaS criteria (range of 33%-100%), and only 2 videos showed every surgical step of distal hypospadias repair (range 33%-100%). Modified LAP-VEGaS score, surgical step score, or quality of the video was not associated with a higher view count. ConclusionDespite being a common procedure, there is a paucity of high-quality videos on YouTube describing distal hypospadias repair techniques. It is unclear how learners select videos for study purposes and the most utilized videos on YouTube are not the most educational videos.

Comparison of Modified Mathieu versus Standard Tubularised Incised-Plate Urethroplasty for Distal Hypospadias Repair

Objective: To compare the outcomes of modified Mathieu versus standard tubularised incised-plate urethroplasty for distal hypospadias repair. Materials and Methods: This prospective comparative study was conducted on 54 cases affected by distal hypospadias presenting to Institute of Kidney Disease, Hayatabad, Peshawar form February 2015 to June 2020. The inclusion criteria was patients with distal hypospadias (coronal, sub-coronal, or distal penile), age range of 15 to 60 months. Cases with severe chordee/ventral curvature, history of previous hypospadias repair, and poorly developed urethral plate were excluded. The patients with distal hypospadias were divided into two equal groups: in-group I repair done with Mathieu procedure plus incision of the urethral plate (modified Mathieu) and in-group II repair was performed with Tubularized Incised Plate (TIP). The principal author performed functional and cosmetic assessment at follow up visits which includes; denvo meatus; size and pressure of the stream; and complications like meatal stenosis, urethral cutaneous fistula. Fisher Exact test was used to compare categorical variables between the two groups and student t test for continuous variables. Results: The mean age of the study was 38.13±12.55 months. The operating time was less in TIP than modified Mathieu procedure statistically (P=0.036, 95% CI=0.315, 9.02). In modified Mathieu procedure the sprayed stream of micturition was higher (n=4, 14.8%) while in TIP procedure the frequency of narrow stream was higher (n=4, 14.8%). The difference was statistically significant (P=0.054). Only in modified Mathieu procedure the meatus shape was round in 4 (14.8%) cases and the results were statistically different (P=0.038). Post-operative fistula was higher TIP (n=6, 22.2%) than modified Mathieu (n=1, 3.7%) statistically (P=0.043). Only in TIP procedure postoperative meatal stenosis was found in 5 (18.5%) and the difference was statistically significant (P=0.019). Conclusion: The modified Mathieu technique can improve the cosmetic outcome through creation of slit-like meatus, low incidence of fistula and meatal stenosis than tubularized incised plate urethroplasty in the repair of distal hypospadias.

Comparing Mathieu and Tubularized Incised-Plate Urethroplasties for Repairing Distal Penile Hypospadias: A Single-Center Experience with Long-term Outcome

Background: Hypospadias is a congenital anomaly on the penis, in which the meatal orifice opens ventrally and proximal to the tip of the penis. In this regard, two common treatment methods are tubularized incised-plate urethroplasty (TIP) and the Mathieu incised-plate (MIP) technique. The present study aimed to compare the early and long-term outcomes of TIP and MIP among patients with distal penile hypospadias. Objectives: The study was also to evaluate the postoperative functional outcome of hypospadias over a long-term follow-up. Methods: Fifty-nine patients were randomly selected and assigned to two groups (TIP (n = 31) and MIP (n = 28)). Demographic information, preoperative findings, and postoperative complications were collected from the two groups. The Hypospadias Objective Scoring evaluation (HOSE) questionnaire and uroflowmetry were obtained to evaluate the long-term outcome of hypospadias repair. Results: The success rates of the surgical TIP and MIP techniques were 71.0% and 82.1%, respectively. Postoperative complications in the TIP group were three (9.7%) distal UCF and four (12.9%) meatal stenosis. In the MIP group, two (7.1%) and three (10.7%) patients suffered from distal UCF and meatal stenosis, respectively. Moreover, 89.3% of the patients in the MIP group and 80% of the patients in the TIP group had acceptable HOSE. Regarding the uroflow rates in the MIP group, 12% and 58% of the participants were below the 5th percentile and above the 25th percentile, respectively. Concerning the uroflow rates of TIP, 32% of the patients were below the 5th percentile, and 18% of the participants were above 25th percentile. Conclusions: Although there have been some reports on the superiority of TIP, we found these two techniques at approximately equal levels with a slightly higher success rate for the MIP regarding the early outcomes. With the exception of the long-term outcomes in cosmetic and functional evaluation, MIP is superior to TIP.

