Tubularized Incised Plate Technique Research Articles

Cumulative sum learning curve analysis of tubularized incised plate repair for hypospadias: a study of a single surgeon with a single surgical procedure.

To ascertain the quantity of instances by which a single surgeon achieves competency and proficiency in using tubularized incised plate (TIP) technique for the repair of distal and mid-shaft hypospadias using the cumulative sum (CUSUM) analysis. We retrospectively evaluated patients with distal and mid-shaft hypospadias who were treated by a single surgeon between 2015 and 2021, using a single primary TIP technique with a de-epithelialized Byars flap. Data including type of hypospadias, age at surgery, curvature, operation time (OT), length of the reconstructed urethra, and postoperative outcomes were collected and assessed. CUSUM was used to assess the trends in OT and complication rate (CR) in order to generate the learning curve. The evolution of OT and CR can be divided into three phases: learning, competence, and proficiency. CUSUM identified three phases in the learning curves of all TIP repairs. The median OT decreased from 135 min [interquartile range (IQR) = 125-155] to 92 min (IQR = 80-100) (P < 0.001), CR decreased from 28 (28%) to 8 (5.3%) (P < 0.001), and reoperations decreased from 15 (15.2%) to 4 (2.6%) (P < 0.001). According to the CUSUM learning curve, technical competency plateaued after the 99th case, and both OT and CR entered a significantly declining proficiency phase after the 231st case. Further, when the neourethral length exceeded the total average, total complications, urethrocutaneous fistula, and reoperations increased (P = 0.013, P = 0.006, and P = 0.028, respectively). Our study suggests that surgeons performing TIP repair may reach technical competency and achieve proficiency after operating on 99,231 cases, respectively. Moreover, the longer the neourethral length, the higher is the CR.

Postoperative complications of Mathieu incised plate versus standard tubularized incised plate urethroplasty for distal hypospadias: a systematic review and meta-analysis

Introduction: Surgical reconstruction is the mainstay treatment for distal hypospadias. A range of urethroplasty techniques is available with their benefits and disadvantages. We conducted a study to investigate the postoperative complications of Mathieu with plate incision technique relative to standard tubularized incised plate (TIP) technique in patients with distal hypospadias. Materials and Methods: The course of the study was referred to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Designated articles were clinical trials comparing postoperative complications of Mathieu with plate incision and standard TIP technique for distal hypospadias, systematically searched through PubMed and ScienceDirect databases. Pooled studies were analyzed in qualitative and quantitative methods. The protocol of this study was registered on PROSPERO (CRD42022341745). Results: Meta-analysis of the included studies yielded a significant difference in the postoperative incidence of meatal stenosis, narrow stream, and fistula formation of distal hypospadias patients in favor of Mathieu with plate incision compared to standard TIP technique, with Mantel-Haenszel test result of OR: 0.08 CI 0.01-0.41 (p = 0.003) for meatal stenosis; OR: 0.09 CI 0.02-0.49 (p = 0.006) for narrow stream; and OR: 0.28 CI 0.08-0.96 (p = 0.04) for fistula formation. All outcomes presented insignificant heterogeneity across studies (p &gt; 0.05). Conclusion: The incidence of meatal stenosis, narrow stream, and fistula formation is lower in patients with distal hypospadias who underwent Mathieu with plate incision procedure than the standard TIP urethroplasty.

Distal hypospadias repair: Comparative study between snodgrass and transverse preputial onlay flap

