Tubularized Incised Plate Urethroplasty Research Articles

Regular dilatation is unnecessary after tubularized incised‐plate hypospadias repair

Objective To determine if patients who undergo tubularized incised‐plate (TIP) urethroplasty need regular dilatation to prevent neourethral strictures or meatal stenosis. Patients and methods The follow‐up of two consecutive series of patients who underwent primary TIP hypospadias repair by one surgeon was reviewed. The first 72 patients (group 1) had periodic neourethral calibrations for 1 year after repair, while the next 62 patients (group 2) had no routine dilatation, except for six patients (10%) in whom the meatus appeared to be small. Urethroscopy was performed in both groups at the time of fistula repair, skin revisions or during anaesthesia for unrelated procedures. Results There was no evidence of scarring in group 1; one case of meatal stenosis and one neourethral stricture were detected in group 2. The difference in outcome was not statistically significant (P = 0.4). Overall, the incidence of meatal stenosis was low (0.7%) and comparable with most recent series in which postoperative calibration was not used routinely. Conclusion Dilatation of the neourethra is unnecessary after TIP urethroplasty. Calibration or uroflowmetry 6 months after surgery may be useful to detect subclinical obstruction.

Tubularized incised‐plate urethroplasty for hypospadias reoperation

ObjectiveTo review our preliminary results of tubularized incised‐plate (TIP) urethroplasty for reoperative hypospadias repair.Patients and methodsThe study comprised 15 patients, of whom eight had undergone a previous repair by techniques that included incision into the midline of the urethral plate, while in the remaining seven the midline of the plate had been left undisturbed. The meatus at reoperation was subcoronal or on the distal shaft in all but one boy, who had a midshaft hypospadias. All had previously undergone one attempt at hypospadias repair, except for one patient presenting after two failed ‘meatal advancement and glanuloplasty incorporated’ procedures. The TIP repair was undertaken as described for primary surgery, except that the dorsal dartos flaps for interposition between the neourethra and skin closure were available less often.ResultsTIP resulted in a functional neourethra and a cosmetically normal meatus in 13 of the 15 patients. One boy healed with a slightly rounded meatus and the other had wound dehiscence; fistulae developed in another two boys, giving three patients with complications. The fistulae occurred in boys whose original surgery did not include urethral plate incision, while the dehiscence was in a patient with partial excision of the plate during previous tubularized preputial flap repair.ConclusionsTIP urethroplasty can potentially be used for hypospadias reoperation. Previous incision of the urethral plate was not a contraindication in these selected cases in which the plate appeared supple. However, TIP repair should be avoided in repeat hypospadias surgery if the plate has been resected or is obviously scarred.

New surgical techniques in pediatric urology.

More sophisticated endoscopic instruments, combined with a better understanding of bladder and urethral pathology, have significantly improved the therapeutic approaches for both posterior urethral valves and ureteroceles. New generation lithotripters have allowed for a safe and efficient method of treating urinary calculi in children, which was once thought too injurious a process with first-generation machines. The rapidly advancing field of laparoscopy, aided by the development of more optically refined and diminutive instruments, has allowed for its application in a wide variety of surgical interventions in pediatric urology. The tubularized incised plate urethroplasty has challenged more traditional approaches to hypospadias repair and is now considered by many pediatric urologists to be the best approach for midshaft and distal hypospadias. The one-stage approach to exstrophy repair may hold the answer to improved continence without a formal bladder neck reconstruction. Finally, the field of tissue engineering leads the way to new advances in autologous biological substitutes in the surgically-challenged patient where there is a shortage of local tissues at the surgeon's disposal.

Tubularized incised-plate urethroplasty for secondary hypospadias surgery.

Reoperation for failed hypospadias has been considered to be seriously bothersome because abundant penile skin does not tend to remain for urethroplasty or for penile shaft skin coverage. In this study, the tubularization of incised urethral plate was employed for those who had no excessive penile skin after failure of hypospadias repair. Five patients with hypospadias underwent tubularized incised-plate urethroplasty as salvage surgery. The surgical techniques necessary for the performance of the reoperation were not different from those for the primary repair. The urethral plate was incised sufficiently deeply in its midline from the tip of the glans to the regressed meatus. The incised urethral plate was tubularized without tension over a catheter of an appropriate size. Four of those who underwent secondary tubularized incised-plate urethroplasty were successfully repaired without complications. A urethrocutaneous fistula occurred at the corona in the remaining patient. The absence of preputial skin in reoperative cases makes tubularized incised-plate urethroplasty the ideal option, although the series was small and postoperative duration is still short. In addition, this procedure can give excellent functional and cosmetic results even in patients who require revisional hypospadias surgery.