Dressing or Not after Tubularized Incised Plate Urethroplasty

Background: Many surgical techniques, as well as dressing models, were identified in the treatment of hypospadias. There are many publications in the literature that are the result of the effort to find the ideal dressing after hypospadias surgery. The dressing has some benefits; however, it has some adverse effects. The present study aimed to discuss outcomes of the patients who have been operated through the tubularized incised plate urethroplasty (TIPU) method and followed with and without dressing postoperatively. Methods: Patients operated on through the TIPU method between March 2015 and August 2019 were reviewed retrospectively. The patients were divided into two groups, dressing and undressing. Preoperative hypospadias severity was evaluated according to the Glans-Urethral Meatus-Shaft (GMS) scoring method. The care results of the patients were recorded. Postoperative outcomes were compared according to the Hypospadias Objective Scoring Evaluation (HOSE) scale, and statistical analyses were conducted. The results of both groups were compared statistically. Results: One hundred and nineteen patients were divided into two groups: dressing (n = 56) and nondressing (n = 63). The patients’ average age was 3.54 ± 2.97 years in group 1 and 3.50 ± 3.01 years in group 2 (p = 0.940). There was not any statistically significant difference between the two groups for demographic data. Minimal bleeding had stopped in three patients in the nondressing group spontaneously before discharging. No severe edema or hematoma, which might have concerned the parents, appeared. Two (3.5%) and 3 (4.7%) patients underwent a maximum of three urethral dilation sessions in dressing and nondressing groups, respectively (p = 0.556). We found no significant difference between groups in the comparison of preoperative GMS and postoperative HOSE scoring. Discussion: The most important limitation of the study is that it is retrospective. Pre- and postoperative scoring systems are objective. The data obtained in the literature show that surgeons prefer to apply dressings commonly after the TIPU technique. Advantages and disadvantages of dressing are mentioned in the literature. Even if the paradigm is dressing in hypospadias surgery, according to the results of our study, dressing may not affect the functional and cosmetic results of TIPU repair. Conclusion: Postoperative functional and cosmetic results of TIPU in hypospadias appear to be independent of dressing. However, the results must be supported by further research.

Tubularized incised plate urethroplasty with or without dilatation in hypospadias repair: a comparative study

Background. After tubularized incised plate (TIP) urethroplasty meatal and urethral dilatation is a common practice. There are some complication of uretheral dilatation like urethral bleeding,urethral perforation and creating a false passage. Moreover dilating the urethra regularly is physically or psychologically painful both for the child and the parents. The aim of this study was to justify the necessity of uretheral dilatation after TIP urethroplasty.Material and Methods. This study was a prospective, comparative study performed in Dhaka Shishu (Children) Hospital from July 2017 to June 2020. Total 60 respondents were participated in this study with maintain inclusion criteria. Respondents with primary distal and mid-shaft hypospadias where TIP urethroplasty was indicated, admitted in Dhaka Shishu Hospital during study period were included. Group 1 was assigned non dilatation group and Group 2 was assigned to regular urethral ditatation group after TIP urethro- plasty. Fistula formation, meatal stenosis and neourethral stricture were compaired between two groups. Informed written consents were taken from legal guardians. Data ware analyzed by SPSS Program.Results. In this study there was no significant difference of ages between two groups. In Group 2 10 %( 3)respondents developed urethrocutaneous fistula, 10% (3) respondents developed meatal stenosis and 3.33% (1)respondents developed neourethral stricture. On the other hand. In Group 1 10% (3) respondents developed urethrocutaneous fistula, 6.66% (2) respondents developed meatal stenosis. None of patient in Group 1 developed neourethral stricture.Conclusion. There was no significant difference in fistula formation, meatal stenosis and neourethral stricture in between regular urethral dilatation group and non-dilatation group after TIP urethroplasty.