Distal hypospadias repair has several operative strategies such as tubularized incised plate (TIP); Transverse preputial onlay flap (TPOF) and Modified Mathieu Procedure. The aim of our work is to compare between TIP and TPOF techniques in the outcome. We conducted this comparative study on 66 patients with different types of distal hypospadias divided in two groups A and B for TIP and TPOF respectively. We reported outcome and complications for both TIP and TPOF repair. Our results revealed mean operative time was significantly higher in group B (123.1±6.8min) than in group A (93.73±3.9min, P value<0.001). Postoperative urinary fistula was reported in group A (15.2%) while no fistula in group B (p value=0.05). The vertical slit appearance of meatus was better in group A (54.5%) than in group B (24.2%, P value 0.023). As regard to hypospadias objective scoring evaluation (HOSE) (Summary Figure) the meatal shape score was higher in group A (1.55±0.51) than in group B (1.24±0.44, p value=0.0l), the urinary stream score was significantly higher in group A (1.82±0.39) than in group B (1.97±0.17, p value=0.04) and the urinary fistula score was significantly higher in group A (3.79±0.60) than in group B (4±0, p value=0.04). Complications are more common after TIP than in TPOF. As regard the meatus shape, the naturally looking vertical slit like meatus was achieved more in the TIP than in TPOF. We advocate further studies with a large number of patients with a long follow up period. TPOF is a great option to consider in cases of distal hypospadias because it is an effective technique for primary distal hypospadias repair with a good cosmetic outcome and a low associated complication.

Urethroplasty for chordee with a paper-thin hypoplastic urethra: A long-term study.

ObjectivesTo establish a standard surgical procedure for children with chordee with a paper‐thin hypoplastic urethra, which was based on the degree of curvature and urethral plate quality. To guidelines for the management of this disorder.MethodsWe reviewed 58 cases of chordee with a paper‐thin hypoplastic urethra, managed between March 2006 and September 2020. The age of the patients ranged from 23 to 89 months. Operative details and postoperative complications were analyzed.ResultsMild‐moderate chordee with a paper‐thin hypoplastic urethra correction was performed using a tubularized incised plate (13 cases) or onlay island flap (five cases) technique after penile degloving. Severe chordee with a paper‐thin hypoplastic urethra required transection of the urethra and underwent a Duckett (11 cases) or staged (29 cases) urethroplasty. Complications in the tubularized incised plate and onlay island flap groups were 7.7% and 20%, respectively. The overall complication rate was 10.3% in the staged group and 27.3% in the Duckett group.ConclusionsReconstruction of the entire hypoplastic urethra should be recommended in the management of chordee with a paper‐thin hypoplastic urethra. We propose an algorithm based on the degree of curvature and urethral plate quality. The tubularized incised plate or onlay island flap technique can be used for mild to moderate chordee with a paper‐thin hypoplastic urethra, and the outcome of the tubularized incised plate technique tends to be better than that of the onlay island flap technique. Duckett or staged urethroplasty is suitable for severe chordee with a paper‐thin hypoplastic urethra, and the staged technique can improve the overall success rate.

Is Tip Repair in Hypospadias is a Confidence Building Procedure? Analysis of early Hundred Cases at A Pediatric Surgical Centre

Purpose: The tubularized incised plate (TIP) technique for hypospadias repairis a well-known procedure for urethroplasty. The authors in this studyanalyze the application and outcome of TIP by the Pediatric Surgeon. They describe how this procedure helps to start hypospadias surgery services especially to the newly established centres. The procedure can provide surgeons required confidence and prepare them to undertake the complex surgeries for hypospadias. Method: This is a prospective study done on all cases of hypospadias operated with TIP technique in a newly established centre for Pediatric Surgery for a period of two years. The results were evaluated on the basis of outcome in the form location and shape of meatus, correction of curvature. The complications were noted and individually treated. Results: Total 100 patients were operated with TIP technique during the study period. The Distal type of the hypospadias was the main variety treated (n=64) followed by mid penile and proximal penile type of hypospadias (n=21 and n=13 respectively). All patients were offered TIP as the method of urethroplasty and were operated by a single surgeon. The procedure was well tolerated by all the patients. There were few complications, mainly meatal stenosis and urethrocutaneous fistula. No Major complications were found. The cosmetic and functional outcome was good in all cases. Conclusion: The TIP urethroplasty offers a considerable safe technique in the patients of hypospadias. It can be easily learnt and reproduced. There is a learning curve associated with the procedure. The authors can conclude that the procedure of TIP in the cases of hypospadias brings a good amount of confidence in a Pediatric Surgeon to offer the services of hypospadias surgery especially in newly established setup. Keywords: Hypospadias; Pediatric; Fistula; Hypospadias.