A comprehensive analysis of a tubularized incised plate hypospadias repair

Objectives. To critically evaluate my experience using a modified tubularized incised plate (TIP) hypospadias repair. Methods. Sixty-four boys, 7 months to 11 years old (mean age 22.9 months), underwent a TIP urethroplasty by a single pediatric urologist for primary hypospadias. The hypospadias defects included 53 distal and 11 midshaft. The incision of the urethral plate was always deep and proximal but never extended the entire length of the plate. In 25 cases (39%), the incision was less than one half the length of the urethral plate. A two-layer urethroplasty was always obtained. A vascularized subcutaneous pedicle was always placed onto the urethroplasty. This pedicle was ventrally based in 56 of the repairs (87.5%). Postoperative urethral stents were not used in 52 boys (81.3%), including 7 with midshaft repairs. All children were scheduled for a postoperative evaluation at 1 month. A confidential phone survey was later conducted by someone other than the surgeon. The parents were asked if they were satisfied or dissatisfied with the direction and caliber of the urinary stream, chordee correction, and overall general appearance. Results. The clinical evaluation was performed in 54 boys (84.7%) not earlier than 1 month after the repair. The examination revealed a conical glans, slit meatus, circumferential mucosal collar, and a straight phallus in all cases. No cases of fistula, stricture, or dehiscence occurred. A follow-up phone survey 3 to 43 months (mean 21 months) postoperatively was obtained from the parents of 40 patients. Without exception, the parents were satisfied with the urinary stream, chordee correction, and overall appearance. Conclusions. Without incising the entire urethral plate and stenting the repair, a TIP urethroplasty can still be expected to provide excellent results when correcting distal and midshaft hypospadias. Parents were satisfied with the long-term cosmetic and functional results obtained with a TIP urethroplasty.

Functional evaluation of tubularized-incised plate repair of midshaft-proximal hypospadias using uroflowmetry.

To determine objectively, using uroflowmetry, the functional results of the tubularized-incised plate urethroplasty to repair midshaft-proximal hypospadias. Twenty-one patients (mean age 4 years, mean follow-up 1.8 years) were selected from those undergoing surgery between January 1996 and January 1998 at our institution. All patients had midshaft-proximal hypospadias and were treated using the Snodgrass technique. Patients were included if they were able to void volitionally and had no fistula. The flow pattern, maximum (Qmax) and mean flow rate (Qave) were measured; the results were expressed as percentiles and compared with published values from normal children. The Qmax and Qave were considered normal if > 25th percentile, as equivocally obstructed when in the 5-25th percentile and obstructed if < 5th percentile. Fourteen patients were considered normal, four as equivocally obstructed and three as obstructed. Of the second group, one patient had a urethral diverticulum at the native meatus (confirmed by voiding cysto-urethrography) and the remaining three patients had meatal stenosis that responded to dilatation, with normal flow in two and improvement in the other. Of the obstructed group, one patient responded to dilatation and two underwent meatoplasty. The tubularized-incised plate repair provides satisfactory functional results for midshaft-proximal hypospadias; uroflowmetry is an important noninvasive tool to evaluate this technique. A long-term follow-up is needed to confirm these results.