Tubularized incised plate urethroplasty with or without dilatation in hypospadias repair: a comparative study

Background. After tubularized incised plate (TIP) urethroplasty meatal and urethral dilatation is a common practice. There are some complication of uretheral dilatation like urethral bleeding,urethral perforation and creating a false passage. Moreover dilating the urethra regularly is physically or psychologically painful both for the child and the parents.The aim of this study was to justify the necessity of uretheral dilatation after TIP urethroplasty.Materials and Methods. This study was a prospective, comparative study performed in Dhaka Shishu (Children) Hospital from July 2017 to June 2020. Total 60 respondents were participated in this study with maintain inclusion criteria. Respondents with primary distal and mid-shaft hypospadias where TIP urethroplasty was indicated, admitted in Dhaka Shishu Hospital during study period were included. Group A was assigned non dilatation group and Group B was assigned to regular urethral ditatation group after TIP urethro- plasty. Fistula formation, meatal stenosis and neourethral stricture were compaired between two groups. Informed written consents were taken from legal guardians. Data ware analyzed by SPSS Program.Results. In this study there was no significant difference of ages between two groups. In Group B 10% (3)respondents developed urethrocutaneous fistula, 10% (3) respondents developed meatal stenosis and 3.33% (1)respondents developed neourethral stricture. On the other hand In Group A 10% (3) respondents developed urethrocutaneous fistula, 6.66% (2) respondents developed meatal stenosis. None of patient in Group A developed neourethral stricture.Conclusion. There was no significant difference in fistula formation, meatal stenosis and neourethral stricture in between regular urethral dilatation group and non-dilatation group after TIP urethroplasty.

The Use of Autologous Platelet Rich Fibrin Membrane as a Second Layer in Snodgrass Repair of Distal Hypospadias

Background: Hypospadias is a common pediatric health problem. Snodgrass [Tubularized Incised Plate Urethroplasty]surgical repair was adopted as the standard technique, although different techniques had been described. However, higher complication rate continues to be a problem. The aim of the work: To evaluate the use of platelet rich fibrin membrane as an intermediate layer in the Snodgrass repair of distal hypospadias. Patients and Methods: Thirty children were included. All were evaluated preoperatively by full history taking, clinical examination and laboratory investigations. Then all were treated by Tubularized Incised Plate Urethroplasty with the use of platelet rich fibrin membrane as an intermediate layer. They then followed up and any early or late complications were registered. Results: Hypospadias was recurrent among 83.3%. Patient age ranged between one and six years and the mean operative time was 67±5.4 minutes; the mean hospital stay duration was 7.0±1.2 days. The success rate was 93.3% and complication rate was 6.7%. Complications were edema in 6.7%, urethro-cutaneous fistula [UCF] in 6.7% and skin infection among 3.3%. Conclusion: The use of a platelet rich fibrin membrane is a feasible and safe intermediate layer for hypospadias surgery in Tubularized Incised Plate Urethroplasty. The procedure is quick and straightforward and has a low postoperative complication.

Comparative study between two days versus seven days urethral stenting of distal hypospadias after tubularized incised plate urethroplasty

Background: The duration of urethral stenting after tubularized incised plate (TIP) urethroplasty for hypospadias varies among surgeons.Methods: Forty male cases with distal hypospadias aging from one year till the age of six years randomly allocated into two groups for undergoing tubularized incised plate urethroplasty with removal of the urethral stent after two days in one group and after seven days in the other one. The rate of postoperative complications such as urethrocutaneous fistula, urinary retention, meatal stenosis and complete wound dehiscence requiring redo and cosmetic results were compared.Results: The prevalence of post-operative complications and cosmetic results in two studied groups were not significantly different.Conclusions: There is no significant difference between removal of the stent after two days or seven days regarding the incidence of postoperative complications and the cosmetic results.

Comparison of Urethrocutaneous Fistula Rate After Single Dartos and Double Dartos Tubularized Incised Plate Urethroplasty in Pediatric Hypospadias.

Background and objectiveTubularized incised plate (TIP) urethroplasty is an easy and popular technique for repairing hypospadias, however urethrocutaneous fistula (UCF) is a frequently reported complication. Different techniques are used to reduce this complication. We aimed to compare the rate of UCF after single dartos and double dartos TIP urethroplasty in children with distal and mid penile hypospadias.MethodsA randomized controlled trial (NCT 04699318) was conducted in the Department of Pediatric Surgery, Mayo Hospital, Pakistan from August 2017 to February 2018, after ethical approval. After informed consent, a total of 60 patients with distal and mid penile hypospadias who were uncircumcised, had no chordee, and/or previous surgery, were randomly allocated in two groups using computer generated table numbers. Group A underwent single dartos TIP urethroplasty and Group B underwent double dartos TIP urethroplasty. Catheter was removed on day 10 post-operatively in both groups and primary outcome (UCF) was noted after a week of catheter removal. Rate of UCF was compared using chi square and p-value of <0.05 was taken as significant. Data was stratified to check for effect modifiers.ResultsOut of 60 children, eight (13.3%) developed UCF. In Group A, seven (23.3%) developed UCF and in Group B, one (3.3%) developed UCF (p-value 0.02). In both groups, no patient (0%) had urethral disruption, penile torsion, skin necrosis or meatal stenosis.ConclusionAdditional covering of neo-urethra by a double dartos layer significantly reduces fistula rate after tubularized incised plate urethroplasty in both primary distal and mid penile hypospadias.

