Technique For Hypospadias Repair Research Articles

Enhancing Tubularized Incised Plate (TIP) Technique for Hypospadias Repair: The Role of Tunica Vaginalis Flap in Minimizing Urethrocutaneous Fistula

Enhancing Tubularized Incised Plate (TIP) Technique for Hypospadias Repair: The Role of Tunica Vaginalis Flap in Minimizing Urethrocutaneous Fistula

Long term follow-up on young adults that underwent hypospadias repair through urethral advancement in childhood.

Assess the long-term outcome on cosmetic appearance, voiding, sexual function, and psychological impact of young adults operated by urethral advance (UA) technique in childhood. Patients over 14 years old, who underwent UA hypospadias repair in our centre (2000-2010) were evaluated. All patients presented mid-distal hypospadias with subcoronal or penile meatus and curvature lower than 20°. The cosmetic appearance, urinary and sexual function, body perception and overall satisfaction were assessed through 5 questionnaires. From 2000 to 2010, 143 children underwent UA hypospadias repair. 36 patients between 14 and 27 years were evaluated. The Hypospadias Objective Penile Evaluation (HOPE) showed an average of 8.75 (+/- 0.97), which indicates a good aesthetic result. Voiding dysfunction symptoms were assessed through the American Urological Association Symptom Index (AUASI) where 80.6% had none or mild symptoms and 19.4% had moderate symptoms. Only 11/36 patients were sexually active, according to the International Index of Erectile Function (IIEF-15) scale, none had erectile dysfunction, and their relationships were satisfactory. Assessment of the body perception through the Genital Perception Scale (GPS) was positive or very positive in 88.9% of the patients. However, the perception of their genitals was positive or very positive in 77.8%, there is a negative correlation between the perception of their body and genitals in 13.9% of the patients. Our results indicate that UA technique for hypospadias repair might be a valid option for the correction of mid-distal hypospadias when indicated.

MP18-10 DOUBLE VS SINGLE DIAPER TECHNIQUE AFTER HYPOSPADIAS REPAIR, DOES IT REALLY MATTER?

You have accessJournal of UrologyCME1 Apr 2023MP18-10 DOUBLE VS SINGLE DIAPER TECHNIQUE AFTER HYPOSPADIAS REPAIR, DOES IT REALLY MATTER? Khaled Aldabek, Samuel Luketich, Amr A. Elbakry, Ahmed Abdelhalim, and Osama Al-Omar Khaled AldabekKhaled Aldabek More articles by this author , Samuel LuketichSamuel Luketich More articles by this author , Amr A. ElbakryAmr A. Elbakry More articles by this author , Ahmed AbdelhalimAhmed Abdelhalim More articles by this author , and Osama Al-OmarOsama Al-Omar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003238.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Double-diaper technique is a common practice after hypospadias repair, which is believed to have fewer complications and better surgical outcomes. This practice is not evidence-based, and some families get stressed about this particular step of postoperative care. This study hypothesizes that the single-diaper technique offers similar surgical outcomes compared to the double-diaper technique. METHODS: A single surgeon database was retrospectively reviewed for patients who underwent hypospadias repair between 2013 and 2021. Patients who were lost to follow-up and those in whom the type of diaper care (single or double diaper) was not documented were excluded. Patients in the single-diaper technique received the same type of dressing and discharge instructions, as those in the double-diaper group, except for leaving the catheter free inside the single diaper. Short-term complications including: surgical site infection (SSI), urinary tract infection (UTI) and wound dehiscence were the primary outcome; whereas long-term urethroplasty complications were secondary outcomes. Outcomes were analyzed according to the type of diaper care. RESULTS: Among 323 patients reviewed, 219 patients met the inclusion criteria (72 patients in the double-diaper and 147 in the single-diaper group). Both study groups were similar regarding the age at surgery, follow-up duration, type of hypospadias, associated chordee and surgical technique. Looking at the primary outcomes, there was no statistically significant difference in SSI, UTI or wound dehiscence rates between the study groups. Only one dehiscence was reported in the single-diaper group for a patient with myelomeningocele who required self-catheterization. For the secondary outcomes, the incidence of meatal stenosis (8.3 vs. 1.4%, p=0.044), and fistula formation (5.4 vs. 15.3%, p=0.037) was significantly higher in the double-diaper than the single diaper group, respectively. Patient demographics and surgical outcomes are summarized in table 1. CONCLUSIONS: Single-diaper technique for hypospadias repair is simple, easy, and is not associated with increased risk of complications compared to double-diaper technique. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e226 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Khaled Aldabek More articles by this author Samuel Luketich More articles by this author Amr A. Elbakry More articles by this author Ahmed Abdelhalim More articles by this author Osama Al-Omar More articles by this author Expand All Advertisement PDF downloadLoading ...

