Tubularized Incised Plate Urethroplasty Repair Research Articles

Evaluation of Tubularized Incised Plate Urethroplasty with Spongioplasty-Dartosoraphy Reinforcement in Pediatric Hypospadias: A Randomized Controlled Study.

The original description of tubularized incised plate urethroplasty (TIPU) was provided by Snodgrass in 1994. The results were significantly improved by several modifications. To decrease the incidence of complications, interposing a vascularized flap after tubularization of the neourethra is recommended. The extent to which the type of interposed tissue has a direct effect on the rate of complications and cosmetic outcomes after TIPU repair is considered the answer to the main hypothesis of this study. This prospective controlled randomized trial was conducted in the Department of Pediatric Surgery, Al-Azhar University, Cairo, Egypt, between May 2019 and May 2023. A total of 220 patients were included in this study. Patients were randomly assigned to either group A or group B. Group A included 110 patients who underwent TIPU with spongioplasty-dartosoraphy reinforcement. The other 110 patients (group B) underwent TIPU with dorsal dartos flap interposition, without spongioplasty. Complications developed in 34 of 220 patients (15.4%). In group A, complications developed in 11 of 110 patients (10.0%). In group B, complications occurred in 23 of 110 patients (20.9%). Although the fistula rate, glanular dehiscence, disruption, and meatal stenosis were not significantly different between the study groups, the skin necrosis rate was significantly lower in group A than in group B. The overall complication rate was significantly lower in group A than in group B. Also, the difference in the mean Hypospadias Objective Scoring Evaluation between the two groups was statistically significant. TIPU with spongioplasty-dartosoraphy reinforcement is an effective modification of conventional TIPU. This modification appears to reduce the rate of complications and yield better cosmetic outcomes.

Tubularized incised plate urethroplasty and grafted tubularized incised plate urethroplasty: systematic review, meta-analysis and trial sequential analysis

BackgroundHypospadias is one of the most common genital birth defects. There are around 300 various techniques available for the repair of hypospadias. This study aims to compare the reported outcomes...

Comparison of urethrocutaneous fistula after tubularized incised plate urethroplasty and urethral advancement and glanuloplasty incorporated in coronal hypospadias.

Objective: To find the incidence of urethrocutaneous fistula after Tubularized Incised Plate Urethroplasty (TIPU) and Urethral Advancement and Glanuloplasty Incorporated (URAGPI) repairs in children presenting with coronal hypospadias. Study Design: Randomized Prospective Study. Setting: Department of Paediatric Surgery, Pak Emirates Military Hospital, Rawalpindi. Period: 10th March 2022 to 10th November 2022. Material & Methods: A total of 40 children were enrolled in the study. Patients were randomly allocated to receive either TIPU (n=20) or URAGPI (n=20) technique after approval of hospital ethical review committee. Data was collected on a specifically designed proforma. Outcome was measured in terms of incidence of urethrocutaneous fistula in the two study groups. Results: Average age of patients was 28.2 ± 9.7 (months) in TIPU and 29.6 ± 9.9 months in URAGPI group. Frequency of fistula was 4 (20.0%) in TIPU repair compared to none 0 (0.0%) in the URAGPI repair. Difference in proportions of urethrocutaneous fistula was found statistically significant between the two groups (p-value = 0.03). Conclusion: Incidence of urethrocutaneous fistula was found greater in TIPU technique when compared with URAGPI technique.