Does the suturing technique (continuous versus interrupted) have an impact on the outcome of tubularized incised plate in hypospadias repair with adequate urethral plate? A prospective randomized study

Hypospadias is one of the most common anomalies of male external genitalia. The aim of hypospadias repair is to achieve a normal phallus with a satisfactory functional and cosmetic result and to develop a single and consistent urinary stream while in standing position. The introduction of tubularized incised plate (TIP) urethroplasty by Snodgrass in 1994 resulted in revolutionizing management of different types of hypospadias. While there is consensus on the use of absorbable sutures in hypospadias repair, there are no specific guidelines for the suturing technique and the technique itself remains debatable. To compare the outcome of interrupted- and continuous-suture in hypospadias repair using TIP technique. This was a prospective randomized study. It comprised 260 uncircumcised hypospadiac boys with adequate urethral plate who underwent TIP repair. Boys with glanular, recurrent, proximal hypospadias and inadequate urethral plate were excluded from the study. The boys were randomized into two groups: Group A consisted of 130 boys who underwent TIP repair using continuous subcuticular suture urethroplasty and Group B of 130 boys who underwent TIP repair using interrupted subcuticular suture urethroplasty. The operative time was of lower statistical significance in group A (P=0.006) while the rate of complications were of higher statistical significance in group A (P=0.027). Urethrocutaneous fistulae occurred in 20 patients (14 in Group A and six in Group B), which is a statistically significant difference (P=0.048). On the other hand, superficial wound infection, partial glans dehiscence, meatal stenosis, urethral stricture, and aesthetic appearance were statistically insignificant. The effect of suturing techniques in bowel anastomosis has been studied and it has been found that the use of an interrupted-suturing technique results in a decreased complication rate compared to continuous suturing. This agrees with our study where the running sutures groups was associated with a higher complication rate compared to interrupted sutures.

The outcomes of tubularized incised plate hypospadias repair and tubularized incised plate grafting using muccal mucosal graft and preputial free graft: a prospective randomized study

Objective Hypospadias is the most common anomaly of congenital urogenital defects. Tubularized incised plate (TIP) repair is an established technique. High rates of its complication advocate the idea of grafting of TIP incision. Grafts may be buccal mucosa or prepuce in this study. Patients and methods This prospective study included 64 patients complaining of mid and distal penile hypospadias. The patients were randomized into three groups according to the technique used in the repair of hypospadias. The first group included patients repaired by TIP urethroplasty, whereas group B and group C included patients repaired by inner perpetual skin and buccal mucosa, respectively. Follow-up was for 6 months. Results This study included 64 cases. TIP repair (group A) was done for 20 patients, whereas in 44 cases, TIP grafting was performed; groups B and C included 21 and 23 cases, respectively. The TIP urethroplasty was successful in 85%, whereas in groups B and C, the success rates were 91.5 and 87%, respectively. There were statistically insignificant differences in complications among all groups (P>0.005). Conclusion Outcomes of TIP grafts have no significant difference than outcomes of TIP technique.

Self-reported outcomes after the onset of puberty in patients undergoing primary distal hypospadias repair by the tubularized incised plate technique combined with preputial reconstruction vs. circumcision: A norm related study