TUBULARIZED INCISED PLATE URETHROPLASTY:: EXPANDED USE IN PRIMARY AND REPEAT SURGERY FOR HYPOSPADIAS

We evaluated the impact of tubularized incised plate urethroplasty on primary and repeat hypospadias repair. We retrospectively reviewed the medical records of all boys who underwent hypospadias repair at our institution during a recent 3-year period. The level of the hypospadias defect, technique of repair, primary repair versus reoperation, age at surgery and complications were recorded. A total of 520 hypospadias repairs were done from May 1996 through June 1999. We began to perform tubularized incised plate urethroplasty in November 1996. During the ensuing consecutive 32 months 181 primary and 25 repeat hypospadias repairs were done using this technique. Mean patient age at surgery was 22 months (range 3 months to 30 years). During the 6 months immediately before we began to use this method the Mathieu flip-flap procedure was the most commonly performed technique, accounting for 38% of all hypospadias repairs. In contrast, during the last 6 months reviewed tubularized incised plate urethroplasty accounted for 63% of all repairs, including 41 of 65 primary operations (63%) and 4 of 6 reoperations (67%), while no Mathieu procedures were performed. Postoperative followup was 6 to 38 months for tubularized incised plate repair. Overall meatal stenosis and a urethrocutaneous fistula developed in 1 and 14 boys, respectively (7% complication rate). Tubularized incised plate urethroplasty has become the preferred technique of primary and repeat hypospadias repair at our institution. The technique has few complications as well as proved success and versatility that continues to expand its applicability and popularity.

MECHANISM OF HEALING FOLLOWING THE SNODGRASS REPAIR

It has been suggested that healing after tubularized incised plate urethroplasty occurs through re-epithelialization with normal tissue ingrowth or by secondary intent through scarring. We investigated healing in tubularized incised plate urethroplasty. Hypospadias was created in 5 dogs by incising the ventral urethra, allowed to heal for 21 days and subsequently repaired. During hypospadias creation a tattoo was made longitudinally in the midline dorsal urethral plate. The tattoo was bisected during repair, thus creating 2 distinct lines marking the edges of the incision. A neourethra was tubularized and closed in 2 layers. At 21 days the phallus was harvested, inspected and embedded for histology. The dorsal urethral plate incision contained 2 distinct lines in all samples representing the area of separation between the native and ingrowing urethras. The distance between these lines was 0.9 +/- 0.1 mm. Proximal urethral lumen diameter (3. 3 +/- 0.1 mm.) was not significantly different from that of the neourethral lumen (3.1 +/- 0.1 mm.). Histologically all repairs had intact squamous epithelium. There was normal appearing subepithelial architecture with scant perivascular lymphocytic infiltrates between the tattoos. In contrast, the area around the sutures showed a desmoplastic (fibroblastic) reaction with an inflammatory, primarily neutrophilic response. Healing of the incision in the dorsal urethral plate during tubularized incised plate urethroplasty occurs by re-epithelialization with normal tissue ingrowth. In contrast, the sutured closure heals with a desmoplastic and inflammatory response.

Comparison of the perimeatal-based flap (mathieu) and the tubularized incised-plate urethroplasty (snodgrass) in primary distal hypospadias.: J. Oswald, L.L Korner, and M. Riccabona. Br J Urol Int 85:725–727, (April), 2000.

Comparison of the perimeatal-based flap (mathieu) and the tubularized incised-plate urethroplasty (snodgrass) in primary distal hypospadias.: J. Oswald, L.L Korner, and M. Riccabona. Br J Urol Int 85:725–727, (April), 2000.

RADICAL BULBAR DISSECTION TO CORRECT SEVERE CHORDEE AND PROXIMAL HYPOSPADIAS

We describe a technique of proximal hypospadias correction that involves freeing the proximal normal bulbar urethra from perineal attachments to lengthen the ventral penis and decrease chordee. Correction was performed in 9 patients with a mean age of 11.5 months who had proximal hypospadias and severe chordee that was perineal in 2, mid scrotal in 6 and penoscrotal in 1. After the penis was degloved the bulbar urethra was detethered to or beyond the perineal body without lifting the urethra from the corpora cavernosa. Any remaining penile chordee was corrected and the urethral plate was transected only when chordee persisted. When the urethral plate was intact and the penis straight, tubularized incised plate urethroplasty was done to correct hypospadias in 1 stage. Otherwise 2-stage repair was performed. Using this maneuver penile straightening was achieved in 2 of the 9 patients, resulting in a glanular urethral or penoscrotal meatus. Dorsal plication sutures required in 4 cases resulted in a mid shaft and penoscrotal meatus in 1 and 3, respectively. Residual chordee in the remaining 3 patients necessitated division of the urethral plate and 2-stage repair despite aggressive mobilization of the proximal urethra. Simultaneous tubularized incised plate urethroplasty was then performed in the 4 penoscrotal and 1 mid shaft meatus. All 6 patients who underwent a successful 1-stage procedure have excellent cosmetic results, while 1 required meatotomy. No fistula or chordee was present at a mean of 13.8 months of followup (range 3.9 to 27.1). This safe, rapid technique may compensate for significant penile tethering and chordee in a subpopulation of patients with proximal hypospadias, such as 6 of the 9 in our study. It also allows successful tubularized incised plate urethroplasty to be done simultaneously.