A multicenter study on surgical procedure selection and risk factor analysis of postoperative complications after TIP and Duckett hypospadias repair

BackgroundHypospadias is a common congenital malformation in pediatric urology with surgery being the only curative treatment. Although there are hundreds of surgical methods for hypospadias, no single method can treat all types, and there are still high rates of postoperative complications. We performed this study to investigate surgical procedure selection and perform risk factor analysis of postoperative complications in hypospadias repair.MethodsRetrospective analysis was performed of complete clinical and follow-up data of children with hypospadias who were treated and followed up at 15 children’s clinical centers in Mainland China from December 2018 to December 2019. Children were divided into groups according to Barcat classification and surgical methods in order to analyze the surgical choice for different types of hypospadias and the influencing factors of different surgical methods for complications.ResultsIn total, 1011 patients were followed up for 26 months. According to Barcat classification, there were 248 cases of distal type hypospadias, 214 of intermediate, and 549 of proximal type. Transverse preputial island flap urethroplasty (Duckett) and tubularized incised plate urethroplasty (TIP) were performed in 375 (37.1%) and 336 cases (33.2%), respectively. The postoperative complication rate of distal hypospadias was 23.4% (15.8–57.1%), mid shaft 29.0% (22.7–40.0%), and proximal 43.7% (30.2–52.9%). Among the 375 patients in Duckett group, 192 had complications. Multivariate logistic analysis showed that the length of prepuce island flap (OR = 3.506, 95% CI: 2.258–5.442) was an independent risk factor for complications after Duckett operation (P < 0.001). In TIP group, there were 336 cases with 84 complications. Multivariate logistic analysis showed that the width of urethral plate after longitudinal resection (OR = 0.836, 95% CI: 0.742–0.942) and glans width (OR = 0.851, 95% CI: 0.749–0.965) were independent risk factors for postoperative complications after TIP (P = 0.003, P = 0.012).ConclusionSeveral anatomical features play a role during the selection process among the different surgical approaches, including glans size, urethral plate width, and the meatal position. The width of the urethral plate and glans width were risk factors for postoperative complications after TIP. The length of prepuce island flap was a risk factor for complications after Duckett operation.

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.

HYPOSPADIAS REPAIR IN CHILDREN: 10-YEARS EXPERIENCE AT SHAIKH ZAYED HOSPITAL LAHORE.

Introduction: Hypospadias is one of the common urogenital condition affecting male children. Multiple factors have been reported by different studies that contribute towards hypospadias, including in utero growth retardation, higher maternal age and endocrine disruptors. Usually multiple surgical procedures are required for correction of hypospadias especially in cases of proximal hypospadias associated with chordee. Objectives: The purpose of study was to report the early outcomes after single stage repair for distal hypospadias and staged repair for proximal hypospadias over the last 10 years in our department. Study Design: Descriptive Study. Setting: Department of Paediatric Surgery, Shaikh Zayed Hospital Lahore. Period: January 2006 to December 2016. Materials &amp; Methods: This study was conducted in Department of Pediatric Surgery, Shaikh Zayed Hospital Lahore. All the patients who were operated between January 2006 to December 2016 for hypospadias or their complications in our unit were included. Data was collected from chart review and outpatient follow up. Data for age at presentation, type of anomaly, congenital curvature, testosterone stimulation, surgical procedure and complications with their management were collected. Patients were divided in two groups depending upon whether single stage procedure was performed or two stage surgery was undertaken. All patients with glandular hypospadias had meatal advancement but glanuloplasty was done in selected cases. Patients with distal hypospadias without chordee underwent tubularized incised plate urethroplasty (TIP) repair. Patients with proximal hypospadias had two stage surgery with correction of chordee with grafting and tubularization of graft after 6 months. Data was analyzed by SPSS v 22. Results: During the study period 134 patients with hypospadias or its complication were managed. Out of these 90 patients met our inclusion criteria. The mean age of patients was 5.0 years. Sixty three (70 %) had distal hypospadias. MAGPAI was performed in 12 (13.3%), TIP repair in 51 (56.7%), Bracka I in 25 (27.8%), Bracka II in 18 (20.0%) and Mathieu repair in 2 (2.2%) patients. Both the patients with Mathieu repair had dehiscence. The most common complication in distal cases was meatal stenosis. In patients with distal hypospadias 10.8% developed fistula while 44.5% of patients with proximal hypospadias developed fistula. Conclusion: Repair of proximal hypospadias with chordee is associated with more complications. Outcomes may be improved by specialized training with adequate workload.