PurposeWe assessed self-reported outcomes after the onset of puberty in patients undergoing tubularized incised plate (TIP) repair in combination with preputial reconstruction (PR) or circumcision for primary distal hypospadias, in comparison to normal controls. Material and methodsOut of 498 patients undergoing primary distal hypospadias repairs between 2001 and 2012, 83 underwent TIP repair associated with PR or circumcision before age 10-year, and had a Tanner stage ≥2 at study. Outcomes were assessed by online self-administration of validated questionnaires and additional non-validated questions. Results were compared between patients undergoing TIP repair vs. normal age-matched controls (healthy volunteers), and, between patients undergoing PR vs. circumcision. ResultsForty-one of the 83 eligible patients completed the study (response rate 49.3%). Of these, 26 had undergone PR. Median post-operative follow-up was 11.8 (range 6.5–16.2) years. The control group included 45 healthy boys. Comparing groups, there were no statistically significant differences in the cosmetic aspect of the penis, patient perception of penile appearance, and quality of life. Irrespective of preputial management, patients reported fear of being teased for the appearance of their genitalia much more commonly than controls (p = 0.02), but this did not affect their relationship patterns and quality of life. ConclusionSelf-reported outcomes after the onset of puberty were not significantly different between patients undergoing primary TIP repair of distal hypospadias in childhood and normal controls. Patients were significantly more commonly feared of being teased for their genital appearance, but this did not interfere with their social skills. Preputial management, namely PR vs. circumcision, did not affect the outcome.

Comparison of meatal-based flap (Mathieu) and tubularized incised-plate (TIP) urethroplasties for primary distal hypospadias: A systematic review and meta-analysis

PurposeWe conducted this meta-analysis to compare postoperative outcomes between meatal-based flap (Mathieu) and tubularized incised plate (TIP) techniques for distal hypospadias. MethodsA comprehensive literature search of PUBMED, Web of Science, EMBASE, and Cochrane Library was conducted. Outcomes evaluated in this review were fistula, meatal stenosis, wound dehiscence and flap necrosis. We calculated odds ratio (OR) with 95% confidential interval (CI) to compare postoperative outcomes between Mathieu and TIP after data extraction and literature identification. All data were analyzed using Review Manager 5.2. In order to find potential affective factors, meta-regression and subgroup analyses were applied. Results16 studies, 1386 patients, including 762 patients receiving Mathieu and 624 individuals subjected to TIP met the inclusion criteria. The synthetic data suggested that Mathieu and TIP were comparable in terms of fistula (OR = 0.93; 95% CI: 0.65 to 1.33; P = 0.70, I2 = 14%), wound dehiscence (OR = 0.89; 95% CI: 0.33 to 2.39; P = 0.81, I2 = 11%), and flap necrosis (OR = 1.9; 95% CI: 0.51 to 7.09; P = 0.20, I2 = 38%) without significant heterogeneity for each comparison group. Pooled estimates showed a significantly lower rate of meatal stenosis with Mathieu than with TIP (OR = 0.41; 95% CI: 0.24 to 0.73; P = 0.002, I2 = 4%). Subgroup analyses showed that the difference between Mathieu and TIP was more obvious in the studies published before 2013 in meatal stenosis. The modified Mathieu technique and a running suture for urethroplasty might be relevant to a lower rate of meatal stenosis in the data, although no statistical significance in the present effects model overall was found. One-way sensitivity analysis showed that the results were stable. There was no publication bias detected using both funnel plot and Egger's test. ConclusionThis meta-analysis suggested that Mathieu and TIP technique were equivalent for primary distal hypospadias in terms of fistula, wound dehiscence, and flap necrosis. Pooled estimates indicated that there was a lower rate of meatal stenosis with Mathieu rather than with TIP significantly. The modified Mathieu technique and a running suture for urethroplasty might be relevant to a lower rate of meatal stenosis. Type of studyMeta-analysis. Level of evidenceIV

