Plate Urethroplasty For Hypospadias Research Articles

Application of modified grafted tubularized incised plate urethroplasty in hypospadias

To investigate the clinical feasibility and effectiveness of the modified grafted tubularized incised plate urethroplasty (G-TIP), namely "glans G-TIP (GG-TIP) ", in treatment of hypospadias. A clinical data of 137 children with hypospadias qualified by the selection criteria between January 2021 and June 2023 was retrospectively analyzed. Among them, 75 children were treated with GG-TIP (GG-TIP group) and 62 with G-TIP (G-TIP group). There was no significant difference ( P>0.05) between the two groups in terms of age, hypospadias type, penile length, penile head width, penile head height, penile curvature, meatus-apex distance, urethral plate width, and distance from the distal endpoint of navicular groove to the dorsal or ventral midline point of the glans corona, and the difference between the two. The operation time, reconstructed urethral length, distance from meatus to ventral glans corona, postoperative complications, maximum urinary flow rate at 2 weeks after operation, and the hypospadias objective scoring evaluation (HOSE) score at 6 months after operation in the two groups were recorded and analyzed. The operation time was significantly shorter in GG-TIP group than in G-TIP group ( P<0.05); but there was no significant difference ( P>0.05) between the two groups in terms of reconstructed urethral length and distance from meatus to ventral glans corona. All urinary meatus located at the tip of glans with vertical fissure shape. All children in the two groups were followed up 6-35 months (median, 26 months). During follow-up, there were 3 cases of urethral fistula, 2 cases of urethral stricture, and 1 case of glans separation in GG-TIP group, and 3, 3, and 1 cases in the G-TIP group, respectively. There was no significant difference in the incidence of complications between the two groups ( P>0.05). The maximum urinary flow rate at 2 weeks and the HOSE score at 6 months after operation were significantly higher in GG-TIP group than in G-TIP group ( P<0.05). GG-TIP is safe and effective for repairing hypospadias in children. Compared with G-TIP, it has the advantages of relatively simple operation, shortened operation time, significant improvement in urinary flow rate, and better cosmetic results.

Application of Buck's fascia to restore the complete wrapping of the neourethra with corpus spongiosum in tubularized incised plate urethroplasty in hypospadias

The aim of this study was to evaluate the outcome and complication rate of Buck's fascia used as the third coverage layer of the neourethra to restore the complete wrapping of the neourethra with corpus spongiosum in TIP surgery. 140 patients with hypospadias in our hospital from March 2016 to March 2018 were prospectively studied. Age range 9-48 months. All patients underwent TIP surgery to repair hypospadias. In the surgery corpus spongiosum tissues were sutured as the second coverage layer of the neourethra. Patients were randomly divided into two groups: group A (with dorsal dartos flap as the third coverage layer) and group B (with Buck's fascia as the third coverage layer). Complication rates were compared between two groups. There was no significant difference in the composition ratio of hypospadias between groups A and B (P > 0.05). All patients were followed up for 1 year. The incidence of complications in group A: urethrocutaneous fistula (11%), meatal stenosis (1.4%), partial glans dehiscence (5%) and wound infection (1.4%). The incidence of complications in group B: urethrocutaneous fistula (2%), meatal stenosis (2%), partial glans dehiscence (0%) and wound infection (0%). The occurrence rates of urethrocutaneous fistula and partial glans dehiscence of two groups were statistically significant (P < 0.05). Buck's fascia is easily available, needs minimal dissection. It is well vascularized, thick and has good tensile strength. Buck's fascia used as the third coverage layer of the neourethra in TIP can restore the complete wrapping of the neourethra with corpus spongiosum and regain normal anatomical structure of corpus spongiosum and corpora cavernosa. It is simple and very effective to prevent urethrocutaneous fistula and partial glans dehiscence.