Outcome of Classical Tubularized Incised-Plate Urethroplasty (TIP) for Primary Anterior Hypospadias Repair: 5 Years’ Experience

Introduction: Classical Tubularized Incised-plate Urethroplasty (TIP) is a surgical procedure used to repair hypospadias, which is a birth defect in which the opening of the urethra located on the underside of the penis rather than at the tip. Aim of the Study: The aim of this study was to evaluate the surgical outcome of classical tubularized incised plate (TIP) urethroplasty. Methods: This retrospective study was conducted in the Department of Pediatric Surgery, Bangladesh Shishu Hospital & Institute, Dhaka from July 2017 to June 2022. Total 53 patients were included in this study. Result: In the current study, the mean age of participants was 43.08±21.72 months where the minimum age was 12 months and maximum age was 103 months. The mean weight of participants was 19.25±7.78 kg. The mean penile length of participants was 35.9±8.05 mm. The mean operation time was 73.24±4.80 minutes. Mean operation cost was 277.50±40.46 US$. Mean hospital stay was 10.7±0.75 days. In our study, 15.09% had UC fistula, 5.66% had wound infection and 7.54% had meatal stenosis. Follow up period was 7.9±2.1 months. In this study, more than half (50.94%) had distal penile hypospadias, 28.30% had coronal hypospadias and 20.75% had sub-coronal hypospadias. Conclusion: According to the findings of our study, Tubularized Incised-plate (TIP) urethroplasty is found to be a safe and reliable technique for hypospadias repair. The rate of complications was found low in TIP urethroplasty.

Identifying variability in surgical practices and instrumentation for hypospadias repair across the Western Pediatric Urology Consortium (WPUC) network

Although hypospadias outcomes studies typically report a level or type of repair performed, these studies often lack applicability to each surgical practice due to technical variability that is not fully delineated. An example is the tubularized incised plate (TIP) urethroplasty procedure, for which modifications have been associated with significantly decreased complication rates in single center series. However, many studies fail to report specificity in techniques utilized, thereby limiting comparison between series. With the goal of developing a surgical atlas of hypospadias repair techniques, this study examined 1) current techniques used by surgeons in our network for recording operative notes and 2) operative technical details by surgeon for two common procedures, tubularized incised plate (TIP) distal and proximal hypospadias repairs across a multi-institutional surgical network. A two-part study was completed. First, a survey was distributed to the network to assess surgeon volume and methods of recording hypospadias repair operative notes. Subsequently, an operative template or a representative de-identified operative note describing a TIP and/or proximal repair with urethroplasty was obtained from participating surgeons. Each was analyzed by at least two individuals for natural language that signified specified portions of the procedure. Procedural details from each note were tabulated and confirmed with each surgeon, clarifying that the recorded findings reflected their current practice techniques and instrumentation. Twenty-five surgeons from 12 institutions completed the survey. The number of primary distal hypospadias repairs performed per surgeon in the past year ranged from 1-10 to >50, with 40% performing 1-20. Primary proximal hypospadias repairs performed in the past year ranged from 1-30, with 60% performing 1-10. 96% of surgeons maintain operative notes within an electronic health record. Of these, 66.7% edited a template as their primary method of note entry; 76.5% of these surgeons reported that the template captures their operative techniques very or moderately well. Operative notes or templates from 16 surgeons at 10 institutions were analyzed. In 7 proximal and 14 distal repairs, parameters for chordee correction, urethroplasty suture selection and technique, tissue utilized, and catheter selection varied widely across surgeons. Wide variability in technical surgical details of categorically similar hypospadias repairs was demonstrated across a large surgical network. Surgeon-specific modifications of commonly described procedures are common, and further evaluation of short- and long-term outcomes accounting for these technical variations is needed to determine their relative influence.