Outcomes of mid-penile hypospadias repair using two different techniques

Introduction Several techniques have been reported for mid-penile hypospadias repair, including Snodgrass tubularized incised plate (TIP) and onlay island flap (OIF) procedures, which are two popular procedures. Aim of the work To compare the outcomes and complication rates for both TIP and OIF techniques. Patients and methods A prospective randomized study was conducted on 140 boys (age range, 1–6 years) with primary mid-penile hypospadias who underwent repair from June 2011 to December 2016 at our university hospitals. The patients were prospectively randomly divided into two equal groups: group A (n=70), underwent Snodgrass TIP urethroplasty, and group B (n=70), underwent OIF. Inclusion criteria only males with fresh mid penile hypospadias without ventral chordee from 1 to 6years old. Exclusion criteria were recurrent cases, presence of ventral chordee, parental refusal or children more than 6years of age. Outcomes were assessed in terms of success rates, operative time complication rates, and cosmetic appearance during follow-up. All children were subjected to full history taking, thorough clinical examination, and routine laboratory investigations (CBC, BT, CT, FBS, urinalysis, liver and renal profile), results were compiled and compared statistically. Results There were statistically significant differences between the two techniques regarding success rate, operative time incidence of complications and cosmetic results. Conclusion Both techniques are reliable and feasible for treatment of mid-penile hypospadias, but there was a statistically significant difference regarding operative time, complications, and cosmetic outcome with TIP procedure. So, the authors preferred it if suitable urethral plate is present.

The use of autologous platelet-rich fibrin membrane in hypospadias surgery: a preliminary study

Background Hypospadias, a congenital anomaly with an incidence of 1/300, is a very challenging problem. Despite advances in hypospadias repair surgery, urethrocutaneous fistula remains a very common complication with a reported incidence varying from 4 to 28%. The use of an intermediate layer between the neourethra and the skin is one of the most important techniques used to reduce the likelihood of fistula formation and postoperative complications. Aim The aim of this study was to evaluate the effect of platelet-rich fibrin membrane (PRF) on the success rate of tubularized incised plate (TIP) repair and its postoperative complications. Patients and methods The study was carried out on 20 patients who were admitted to the Plastic and Reconstructive Surgery Department, Tanta University Hospitals, for hypospadias surgery throughout the period from the first of May 2015 to the end of April 2016. Urethroplasty was performed using the TIP technique. PRF membrane was applied and sutured over the sutured urethra as an intervening layer between the skin and neourethra. The perioperative course and postoperative complications were recorded. Results Twenty patients were included in this study. Their mean age at surgery was 2.45 years (range: 1–4 years). No intraoperative complications were encountered. Glanular edema occurred in two patients. Wound infection occurred in one patient. None of the patients had hematoma, wound dehiscence, or flap necrosis. With a mean follow-up of 6 months, urethral fistula occurred in two patients. Conclusion The PRF patch is a safe and efficient technique as an intermediate layer in TIP repair, and it helps to reduce the incidence of postoperative complications especially when healthy tissue is not available as an intervening layer.

RELATION BETWEEN COMPLICATING FACTORS OF HYPOSPADIA AND COMPLICATIONS AFTER TIP: A RETROSPECTIVE STUDY

Objective: This study aims to find an association between hypospadias complicating factor for complications that occurred after hypospadias reconstruction, focusing on tubularized incised plate (TIP) as reconstruction techniques are most commonly used. Material &amp; methods: The study data was obtained from medical records of urologic hypospadias patients in Cipto Mangunkusumo General Hospital, Jakarta. Samples are those who underwent hypospadias reconstruction in Cipto Mangunkusumo General Hospital, since April 2002 until May 2014 with a total sampling method. Data were analyzed using SPSS ver 14. Results: We collected 127 patients who underwent the TIP technique with a mean patient age and treatment duration was 7.58 years and 10.95 days. Fistule is the most common complication in patients with post-TIP hypospadias accounting for as high as 32 (25.2%). Bivariate analysis showed a significant correlation between the location of the hypospadias meatus (distal) with torsion of the penis (n = 2; p 0.019). Conclusion: On the basis of the technical complications TIP, such as fistules, meatus stenosis, urethral stricture, torsion of the penis, and glans dehiscence, then the indication for TIP should be clear or selective.