HISTOLOGY OF THE URETHRAL PLATE: IMPLICATIONS FOR HYPOSPADIAS REPAIR

No AccessJournal of UrologyHypospadias1 Sep 2000HISTOLOGY OF THE URETHRAL PLATE: IMPLICATIONS FOR HYPOSPADIAS REPAIR WARREN SNODGRASS, KATHLEEN PATTERSON, J. CHADWICK PLAIRE, RICHARD GRADY, and MICHAEL E. MITCHELL WARREN SNODGRASSWARREN SNODGRASS More articles by this author , KATHLEEN PATTERSONKATHLEEN PATTERSON More articles by this author , J. CHADWICK PLAIREJ. CHADWICK PLAIRE More articles by this author , RICHARD GRADYRICHARD GRADY More articles by this author , and MICHAEL E. MITCHELLMICHAEL E. MITCHELL More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)67233-3AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We define the histology of the urethral plate in boys with hypospadias. Materials and Methods: Subepithelial biopsies of the urethral plate were obtained in 17 boys, including 13 with distal and 4 with penoscrotal hypospadias. Ventral penile curvature was noted in 5 cases. Specimens were evaluated by 7 light microscopy after hematoxylin and eosin staining. Results: All biopsies demonstrated well vascularized connective tissue comprised of smooth muscle and collagen. There was no evidence of fibrous bands or dysplastic tissue. Conclusions: The urethral plate consists of epithelium overlying connective tissue. We found no histological evidence of fibrous cords historically considered responsible for chordee. References 1 : The correction of hypospadias: a review. Urol Surv1958; 8: 2. Google Scholar 2 : Basic instructions for hypospadias repair. In: . Philadelphia: W. B. Saunders Co.1994: 551. Google Scholar 3 : History of external genital surgery. In: . Boston: Little, Brown and Co.1973: 3. Google Scholar 4 : Controversies in hypospadias surgery: the urethral plate. Dial Pedi Urol1996; vol. 19. No. 8. Google Scholar 5 : A critique on the repair of hypospadias. Surgery1952; 31: 885. Google Scholar 6 : Changing concepts of hypospadias curvature lead to more onlay island flap procedures. J Urol1994; 151: 191. Link, Google Scholar 7 : Microscopic studies of curvature-causing structures in hypospadias. Scand J Plast Reconstr Surg1980; 14: 249. Google Scholar 8 : The congenital anomalies of the lower urinary tract. Br J Urol1956; 28: 118. Google Scholar 9 : Etiologic considerations in penoscrotal hypospadias repair. J Urol1978; 120: 229. Link, Google Scholar 10 : Anatomical studies of hypospadias. J Urol1998; 160: 1108. Link, Google Scholar 11 : The origin and fate of the urethral plate in man. J Anat1954; 88: 413. Google Scholar 12 : Embryogenesis of chordee. J Urol1975; 114: 769. Link, Google Scholar From the Division of Pediatric Urology, Children’s Medical Center, Dallas, Texas, and Department of Pediatric Pathology and Division of Pediatric Urology, Seattle Children’s Hospital and Regional Medical Center, Seattle, Washington© 2000 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited BySpinoit A, Van Praet C, Groen L, Van Laecke E, Praet M and Hoebeke P (2018) Congenital Penile Pathology is Associated with Abnormal Development of the Dartos Muscle: A Prospective Study of Primary Penile Surgery at a Tertiary Referral CenterJournal of Urology, VOL. 193, NO. 5, (1620-1624), Online publication date: 1-May-2015.Snodgrass W and Prieto J (2009) Straightening Ventral Curvature While Preserving the Urethral Plate in Proximal Hypospadias RepairJournal of Urology, VOL. 182, NO. 4S, (1720-1725), Online publication date: 1-Oct-2009.Snodgrass W (2018) A Farewell to ChordeeJournal of Urology, VOL. 178, NO. 3, (753-754), Online publication date: 1-Sep-2007.XU J, LI S, LI Y, LI Q, LIU L and WANG Y (2018) LENGTHENING URETHRAL PLATE WITH INNER PREPUTIAL SKIN GRAFTS: A MODIFICATION OF THE ONLAY TECHNIQUEJournal of Urology, VOL. 173, NO. 1, (202-203), Online publication date: 1-Jan-2005.JAYANTHI V (2018) The Modified Snodgrass Hypospadias Repair: Reducing the Risk of Fistula and Meatal StenosisJournal of Urology, VOL. 170, NO. 4 Part 2, (1603-1605), Online publication date: 1-Oct-2003.Palmer L, Palmer J, Franco I, Friedman S, Kolligian M, Gill B and Levitt S (2018) The “Long Snodgrass”: Applying the Tubularized Incised Plate Urethroplasty to Penoscrotal Hypospadias in 1-stage Or 2-stage RepairsJournal of Urology, VOL. 168, NO. 4 Part 2, (1748-1750), Online publication date: 1-Oct-2002.VELA D, MÉNDEZ R, SOMOZA M, LIRAS J and PAIS E (2018) LENGTHENING THE URETHRAL PLATE WITH A DOUBLE FLAP TECHNIQUE: A NEW PROCEDURE FOR CORRECTION OF PRIMARY HYPOSPADIAS WITH CHORDEEJournal of Urology, VOL. 167, NO. 1, (306-308), Online publication date: 1-Jan-2002. Volume 164Issue 3 Part 2September 2000Page: 988-990 Advertisement Copyright & Permissions© 2000 by American Urological Association, Inc.KeywordsurethrahypospadiashistologypenisMetricsAuthor Information WARREN SNODGRASS More articles by this author KATHLEEN PATTERSON More articles by this author J. CHADWICK PLAIRE More articles by this author RICHARD GRADY More articles by this author MICHAEL E. MITCHELL More articles by this author Expand All Advertisement PDF DownloadLoading ...