External validation of a low fidelity dry-lab platform to enhance loupes surgical skills techniques for hypospadias repair

Hypospadias repair is an index pediatric urology procedure that requires trainee familiarity with surgical loupes. A previous low-fidelity, 6-step curriculum was proposed that deconstructed the most important steps of loupe surgery. We expanded on this curriculum with an intermediate-fidelity silicone hypospadias model and designed an abbreviated version of the 6-step curriculum to precede the hypospadias repair simulation. To assess the validity of our prior, low-fidelity conceptual model using the metric of improved performance on the intermediate-fidelity silicone hypospadias model. A silicone model was first prototyped with the design software Solidworks™, and then fabricated using a cast made of a mixture of silicone rubbers designed to function like skin and soft tissue (Mold Star 20T, Dragon skin FX-pro and Slacker). Casts were used to create the penile shaft model and the dorsal hooded foreskin model. The urethral plate was cast separately on a flat surface. The model was then assembled by hand. The model used for simulation included the penile shaft and urethral plate, while the dorsal-hooded foreskin was prepared to simulate the penile anatomy separately. Trainees were then divided into two groups. Group 1 practiced the low-fidelity curriculum (3 tasks) and then performed dissection of the urethral plate and suturing using the intermediate-fidelity hypospadias model. Group 2 practiced hypospadias repair prior to the low-fidelity curriculum. Both groups' models were scored by 3 blinded urologists. Trainees were then asked to complete a post simulation satisfaction survey. Data analysis was performed in IBM SPSS Statistics for Macintosh (Version 28.0 Armonk, NY: IBM Corp). Twenty-two candidates across Wisconsin, USA, and Dublin, Ireland participated in the study. This included 7s-year residents, 9 third-year residents, 2 fourth-year residents, and 3 fifth-year residents. Both Groups 1 and 2 had a similar distribution of trainees (p=0.60). Group 1 outperformed group 2 in all tasks (p<0.05, Table 1). Trainees reported that the platform was very useful (91%). Our curriculum showed improvement in trainee ability and comfort to perform hypospadias repair. Advantages of such a simulated curriculum include improving current resident training in microsurgery, improving surgical ergonomics for trainees prior to real-time experience, and decreasing the learning curve for trainees pursuing pediatric urology. An intermediate-fidelity hypospadias platform externally validates the conceptual model implemented in the low-fidelity loupes curriculum. This appears to lead to improvement in loupe surgical skills regardless of trainee level.

Comparison of the use of graft augmented tubularized split (GATS) and tubularized incised plate urethroplasty (TIPU) techniques for hypospadias repair in patients with narrow plate and small glans

Background/Aim: Hundreds of repair techniques were described for hypospadias repair. It is still a problem to choose the right technique in hypospadias repair for patients with narrow plate and small glans, because the patients with narrow urethral plate and small glans usually suffer from complications. GATS (Glans Augmented Tubularized Split) is an alternative technique with different details from grafted TIPU (Tubularized Incised Plate Urethroplasty). The aim of this study is to compare the outcomes of TIPU and GATS procedures on these difficult cases. Methods: This retrospective cohort study consists of the analysis of patients who underwent GATS and TIPU procedures in our department between January 2017 and January 2020. Patients with distal and midpenile hypospadias and with shallow groove, glans smaller than 17 mm, and plate narrower than 8mm were included the study. Patient with follow-up shorter than 1 year or incomplete data and secondary cases were excluded. Patients were divided into two groups according to the technique performed, as 25 patients in TIPU group and 20 patients in GATS group. Results: The mean diameter of glans were 15.3 mm and 14.5 mm, mean width of plate were 5.2 mm and 4.1 mm in TIPU and GATS groups respectively. Complications were observed in 7 (28%) patients of TIPU group and in 2 (10%) patients of GATS group (P>0.05). Urethral stenosis in one patient, urethral fistula in two patients, urethral dehiscence in two and urethral stenosis and diverticula in one patient, urethral stenosis and fistula in one patient were detected in TIPU group. Urethral fistula in one patient and urethral dehiscence in one patient were observed in GATS group. Conclusion: GATS procedure is an alternative method for difficult cases with narrow urethral plate and small glans with less complications than TIPU technique.

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.