Urethral plate in tubularized incised plate urethroplasty: how wide is enough?

BackgroundPrevious reports found that a preincision urethral plate (UP) width <8 mm increased the occurrence of urethroplasty complications (UCs) in tubularized incised plate (TIP) hypospadias repair. However, is the classification of the UP width based on an 8 mm cut-off value to predict the outcome of TIP urethroplasty objective enough or universally applicable? The purpose of our study was to assess the effect of the UP width on the outcomes of TIP hypospadias repair in the Eastern population we served.MethodsWe retrospectively reviewed the records of patients who underwent TIP hypospadias repair by the same surgeon between August 2013 and December 2019 in our hospital. Data were collected, including demographics, intrinsic parameters of the penis, surgical parameters and subsequent surgical outcomes. The data were analyzed and the cut-off value of the UP width was calculated using a receiving-operator curve.ResultsPrimary TIP urethroplasty was carried out in 116 patients with a mean age of 35.89±29.40 months. The meatal location was distal in 49 patients, midshaft in 56 patients and proximal in 11 patients. The mean glans width was 12.28±1.36 mm, the mean UP width was 5.74±1.37 mm, the mean neourethral length was 1.96±1.32 cm, and the mean operation duration was 87.52±11.47 min. During a median follow-up of 42 (range: 6 to 80) months, UCs developed in 12 patients, and the UP width was significantly related to the occurrence of UCs (P=0.014). According to the 6 mm cut-off value of the UP width by the receiver operating characteristic curve, patients were divided into two groups. Group A (UP width ≥6 mm) included 69 patients, and Group B (UP width <6 mm), 47 patients. UCs occurred in 3 patients in Group A vs. 9 patients in Group B, P=0.010.ConclusionsUP width is a potential risk factor for UCs after TIP hypospadias repair. Using this technique with an UP width ≥6 mm is sufficient to result in a good outcome of hypospadias repair.

A comparative study of polydioxanone (PDS) and polyglactin (Vicryl) in hypospadias repair.

Background:Hypospadias is a fairly common problem, and it is the most common genital congenital anomaly.Objective:This study was carried out to compare polyglactin and polydioxanone in hypospadias repair by assessing the rate of complications, especially urethrocutaneous fistula (UCF) formation.Patients and Methods:This is a prospective observational cross-sectional hospital-based study carried out at the Department of Paediatric Surgery, Ribat University Hospital, from June 2015 to November 2016. In Group A, there were 55 patients who underwent repair using polyglactin, and in Group B, there were 50 patients who underwent repair using polydioxanone. All patients were operated by the same surgeon.Results:The mean age of Group A was 5.7 ± 4.3 years and 5.1 ± 3.9 years in Group B. Meatal advancement and glanuloplasty incorporated operation was done in 47.6%, Tubularized incised plate urethroplasty in (31.4%), Theirsch-Duplay in 20% and Mathieu's repair in 1%. The complication rate was 34% in Group A and 10.9% in Group B. The most frequent complication was UCF, as 19 patients (18.1%) of the study candidates developed UCF; most of them were in Group A (14 patients) and 5 patients in Group B. Another significant complication was meatal stenosis, which occurred in 11 patients (10.5%): 9 in Group A and 2 in Group B.Conclusion:Polydioxanone (PDS) is satisfactory in hypospadias repair as it is associated with better outcome, especially UCF, which is most common and most difficult to treat complication.

Long-term outcome of non-stented tubularized incised plate urethroplasty for distal hypospadias repair: a complication analysis.