Our Tubularized Incised Plate Urethroplasty Repair Results for Hypospadias Surgery

Our Tubularized Incised Plate Urethroplasty Repair Results for Hypospadias Surgery

Tubularized incised plate urethroplasty repair in adult hypospadias patients. Are results similar to those reported in the pediatric age group? A prospective study

ObjectiveMost studies published in the literature report on the results of tubularized incised plate urethroplasty (TIPU) for hypospadias repair in children. Hence, the objective of this study was to evaluate the results of TIPU repair in adults. Patients and methodsThe records of 60 adult patients with primary hypospadias treated with TIPU between April 2009 and May 2012 were reviewed. All the procedures were done by the same surgeon under similar conditions and using the same kind of instruments and suture material. On clinical examination, the meatal location, as well as the presence/absence of chordee and penile torsion was assessed. The quality of the spongiosum and the width of the urethral plate were evaluated intraoperatively. The postoperative complications and results were recorded and the data were analyzed. ResultsThe patients’ age ranged from 16 to 27 years with a mean of 21 years. Out of the 60 cases, 43 (72%) had distal penile, 7 (11%) mid-penile and 10 (17%) proximal hypospadias. Penile torsion was present in 10 (17%) cases with 80% having a torsion ≤45° and 20% having a torsion of 45–90°. Ventral chordee ranging from 30° to 90° was present in 14 (23%) cases. Chordee correction was possible by penile de-gloving in 4 (29%) patients (2 with distal and 2 with mid-penile hypospadias), by further mobilization of the urethral plate with the corpus spongiosum in 3 (21%) and by proximal urethral mobilization in another 6 (42%) patients with proximal hypospadias. One (7%) patient also required tunica albuginea plication. The urethral plate was wide in 22 (37%), average in 26 (43%) and narrow in 12 (20%) patients. Fifty percent of the patients with a narrow urethral plate developed complications, compared to 15% of the patients whose urethral plate had an average width and none of the patients with a wide urethral plate. The spongiosum was well developed in 38 (63%) patients, while in 11 (18%) patients each the spongiosum was moderately and poorly developed. The complication rates were significantly higher (55%) in patients with a poorly developed spongiosum as compared to those with a well-developed spongiosum. The overall complication rate was 17% including fistula in 10% of the patients (2 patients with mid-penile and 4 patients with proximal hypospadias). Meatal stenosis was found in 4 patients with distal hypospadias (7%) who responded well to meatal dilatation. The fistula cases required surgical repair with a success rate of 100%. Mean hospitalization and follow-up were 9 days and 6–24 (median 37) months, respectively. ConclusionsComplications encountered in the present study were urethral fistula and meatal stenosis with a higher incidence in patients with proximal hypospadias than reported in the literature. The important factors for the outcome of TIPU were the severity of hypospadias, the degree of curvature and the development of the spongiosum and urethral plate. Proximal hypospadias with a poor urethral plate and severe curvature in adults is not suitable for TIPU. In such cases, single-stage flap urethroplasty or two-stage buccal mucosal urethroplasty should be considered instead.

Is combined inner preputial inlay graft with tubularized incised plate in hypospadias repair worth doing?