Distension methods of surgical correction of hypospadias in boys

Difficulties in the treatment of hypospadias in boys persist to this day. After surgical correction of hypospadias, fistulas, strictures, urethral diverticula, retraction of the meatus, glans dehiscence and other complications occur. At the same time, it is quite difficult to understand the whole variety of proposed methods for correcting hypospadias, which creates confusion for specialists and negatively affects the results of treatment. The literature describes more than 300 different methods of correcting hypospadias, but none of the methods is perfect, and there are no generally accepted treatment standards. Despite this, it is an established fact that the choice of the surgery procedure depends on the type of hypospadias. A successful technique of hypospadias repair should be completed with a good cosmetic and functional result. The article presents an overview of the distension techniques of urethroplasty. For the first time, the experience of urethral advancement was presented at the end of the XIX century, but the technique was unpopular and did not have significant success. However, by the end of the XX century, more effective distension techniques of urethroplasty began to be developed, which were widely used around the world (Koff S.A., Ti-Seng Chang, Belman A.B., MAGPI, LUM, etc.). According to scientific literature, urethral advancement is a safe and reliable way to correct distal hypospadias, and it is considered as an alternative to creating a neourethra. This technique has many competitive advantages, such as the short operation time, the absence of urethral tubularization, excellent functional and cosmetic results, and a small number of complications. It, therefore, follows that distension techniques of urethroplasty are considered a good option for correcting distal hypospadias, which should be in the arsenal of every pediatric surgeon and urologist.

Ingrafts in hypospadias surgery: Longer-term outcomes

The technique of hypospadias repair with a dorsal inlay graft (ingraft) was initially reserved for boys with an unfavorable glans configuration or in previously failed repairs. Although the ingraft technique has been used for some time, there is scarce literature describing its longer term outcomes. Additionally, there is minimal data comparing inner preputial skin and buccal mucosal graft outcomes in primary and reoperative surgery. To describe longer-term outcomes in the use of buccal mucosa and inner preputial skin ingrafts for primary and revisional hypospadias repairs. We conducted a single-center retrospective review of our hypospadias repairs employing ingrafts along with a review of the literature. A total of 47 patients met inclusion criteria. Primary repair was performed in 38 patients, all with unfavorable glans characteristics at a mean age of 16 months and redo repairs in 9 boys at a mean age of 110 months. We used a buccal mucosal graft (BMG) in 19 boys and the remaining 28 were grafted with inner preputial skin. The complication rate was 32% in primary repairs and amongst those, 6 of 28 patients (21%) with skin grafts and 6 of 10 patients (60%) with BMGs suffered a complication. Only BMGs were used in reoperative situations and complications occurred in 2 of 9 cases (22%) of those cases. Overall, 8 patients (42%) with BMG and 6 patients (21%) with preputial skin ingrafts experienced a complication, at an average time of 17 months (range: 0.4-66 months) and 24 months (range: 1.1-113 months), respectively. Surgical correction of the complications resulted in resolution of symptoms in a majority of patients. In our experience, BMGs used as salvage therapy in revisional hypospadias surgery, had lower observed complication rates when compared to its use in primary repair. Inner preputial skin ingrafts for primary repair yielded an acceptable complication rate. Our study describes some of the longest follow-up times in the literature with complications observed even up to 10 years postoperatively. This reinforces the need for active long-term follow-up in reporting outcomes in hypospadias surgery.

Spongioplasty with Dartos Flap Coverage in the Snodgrass Technique of Hypospadias Repair

Objective: The aim of the study is to evaluate the role of spongiosal tissue with dartos flap coverage for preventing Urethrocutaneous Fistula (UCF) formation in the Snodgrass technique.&#x0D; Materials and Methods: It is a prospective study, performed on 35 patients of mid penile and distal hypospadias aged 15 months to 144 months who underwent urethroplasty in the Snodgrass technique using spongiosal tissue and dartos flap for neourethral coverage.&#x0D; Results: Among 35 patients, Age ranged from 15 months to 144 months (mean 85.94 months). Chordee was corrected by penile degloving alone in 11 patients, partial mobilization of urethral plate with spongiosum in 20 patients and 4 patients required dorsal plication. Glans groove was deep in 19 patients, shallow in 13 patients and no groove noticed in 3 patients. Sixteen patients had narrow urethral plate (&lt;8mm) and 19 patients had adequate urethral plate (&gt;8mm). Urethrocutaneous Fistula (UCF) was encountered in five patients (14.28%), meatal stenosis in two patients (5.71%), and partial glanular dehiscence in one patient.&#x0D; Conclusions: Approximation of spongiosal tissue along with dartos flap as the intermediate layer for neourethral coverage reduces fistula formation.&#x0D; J Bangladesh Coll Phys Surg 2020; 38(2): 64-67

Modified Hinderer's Technique for Serious Proximal Hypospadias with Ventral Curvature: Outcomes and Our Experience.