Proximal hypospadias: A persistent challenge. Single institution outcome analysis of three surgical techniques over a 10-year period

The optimal treatment of proximal hypospadias remains controversial. Several techniques have been described, but the best approach remains unsettled. To evaluate and compare the complication rates of proximal hypospadias with and without ventral curvature (VC), according to three different surgical techniques: tubularized incised plate (TIP) uretroplasty, dorsal inlay graft TIP (DIG), and staged preputial repair (SR). It was hypothesized that SR performs better than TIP and DIG for proximal hypospadias. Single-center, retrospective chart review of all patients with primary proximal hypospadias reconstructed between 2003 and 2013. The DIG was selectively employed in cases with narrow urethral plate (UP) and deficient spongiosum. Extensive urethral plate (UP) mobilization (UPM), dorsal plication (DP) and/or deep transverse incisions of tunica albuginea (DTITA) were selectively performed when attempting to spare transecting the UP. Division of UP and SR was favored in cases with severe VC (>50°), which was often concurrently managed with DTITA if intrinsic curvature was present. For SR, tubularization of the graft was performed 6 months later. A total of 140 patients were included. Tubularized incised plate (TIP), DIG, and SR techniques were performed in 57, 23, and 60 patients, respectively. The TIP and DIG techniques achieved similar success rates, although DIG was performed in cases of narrow and spongiosum-deficient plates. Reoperation rates with TIP and DIG techniques was 52.6% and 52.1% (NS). Urethro-cutaneous fistulas were seen in 31.5% and 13% of TIP and DIG techniques, respectively. Staged repair accomplished better results than both TIP and DIG techniques, despite being performed in the most unfavorable cases (reoperation rate 28%). After technical modifications, the DIG technique achieved similar outcomes of SR. Proximal hypospadias remains challenging, regardless of the technique utilized for its repair. Urethro-cutaneous fistulas were more commonly seen after long TIP repairs. Approximately half of the patients undergoing long TIP and DIG procedures needed re-intervention, although the percentage decreased significantly with late modifications in the DIG group. Recurrence of VC after TIP and DIG techniques seemed to be a significant and under-reported complication. Staged repairs, despite being performed for the most severe cases, resulted in overall better outcomes.

Comparison between tubularized incised plate urethroplasty and other types of urethroplasty for mid and distal penile hypospadias

Background: Hypospadias is a common congenital anomaly seen in the male child. The aim of this study was to compare tubularized incised plate (TIP) urethroplasty and other types of single stage urethroplasty for mid and distal penile hypospadias. Patients and Methods: Seventy-seven patients having mid and distal penile hypospadias were assessed prospectively and retrospectively from March 2010 to September 2014. The study had retrospective (March 2010-February 2013) and prospective (April 2013-September 2014) divisions. Forty-four patients underwent surgical repair using TIP technique and 33 patients, using other urethroplasties (Mathieu, meatal advancement and glanuloplasty incorporation, and Asopa techniques). Patients were reviewed at 2 weeks, 1-month, and 3 months after discharge. Data including fistula formation, cosmetic disfigurement, and duration of the surgery were collected and the two groups were compared. Results: In both retrospective and prospective groups, TIP urethroplasty has a better outcome than other type of urethroplasties for both mid and distal hypospadias. The fistula formation rates were 31.82% (7) and 64.70% (11) in distal and 31.82% (7) and 62.5% (10) in mid hypospadias in TIP and other urethroplasty group, respectively, significant result in distal hypospadias. The cosmetic disfigurement rates were 5.88% (1) and 17.64% (3) in distal and 9.09% (2) and 18.75% (3) in mid hypospadias in TIP and other urethroplasty group, respectively. Mean operative time duration in TIP urethroplasty was 90.79 min and 110.15 min in other urethroplasty group and was statistically significant. Conclusion: TIP urethroplasty is a simple procedure for treatment of both mid and distal penile hypospadias, with less complications and satisfactory results as compared to other urethroplasties. Cosmetic appearance of urethral meatus was also more satisfactory with TIP urethroplasty than other urethroplasties.

Tubularized incised plate urethroplasty for hypospadias reoperation: a review and meta-analysis.