It has been noted that after tubularized incised plate urethroplasty (TIP) repair, the final meatal position is glanular but not at the optimum position. Inner preputial inlay graft combined with tubularized incised plate (G-TIP) has been proposed for redo urethroplasty. We extended this indication to be the standard technique for primary hypospadias repair. We conduct this prospective study to obtain a wide, slit-like appearance neomeatus at the optimum position in the glans proper and to judge if hypospadias repair complications differ from TIP repair in the published data in the literature. This prospective study included 230 consecutive patients who underwent this technique. The study was conducted from November 2011 to August 2014 for all hypospadias cases to be repaired in a single stage regardless of the width and depth of urethral plate or the glans size and shape. Localization of the meatus was glanular in 13 patients, coronal in 75, distal penile in 112, mid penile in 25 and proximal in five. The urethral plate was incised deeply and extended distally beyond the end of the plate by 3 mm in glans proper. The mucosal graft was harvested from the inner prepuce, inlayed and quilted in the incised urethral plate. The neourethra was created over a urethral catheter in two layers. The vascular dartos flap was mobilized dorsally and moved ventrally to cover the neourethral suture line as a barrier. The follow-up period ranged from 5 to 36 months. Excellent cosmetic and functional results were achieved in 221 of 230 patients (96.09%). Neither meatal stenosis nor urethral diverticulum were encountered. An excellent glanular position of a wide slit-like neomeatus was achieved using this technique. Nine patients (3.91%) developed urethrocutaneous fistula. Excellent urinary stream was reported by parents. Combined inner preputial graft with TIP urethroplasty secures the optimal glanular position of a wide slit-like neomeatus because of extension of the incision beyond the end of the plate, thus optimizing functional and cosmetic outcome with no meatal stenosis.

Inclusion and Exclusion Criteria to Overcome Bias and Reach a Valid Conclusion for Interpositional Flap Coverage in Primary Hypospadias Repair With Tubularized Incised Plate Urethroplasty

There is no general consensus about the best vascularized layer between the neourethra and the skin in tubularized incised plate urethroplasty (TIPU) of Snodgrass. Inclusion of 1 surgeon to repair specific forms of hypospadias by using determined surgical materials and exclusion of definite patients and conditions and definite anomaly parameters may present the needed reliable data about the role of a specific type of interpositional coverage of the neourethra. The 37 patients had been operated by TIPU with a ventral subcutaneous dartos flap covering the neourethra who designed as group A, while 26 patients had been operated by the standard TIPU without urethral coverage who designed as group B. Good cosmetic results were obtained in 93.65% of the patients. In group A, urethral fistulae were encountered in 2 cases of distal hypospadias and 1 case of midpenile hypospadias with a total fistula rate of 8.1%. In group B, urethral fistulae were found in 5 cases of distal hypospadias and 3 cases of midpenile hypospadias with a total fistula rate of 30.7%. Flapless repair should not be tried as long as there is the needed experience to harvest a well-vascularized coverage. Interpositional flap coverage of the neourethra is crucial to decrease the rate of fistula in primary hypospadias TIPU repair. However, before designating a relative study, different forms of the anomaly, surgeon's experience, the potential harvesting complications, complexity degrees of different repairs, and the used surgical materials should be really considered.

How do asymptomatic toilet-trained children void following

Purpose: To evaluate the functional outcome in the form of urinary flow rates in asymptomatic children following uncomplicated tubularized incised plate urethroplasty (TIPU) hypospadias repair.Methods: We reviewed the records of children who underwentTIPU at our institution between April 1997 and September 2007and included only asymptomatic toilet-trained children who hadan uncomplicated postoperative course and had undergone uroflometry not less than 1 year postoperatively. Unfavourable voiding parameters were either a plateau curve, a peak flow below the 5th percentile range in nomogram or a post-void residual (PVR) more than 20% of the total functional capacity of the bladder. Uroflowmetry findings were analyzed against variables, including the surgeon, the severity of hypospadias, the presence of a hypoplastic urethra, the use of double layer closure, the performance of a spongioplasty and the use of a stent. Serial uroflowmetries when available, were compared with respect to the initial flow study.Results: In total, 59 patients were eligible for the study. The mean age at surgery was 2.4 years. Hypospadias was distal penile in 50 (85%) and mid and proximal penile in 9 (15%). Mean follow-up was 3.3±2 (1-9.5) years. The uroflow curve was bell-shaped in 18 (30%), interrupted in 8 (14%), slightly flattened in 27 (46%) and plateau in 6 (10%). Flow rate nomograms revealed that 40 (68%) were above the 20th percentile, 10 (17%) were below the 5th percentile and 9 (15%) were between these ranges. PVR was &gt;20% of the pre-void volume in 9 children (15%). No patient demonstrated all three unfavourable parameters together. The groups of childrenwith unfavourable functional voiding parameters were compared to the children with favourable parameters specifically with respect to the possible predictors of outcome. Follow-up uroflometry in 17 patients showed improvement in the flow curve, flow rate and PVR with significant improvement of maximum urinary flow rate (Qmax) and PVR values.Conclusions: Asymptomatic, urodynamic abnormalities wereobserved in our study following uncomplicated TIPU repair. These abnormalities were not related to the variation of the technique among surgeons. Spontaneous improvement has been noted on serial flow studies.