Hypospadias is a congenital anomaly that includes defi¬cient ventral structure of the penis. Proximal hypospadias cases make up 20% of all hypospadias cases. The choice of operative technique for hypospadias repair depends on the severity, and it is influenced by the surgeon's experience and perception of where priorities should lie. Several other factors interact to determine the type of repair, such as meatal site, presence of chordee, availabil-ity of the prepuce, and quality of the urethral plate and in addition surgeon's experience affects the type of repair. The treatment records of 42 penoscrotal and perineal hypospadias cases that were treated in our clinic from 1998 to 2017 were reviewed retrospectively. Cases with penoscrotal and perineal meatus were included in the study at the beginning of the urethroplasty. All cases had surgical intervention via Hinderer's tech-nique. Acceptable cosmetic results were obtained in 37 (85%) patients with an objective scoring system (HOSE) for evaluating the results of hypospadias surgery score. The mean score after surgery was 14.8. Fistula and wound breakdown occurred in 7 out of the 42 cases. In conclusion, the modified Hinderer's technique is a safe and reliable technique for both proximal and perineal hypospadias. Low complication rates and application in a single surgical session increase the comfort of both the patient and the surgeon.

Modified Tubularised Incised Plate Urethroplasty (TIPU) with Dorsal Inlay Preputial Skin Graft: An Outcome Evaluation of 21 cases

There are different techniques of hypospadias repair, out of them TIPU is widely practiced and popular procedure. Here a midline incision is made over the urethral plate for widening of urethral lumen and creation of neomeatus. Meatal stenosis may subsequently develop at new meatus and it is the limitation of this procedure. In this study TIPU procedure is modified by applying preputial skin graft on incised urethral plate in dorsal inlay fashion and outcome is evaluated. In this prospective study total 21 patients with distal penile hypospadias underwent repair between 2016 and 2017. TIPU urethroplasty was done as usual along with application of a preputial skin graft on midline incised urethral plate. Tubularization was done over appropriate sized catheter and double layers bilateral Dartos flap was applied to cover the suture line. SPC catheterization was done in every patient. On 14th post-operative day urethral catheter was removed and on the same day if patient voids satisfactorily, SPC catheter was also removed. The outcome was evaluated according to the Hypospadias Objective Scoring Evaluation (HOSE) system. 95.23% of the patients achieved apical neomeatus and 90.47% of slit like meatal shape. Mild degree chordee and normal caliber urinary flow was in 9.5% and 95.23% of the patients respectively. 4.76% of the patients developed urethrocutaneous fistula. Dorsal inlay preputial skin grafting is a very simple and feasible technique to maximize the outcome of TIPU procedure. However, multicenter and high volume data are needed for its wide application.&#x0D; Bangladesh Med J. 2018 Jan; 47 (3): 9-12

Chronological Changes In Uroflowmetry After Hypospadias Repair: An Observational Study.

AimUrinary flow after urethroplasty is of paramount importance. The aim of this study is to evaluate the progression of uroflowmetry (UF) parameters after different distal and proximal hypospadias repair techniques.MethodsIn this cohort study, cases that underwent primary hypospadias repair at our institution between March 2010 and December 2018 were included when uncomplicated, asymptomatic and toilet-trained. UF findings and post void residual were described after each specific technique.ResultsIn all, 88 patients were eligible. Time to last UF ranged from 35 to 138 months postoperatively. Significant increase started 36 months after distal tubularized incised plate urethroplasty (TIP) and afterwards than Mathieu technique. While was noticed 24 and 36 months after Onlay technique and proximal TIP, respectively; however, TIP showed steady significant increase atall time intervals. Duckett repair exhibited insignificant change in maximum flow rate (Qmax) values, buccal mucosal graft (BMG) and inner preputial graft (IPG), significant increase in the Qmax values after 6 and 24 months, respectively, then remained steady high. Transposed preputial flap (TPF) showed significant increase at 6–12 months only, then remained steady lower than the other two techniques. Obstructed flow was 37% after distal TIP, 30% after Mathieu, 25% after proximal TIP, 66.7% after Duckett repair, and 33.3% after TPF. There were no obstructed cases after BMG and IPG.DiscussionImprovement by time varied between techniques. After repair most cases are below the 50th percentile, implying that the reconstructed urethra is not functioning as a normal urethra. Staged repair for proximal hypospadias is preferable to a heroic one-stage procedure.ConclusionChoice of the surgical technique for hypospadias repair had impact on the improvement of Qmax values. TIP improved 36 months postoperatively. However, for proximal cases staged graft repair had earlier improvement and higher Qmax values than proximal TIP and Onlay techniques.