Tubularized Incised Plate (TIP) urethroplasty is a technique for urethral reconstruction of hypospadias although there are some controversies for its use in recurrent cases. The aim of this study was to review the results of TIP technique in various studies and the usage of different flaps for covering the repair site. Extensive Search was performed for articles published between 1994 and 2013 in common electronic databases. The overall TIP complication rates were estimated by a fixed effects model meta-analysis. 17 articles of hypospadia repair using the TIP method were reviewed. All studies performed surgery and repair on the basis of the Snodgrass's method; however, some introduced modifications to the method. The prevalence of complications in repeated TIP surgery was 11.1 to 33.3% and the most prevalent complication in different studies was fistula. Based on the meta-analysis, the overall estimation of complications was 21.8% (95% CI: 18.3 to 25.5). Most studies performed the incision of the urethral plate to create a supportive coverage upon neourethra, and confirmed its success. We recommend further investigation on using different flaps in well-designed randomized controlled trials to choose the best surgical method for repairing recurrent hypospadias.

Safety of latex urinary catheters for the short time drainage

Background:In this study, we attempt to identify the most appropriate catheter (silicone vs. latex) for short-term urinary catheterization. We compared the post-operative clinico-pathological complications between latex and silicone for short term catheterization in rabbits with hypospadias.Materials and Methods:Forty rabbits were used in our study to compare complications of catheterization. They were divided in two groups. Hypospadias like defect was created by a 1 cm long excision of the ventral urethra. For urethroplasty, we used tubularized incised plate technique. Latex and silicon catheters were used in groups 1 and 2, respectively. Post-operatively, routine laboratory urine test and complications (allergy, infection, bleeding) were compared in groups.Results:A total of 40 rabbits underwent hypospadias repair. Findings showed that there were no significant differences between groups based on urine test indices (P = NS). Urinary tract infection rate was 10% (2 rabbits) in latex and 0% in silicone groups (P = NS). There were no significant differences between groups regarding of cystitis grades between study groups (P = NS).Conclusion:It seems that urinary tract catheterization with latex catheters is a safe, feasible, and in-expensive procedure for short-term post-operative course in hypospadias surgery in patients without latex hypersensitivity.

Systematic review and meta-analysis of studies comparing the perimeatal-based flap and tubularized incised-plate techniques for primary hypospadias repair

To conduct a systematic review and meta-analysis of studies comparing the perimeatal-based flap (PBF) and tubularized incised-plate (TIP) techniques for primary hypospadias repair and determine whether the two techniques had similar reported outcomes. The PubMed, Embase and Cochrane databases were searched using the terms: hypospadias, Snodgrass, TIP*, tubularized incised plate, tubularized incised-plate, Mathieu*, perimeatal-based flap, perimeatal flap, meatal-based flap and meatal based flap. No other limits were used. Inclusion criteria included: primary hypospadias repair only; both including the PBF and TIP techniques; at least one of the quantitative outcomes obtainable from study; comparative studies. Twelve studies fulfilled the inclusion criteria and were included in the final analysis. Meta-analysis showed that there were no significant differences between the two techniques when comparing fistula (OR=1.47; 95% CI: 0.82-2.63; P=0.20), meatal stenosis (OR=0.53; 95% CI: 0.24-1.16; P=0.11), and wound dehiscence (OR=0.82; 95% CI: 0.24-2.84; P=0.76). Both the studies which assessed cosmesis objectively showed a consistent better cosmetic result of the TIP technique (P<0.05). There were no significant differences of complication rates between the two techniques, and the TIP technique was usually of better cosmesis. Given the large clinical heterogeneity among studies, future more well-designed studies with full data and uniform criterion were awaited.