Effect of Double Layer Dartos Flap in Reduction of Fistula Rate Post Hypospadias Repair = استخدام طبقة مزدوجة من السديلة السلخية يقلل من حدوث الناسور الإحليلي بعد إجراء عمليات إصلاح المبال التحتي

Objective: To assess the impact of double layer dartos flap on urethro-cutaneous fistula rate reduction and to compare it with single layer dartos flap in Tubularized Incised Plate Urethroplasty (TIPU) for hypospadias in children. Methods: Between January 2008 and month 2011 retrospective charts review for 120 patients who had hypospadias repair by the author. 26 patients were excluded from the study because they were not suitable for TIPU procedure. Therefore, our study sample involved 94 children. Results: Mean age at time of surgery was 16 months (10-96 months), with a mean follow up of 18.2 months (10–36 months). All patients had hypospadias repair by utilizing TIPU. Patients were divided into two groups: Group one involved 50 patients had double layer dartos flap. Group two involved 44 patients had single-layer dartos flap. All patients had stent insertion at the time of repair. 6/44 patients [13.6%] developed fistula in group two and 2/50 patients [4%] in group one had fistula. Conclusions: Dartos coverage appears to have significant effect in reducing urethro-cutaneous fistula in TIPU repair. With double layer dartos coverage further reduction can be achieved.

Modified Tubularized Incised Plate Urethroplasty Repair: Frenuloplasty and Long-Term Results in 155 Patients.

To describe a modification of tubularized incised plate (TIP) urethroplasty which we refer to as "frenuloplasty". We retrospectively reviewed 155 children who underwent TIP urethroplasty between June 2008 and August 2011 in our institution. In our technique, the circumcision incision went on through the mucocutaneous junction obliquely in order to form frenular wings instead of linear circumscribing incision joined the urethral plate vertically. The little triangle-shaped skin flaps between the oblique mucocutaneous incisions and urethral plate incisions were excised. The glans wings and frenular wings were re-approximated without tension after uretroplasty. The mean age of the patients was 4.63 ± 3.82years. The mean follow-up was 15.94 ± 5.46months. Location of hypospadias was distal penile in 126 patients (81.3%) and mid-shaft in 29 (18.7%). The following complications occurred in 21 patients (13.5%): urethrocutaneous fistula formation in 7 (4.5%), meatal stenosis in 14 (9%) and no dehiscence. We suppose that there is no incompletely formed prepuce but a ventral fusion defect in the midline. Frenuloplasty reduces the necessity of ventral preputial flaps and provides satisfactory cosmetic outcomes with the appearence of normal circumcised penis.

How do asymptomatic toilet-trained children void following tubularized incised-plate hypospadias repair?