A comparative study between Snodgrass versus Mathieu with dartos flap urethroplasty for distal hypospadias repair

Objective The aim of this study was to compare between Snodgrass and modified Mathieu procedures regarding the complications rates and the operative time. Background Hypospadias is the presence of abnormal meatal opening along the ventral aspect of the penile shaft or into the perineum. Surgical management of hypospadias abnormality has challenged and perplexed surgeons. Patients and methods From April 2015 to December 2016, eligible boys were randomly assigned with equal probability to undergo one of the two techniques of hypospadias repair. The study included 40 children experiencing anterior distal shaft hypospadias. Surgeries were performed by a single surgeon. Patients were followed up after discharge. Results Mean age for the patients was 23 months, and the mean operative time varied from 70 min for Snodgrass to 100 min for Mathieu (P = 0.170). Success rate was 17 (85%) of 20 for the Snodgrass and 18 (90%) of 20 for modified Mathieu (P = 0.072). Complication rates in the form of urethrocutaneous fistula and meatal stenosis were the commonest, being 15% in Snodgrass and 10% in modified Mathieu repair. No statistically significant difference was found between tubularized incised plate and modified Mathieu procedure regarding complications (P = 0.721). Conclusion Snodgrass and modified Mathieu repair were safe, and the choice of one of the techniques will depend on the surgeon's decision.

Evaluation of different techniques in the management of crippled hypospadias

Objective To evaluate and compare different modalities that used in the management of different complications that we face in cases of crippled hypospadias. Background Hypospadias is one of the most common congenital deformities in humans. It has many causes and its repair is a challenging topic of urogenital reconstructive surgery. Many different techniques are currently being used. Patients and methods This was a randomized prospective study which included 30 patients with crippled hypospadias who presented to Menoufia University Hospital and who were classified into three groups: group A patients underwent tubularized incised plate (TIP) urethroplasty; group B patients underwent Thiersch–Duplay urethroplasty and group C patients underwent buccal mucosal graft. Results The age of the cases at the time of repair ranged between 2 and 14 (8.55 ± 2.3) years. The most common postoperative complications in the whole groups were urethrocutaneous fistula (13.3%), followed by meatal stenosis (6.7%), while urethral stricture and donor site complications were the rarest encountered in only one (3.3%) case. Conclusion There is no single applicable technique for hypospadias repair, if the urethral plate is healthy we can repair with TIP, if we have available nearby penile or preputial skin we use Duplay graft. Moreover buccal mucosa could be used in rest crinkled hypospadias.

Dorsal double layer dartos flap in the Snodgrass technique of hypospadias repair: An experience in Dhaka Medical College Hospital

Introduction: Hypospadias is one of the most common congenital anomalies and more than 300 operation techniques have been described for primary hypospadias. The Snodgrass technique and its modification have become a preferred for all varieties of hypospadias in the past decade. However fistula is the most common of this technique. The aim of the study is to investigate the importance of double layer dartos flap to prevent fistula formation in the Snodgrass technique. Materials and Methods: It’s a retrospective study, among 52 patients aged 11 months to 144 months who underwent mid penile and distal hypospadias repair in the Snodgrass technique using dorsal dartos flap for neo-urethral coverage. This study was done in the Department of Pediatric Surgery in Dhaka Medical College &amp; Hospital from November 2014 to December 2016. Results: Urethrocutaneous (UC) fistula were encountered in 10 patients (19.23%), meatal stenosis in 3 patients (5.76%), partial glanular dehiscence in 1 patient and residual chordee in 1 patient. Conclusions: For preventing fistula formation, urethral covering by a well vascularized dorsal double layer dartos flap should be the important part of the Snodgrass technique. Journal of Paediatric Surgeons of Bangladesh (2017) Vol. 8 (2): 47-51