IntroductionAlthough it is apparently simpler to perform unstented tubularized incised plate (TIP) repair for distal hypospadias repair, consensus on feasibility of the use of unstented repair is still a matter of debate. Evidence reporting that unstented repair outcome is comparable to stented repair, especially in the long-term, is still weak due to reporting outcome inconsistencies, different study designs, inclusion of more than one technique, and inherent variability in meatal locations. Thus, we need a continuous and evolving assessment of the outcome of unstented repair to compile adequate evidence on the advantage of unstented TIP repair in distal hypospadias entity. The aim of this article was to review our long-term results with tubularized incised plate urethroplasty for distal hypospadias repair without a postoperative stent to determine its outcome which might justify its use.Material and methodsAfter a review of 154 patients with distal penile hypospadias, who underwent repair in Minia Urology & Nephrology University Hospital in the period between June 2015 and February 2018, we excluded cases who underwent MAGPI repair, redo cases and patients who failed to complete follow-up. We chose 72 patients who had only 1st time TIP repair and whom we could contact. A total of 44 out of 72 cases with stented repair were assigned to Group A, while 28 cases with unstented repair were assigned to Group B. Success was assessed based on Hypospadias Objective Penile Evaluation (HOPE) score by three separate senior pediatric urology consultants, independent of the surgeon and in the absence of high post-void residual urine (PVR). Average rate was calculated to be compared between both study groups.ResultsThere was no statistically significant difference regarding preoperative meatal location and age at repair and short-term complications. In the long-term; there was no statistically significant difference between the occurrence of urethrocutanous fistula (UCF, 4 vs 2 cases in Group A & B, respectively) and complete disruption (2 cases in each group) with need for redo repair. Results of total mean of HOPE score calculated showed no statistically significant differences between study groups and also failed to showed statistical significance on individual domains of HOPE score.ConclusionsUnstented TIP repair showed a similar outcome to stented TIP repair of distal hypospadias especially in the long-term despite a more troublesome early postoperative period.

Megameatus intact prepuce and associated anomalies

Objective: Megameatus intact prepuce is described as subset of megalourethra or distal hypospadias by several authors. Despite suggested different operative techniques, some authors prefer not to operate this variant of penile anomaly. We aimed to evaluate 31 patients operated due to megameatus intact prepuce and associated anomalies .&#x0D; Material and methods: Thirtyone patients operated between 2008-2018 for MIP were evaluated retrospectively. All data were collected from hospital records. Patient age, application reasons, raphe anomalies, associated genitourinary and extragenitourinary pathologies, operative techniques, and postoperative complications were analyzed. &#x0D; Results: Mean age was 50 months (8-128 months). Ten of the patients had raphe anomalies. Genital raphe hyperpigmentation was seen in 1 patient, raphe deviation and bifurcated raphe was seen in6 and 3 patients respectively. Genitourinary anomalies were detected in 7 patients, bilateral undescended testes in 1 patient, penile chordee in 2 patients, ureteropelvic junction obstruction in 2 patients, penoscrotal web in 1 patient, nocturnal enuresis in one patient. Tubularized incised plate urethroplasty (TIPU) (n=5), tubularized urethral plate urethroplasty (TUPU)(n=16) and meatoplasty (n=10) were the operative techniques.&#x0D; Conclusion: . Co-occuring raphe anomalies should arise awareness of MIP among the clinicians who are engaged with the children’s medical conditions and also the possible anomalies especially in the societies which circumcision is not traditionally required. Further studies with large number series needed for better understanding of this pathology.

THE OUTCOME OF LONGITUDINAL DORSAL ISLAND FLAP FOR REPAIR OF HYPOSPADIAS IN CIRCUMCISED PATIENTS AND THOSE WITH FAILED PREVIOUS REPAIR

Patients with penoscrotal, proximal shaft and mid shaft hypospadias who were previously circumcised or patients with insufficient urethral plate such as those with severe chordee that cannot be corrected just by simple degloving, or failure of previous hypospadias repair, such patients represent a challenge for subsequent repair and appropriate procedure choice. The aim of this study is to assess the outcome of longitudinal dorsal island flap (LDIF) by both onlay and tubularized repair for patients with hypospadias who were previously circumcised or had poorly developed urethral plate. This prospective study was done on 36 patients who had penoscrotal, proximal and mid shaft hypospadias and were previously circumcised or had poorly developed urethral plate. Twenty four of them were operated upon by using onlay LDIF and 12 patients by using tubularized LDIF. Patients were followed-up for 12 months to look for any complication for these 2 types of surgeries and for assessing the functional outcome of the repair. The success rate for onlay LIDF was 75% and for tubularized LIDF was 58.33%. Overall complications occurred in 11 (30.55%) children. In conclusion, LDIF can be used successfully for repair of hypospadias in circumcised children or those with failed previous repair. Keywords: Hypospadias, LDIF, failed repair, tabularized incised plate urethroplasty