Age of patient is a risk factor for urethrocutaneous fistula in hypospadias surgery

ObjectiveThere is still much debate regarding the effect that age at hypospadias operation has on the rate of complications. The aim of this study was to evaluate whether patient age is a risk factor for surgical complications when using the tubularized incised plate (TIP) urethroplasty technique. MethodsBetween 2005 and 2011, 307 pediatric patients with distal or mid-penile hypospadias underwent the TIP procedure. Demographic and surgical data were evaluated. ResultsThe complications recorded across all age groups were: fistula, meatal stenosis, glans dehiscence and urethral stenosis. Fistula was the most frequent complication in 10–14 year olds compared to the younger patient groups, and this difference was statistically significant. ConclusionAge and surgical technique should be taken into consideration when planning hypospadias surgery, since the complication rate increases with patient age. The TIP technique is a safe procedure with a low rate of fistula formation in distal and mid-penile hypospadias repair for patients of any age during the prepubertal period.

Redo hypospadias repair: experience at a tertiary care children’s hospital

Treatment of patients with failed hypospadias repairs can be challenging. Our study aimed to determine the best type of redo repair depending on the location and size of the urethral meatus, the status of the urethral plate and genital skin, the severity of residual chordee and the amount of scar tissue. The Institutional Review Board approved our retrospective chart review of patients who had a redo hypospadias repair at our institution over the past 6 years. We recorded the type and number of previous repair(s), the type and number of redo procedure(s),as well as the complications and functional outcomes. There were 28 patients, aged 1-12 (mean 3.8) years, with failed hypospadias repairs. The initial severity of the hypospadias were as follows: perineal (1), penoscrotal (9), proximal shaft (1), mid-shaft (9), distal shaft (4), coronal (3) and mega-meatus (1). Of all the patients, 24 had 1 repair, 3 had 2 repairs and 1 had 3 repairs. The initial repairs comprised 11 tubularized island flaps (TIFs), 8 Snodgrass tubularized incised plate (TIP) techniques, 5 Mathieu repairs, 1 Meatal Advancement and GlanuloPlasty Incorporated (MAGPI) technique, 1 Pyramid, 1 Arap technique and 1 Thiersch-Duplay repair. Twenty-one of 28 patients had 1 redo operation, 5 had 2 redo operations, 1 had 3 redo operations and 1 had 4 redo operations, for a total of 38 redo operations. Of these, 26 were TIP techniques (68.4%), 3 were Mathieu (7.9%), 3 were TIF repairs (7.9%), 2 were onlay island flaps (5.3%) and 4 were buccal mucosal grafts (10.5%). Follow-up was 1-5 years (mean 3.5 yr). The final locations of urethral meatus included glans (18), corona (6), mid-shaft (3) and penoscrotal (1). Complications after redo surgery comprised 4 urethrocutaneous fistulae, 2 meatal stenoses, 1 urethral stricture and 3 dehiscences. Sixteen patients were followed with yearly uroflow with a Q-mean (mean uroflow) range of 3-14 mL/s (mean 8.1 mL/s). The majority of hypospadias failures can be salvaged with one operation. The TIP repair is our procedure of choice in most cases. In the setting of a poor urethral plate, TIF or buccal mucosa may be necessary. Complications are not infrequent in redo procedures.

Hypospadias

Hypospadias is one of the most common congenital anomalies in men. We searched the recent literature (since 1 January 2011) using the following keywords in the title or abstract: hypospadia or hypospadias, in order to provide the reader with an updated view of the subject. Early repair is recommended; distal forms are mainly treated by the tubularized incised plate technique; however, meatal stricture concerns are still noticed, limiting its use on proximal forms. The debate of proximal primary repair in either one or two stages is still ongoing. Minor modifications for preparing the distal bed for the urethroplasty in two stages are presented. One-stage repairs, either with reconstruction of the urethral plate (three-in-one concept) or simply with the onlay to tunica albuginea (Rigamonti), is a viable option with over 70% success in one surgery. The importance of barriers, such as tunica vaginalis and dartos flap, was reassessed and flow rates may indicate obstructive voiding patterns after 1-year follow-up. Further experience and comparative studies for distal and proximal hypospadias are required. Long-term data may indicate the appropriate procedure selected for primary repair.