: To evaluate the functional outcome in the form of urinary flow rates in asymptomatic children following uncomplicated tubularized incised plate urethroplasty (TIPU) hypospadias repair. : We reviewed the records of children who underwent TIPU at our institution between April 1997 and September 2007 and included only asymptomatic toilet-trained children who had an uncomplicated postoperative course and had undergone uroflometry not less than 1 year postoperatively. Unfavourable voiding parameters were either a plateau curve, a peak flow below the 5th percentile range in nomogram or a post-void residual (PVR) more than 20% of the total functional capacity of the bladder. Uroflowmetry findings were analyzed against variables, including the surgeon, the severity of hypospadias, the presence of a hypoplastic urethra, the use of double layer closure, the performance of a spongioplasty and the use of a stent. Serial uroflowmetries, when available, were compared with respect to the initial flow study. : In total, 59 patients were eligible for the study. The mean age at surgery was 2.4 years. Hypospadias was distal penile in 50 (85%) and mid and proximal penile in 9 (15%). Mean follow-up was 3.3±2 (1-9.5) years. The uroflow curve was bell-shaped in 18 (30%), interrupted in 8 (14%), slightly flattened in 27 (46%) and plateau in 6 (10%). Flow rate nomograms revealed that 40 (68%) were above the 20th percentile, 10 (17%) were below the 5th percentile and 9 (15%) were between these ranges. PVR was >20% of the pre-void volume in 9 children (15%). No patient demonstrated all three unfavourable parameters together. The groups of children with unfavourable functional voiding parameters were compared to the children with favourable parameters specifically with respect to the possible predictors of outcome. Follow-up uroflometry in 17 patients showed improvement in the flow curve, flow rate and PVR with significant improvement of maximum urinary flow rate (Qmax) and PVR values. : Asymptomatic, urodynamic abnormalities were observed in our study following uncomplicated TIPU repair. These abnormalities were not related to the variation of the technique among surgeons. Spontaneous improvement has been noted on serial flow studies.

Both dorsal and ventral flaps can be used in previously circumcised hypospadic adults with comparable success rates

To compare dorsal and ventral dartos flap outcomes for tubularized incised-plate urethroplasty (TIPU) in terms of success, complication rates and cosmetic appearance in adult circumcised hypospadic men. Forty-two circumcised adult men underwent primary distal or midpenile hypospadias repair for cosmetic reasons by a single surgeon in a prospective randomized trial. Twenty-two patients were randomly selected for TIPU repair with dorsal (Group1, mean age 22.3 years) dartos flap as second layer. Twenty patients were randomly selected for TIPU repair with ventral dartos flap (Group2, mean age 21.1 years). Satisfaction questionnaires were answered by patients before surgery and at postoperative 6 weeks. The operating surgeon also filled in the form blindly at the same postoperative period. The differences between pre and postoperative satisfaction scores for each group were also evaluated. Preoperatively, all cases were evaluated with uroflowmetry and compared with postoperative results measured at 6th week of surgery. P < 0.05 was considered as significant. Mean follow-up was 24 months (4-28). Complications were encountered in 18 and 20% of the patients in groups 1 and 2, respectively. Complications were urethrocutaneous fistula, meatal stenosis, retrusive/proximal meatus and residual curvature. Success rates were 82 and 80%, respectively. No differences were seen in overall satisfaction between the two groups (P = 0.07). Outcome of hypospadias repair in circumcised adults for cosmetic reasons is similar to uncircumcised hypospadics previously mentioned in the literature. Both dorsal and ventral flaps can be used in previously circumcised hypospadic adults with comparable satisfaction and complication rates and uroflow findings.

A prospective randomized comparative study on the use of ventral subcutaneous flap to prevent fistulas in the Snodgrass repair for distal hypospadias