A study of complications and outcome of hypospadias repair at a tertiary care hospital of south Gujarat, India

Background: In clinical practice, many factors influence the choice of surgical technique for hypospadias repair. With this background, we evaluated various methods of surgical repairs of hypospadias with their complications and outcomes. Methods: This prospective study was conducted at a tertiary care hospital of South Gujarat, India including 32 patients of hypospadias. All patents were followed after an interval of one week, one month, three months and six months after discharge and complications were recorded.Results: Out of 32, 20 (62%) of patients were having distal hypospadias while 11 (35%) had proximal hypospadias. Eleven patients were operated with TPIF repair and Snodgrass repair each while 4 patients were operated with stage 1 and stage 2 repair each. In TPIF group, 7(60%) patients developed superficial skin necrosis which in Snodgrass group, 5 (45%) patients developed wound infection &amp; oedema. Delayed complications were seen in only 2 cases of surgical repair. Out of 32, 31(96%) patients had satisfactory shape of penis while 1 (4%) patient had sub-optimal cosmetic result.Conclusions: Most common type of hypospadias was distal type in our study. Approximately one third patients were had their hypospadias repaired by TPIF Repair and same percent by Snodgrass Repair. Skin necrosis and wound infection were the most common early complication of the hypospadias repair. Urethral fistula remains the most worrying complication of surgery. TPIF Repair is one of the method which reduces rate of complications.

Limited Urethral Mobilization Technique in Distal Hypospadias Repair : An Overview

Background: Fistula formation is the most common complication with various rates among different techniques of hypospadias repair. The urethral advancement as an one stage technique for repair of hypospadias is considered a good technique. As no new urethral tube is constructed there is no risk of fistula. We assess the outcomes of the Limited Urethral Mobilization (LUM) technique in distal hypospadias repair.Methods: Our study included 20 patients aged upto 12 years who were treated with Limited urethral mobilization technique for distal hypospadias in Shaheed Suhrawardy Medical College Hospital from December 2014 to December 2015. The urethra proximal to the meatus was mobilized for a distance sufficient to allow it to reach the glans tip without tension. Then the urethra was placed in the glanular bed and glanular reconstruction was performed.Results: Three-fold urethral mobilization was sufficient for construction of tension-free urethra-glanular anastomosis. Cosmetically normal looking circumcised penis with ventrally slit meatus achieved in all but one subcoronal case where the most distal of the glans approximation sutures disrupted leading to a minor detachment in the glans. The minor complications includes preputial edema in one patient, two patients had wound infection, one had meatal stenosis which was treated with gentle dilatations. Postoperative urethro cutaneous fistula, retraction of the urethral meatus or recurrent chordee were not observed.Conclusion: Distal hypospadias repair with the LUM technique can be effective with satisfactory cosmetic and functional results. There is no chance for development of urethro cutaneous fistula, a major postoperative complication of other surgical techniques of creating a neourethra. Postoperative management is simple and a brief hospital stay is sufficient.Chatt Maa Shi Hosp Med Coll J; Vol.16 (1); Jan 2017; Page 37-41

Glans wings are separated ventrally by the septum glandis and frenulum penis: MRI documentation and surgical implications.

In the normal human penis, the glans wings are in apposition in the midline ventrally, and are separated by the "septum glandis" and "frenulum" of the prepuce. However, most of the hypospadias repair techniques include dissection of the glans wings and their approximation enclosing the neourethra within the glans. In order to obtain detailed information about the normal anatomy of glans penis, magnetic resonance imaging (MRI) findings of the penis were studied in three adults. Transverse, and sagittal sections of the penis were performed with a 1.5-T MRI scanner. The present MRI study has confirmed that the glans wings do not fuse at the ventral midline and they are seperated by a fibrous tissue (septum glandis). This fibrous tissue is connected to the frenulum, traversing the wings of the glans penis. The glanular urethra forming the fossa navicularis has a wider caliber than the proximal urethra, and its walls are radiologically seen as the extension of that fibrous tissue. The male urethra is not a uniform tubular structure and has distinct attachments in glans penis. The glans wings are separated ventrally by the septum glandis and frenulum. In hypospadias, the septum glandis and frenulum are entirely missing structures. Therefore, in hypospadias surgery, the anatomical features of the glanular urethra must be taken into consideration.