We evaluated the importance of urethral coverage using vascularized subcutaneous ventral flaps for the prevention of fistulas in patients undergoing distal hypospadias repair. Our prospective study included 130 patients, aged 9 months to 12 years, who underwent distal hypospadias repair using tubularized incised plate urethroplasty (TIPU), from January 2001 through January 2006. Patients were assigned to one of two groups by a computer-generated random selection: 65 patients underwent non-covered urethroplasty (NCU group); another group of 65 patients underwent covered urethroplasty (CU group) with a vascularized subcutaneous ventral flap. The results were evaluated by two pediatric surgeons unaware of the type of treatment each patient had undergone. Successful results were achieved in 99/130 patients (76.2%). We recorded 31 (23.8%) post-operative complications: 20 patients presented with a urethrocutaneous fistula (15 patients in the NCU group and 5 in the CU group); five with urethral stenosis (3 in the NCU and 2 in the CU group); and six with skin dehiscence of the preputioplasty (3 patients in each group). We analyzed the results using the chi2 test and the only statistically significant difference between the two groups (p < 0.05) was in terms of incidence of fistulas. Urethrocutaneous fistulas seem to be the most frequent complication of distal hypospadias after TIPU repair. Urethral coverage should be part of the Snodgrass procedure because it significantly reduces the formation of fistulas. A well-vascularized subcutaneous ventral flap represents, in our experience, a simple and optimal choice for the prevention of fistulas.

Tipu repair for distal hypospadias. to cover or not to cover the urethroplasty? a prospective randomized comparative study

Purpose We evaluated the importance of urethral coverage using a vascularized ventral subcutaneous flap for fistula prevention in patients who underwent a distal hypospadias repair. Material and methods Our prospective study included 130 patients, aged 9 months to 12 years, who underwent distal hypospadias repair using tubularized incised plate urethroplasty (TIPU) from January 2001 to January 2006. Using a computer-generated random choice the patients were enrolled in 2 groups: 65 patients received a no covered urethroplasty (NCU group); the other 65 patients received a covered urethroplasty (CU group) using a vascularised ventral subcutaneous flap. Results The results were evaluated by 2 pediatric surgeons unaware of the type of the treatment the patients had undergone. Median follow-up was of 24 months (6 – 60). A successful result was achieved in 99/130 patients (76.2%). We recorded 31 (23.8%) postoperative complications: 20 patients presented a urethrocutaneous fistula (15 patients were in NCU group and 5 in the CU group); 5 urethral stenoses (3 in NCU group and 2 in CU group); 6 skin dehiscence of the preputioplasty (3 pts for each group). We have analysed the results using test χ2 and the only statistically significant difference between the 2 groups (p Conclusions Urethrocutaneous fistulae seem to be the most frequent complication of distal hypospadias after a TIPU repair. Urethral coverage should be performed as part of the Snodgrass procedure because it significantly reduces the formation of fistulae. A ventral well vascularized subcutaneous flap represents in our experience a good and easy choice for fistulae prevention.

Hypospadias repair with tubularized incised plate. Is uroflowmetry necessary postoperatively?

Objective Hypospadias repair with tubularized incised plate urethroplasty (TIP) produces good cosmesis, but is reported to result in a change in urinary stream postoperatively, with an obstructive pattern. The aim of this retrospective study was to determine whether early uroflowmetry is a good method for diagnosing neourethral stricture. Patients and method In 126 boys, primary TIP repair was performed between 1999 and 2003. Uroflowmetry was performed in potty-trained boys 2 months' postoperatively (68 boys) and both 2 and 12 months (38 boys) after TIP. Boys with obstructed flow and/or clinical symptoms were calibrated in their neourethra. Results Forty-nine percent of the boys with distal hypospadias and 87% of the proximal cases had a flow rate of less than 10 ml/s at uroflowmetry 2 months after TIP, but only 12/126 boys (10%) were considered to have a neourethral stricture. There was a spontaneous increase in maximum flow rate between 2 and 12 months after TIP repair both in patients who had been calibrated and in boys in whom no intervention had been performed. Conclusion Early uroflowmetry appears to be unnecessary, as the voiding history appears to be just as good at alerting a suspicion of urethral stricture after TIP repair. There is a spontaneous normalization of the urinary flow in boys after TIP repair, but the need for long-term follow up beyond puberty is great, especially in cases of proximal hypospadias.