EFFECT OF THE DEPTH AND WIDTH OF THE URETHRAL PLATE ON TUBULARIZED INCISED PLATE URETHROPLASTY

We determined the effect of the depth and width of the urethral groove on tubularized incised plate urethroplasty for distal hypospadias. We retrospectively reviewed the records of 48 patients who underwent tubularized incised plate urethroplasty for distal hypospadias between September 1996 and December 1998 for whom preoperative evaluation of the depth and width of the urethral groove was available. Patients were examined by an independent clinician a median of 28 months after surgery when the neourethra was calibrated and urinary stream assessed. Of the 48 patients 46 were available for clinical examination. The urinary stream was straight in 40 boys and angled in 8, while none sprayed. Urethral fistula developed in 6 patients with a urethral plate of less than 8 mm. wide (p = 0.001). The urethral groove was deep in 13 cases, moderate in 20 and shallow in 15. There were no differences among these 3 groups in regard to urinary stream direction or fistula rate. Of the boys with a shallow urethral groove 6 (40%) have a neourethral caliber of 6Fr or less versus 3 (15%) with a moderate and 0 with a deep groove. This difference was statistically significant (p = 0.028). Each patient in whom meatal stenosis developed had a shallow urethral groove. Urethral groove depth appears to influence neourethral caliber after tubularized incised plate urethroplasty. A shallow groove predisposes to a narrower neourethra and meatal stenosis subsequently. We observed no evidence that incising the urethral plate increases the final urethral diameter. Urethral fistula after tubularized incised plate urethroplasty was associated with an initially narrow urethral plate.

Clinical review of the 'Snodgrass' hypospadias repair.

Snodgrass first described the tubularized, incised plate (TIP) urethroplasty for distal hypospadias repair in 1994 based on the concept of hingeing the incised urethral plate. The use of this technique allows a vertically orientated glanular meatus to be produced. A retrospective review of patients who had this procedure for the primary repair of distal hypospadias at New Children's Hospital was performed to objectively assess the cosmetic and functional outcomes of this technique. All patients having a TIP urethroplasty for the primary repair of distal hypospadias between 1996 and 1998 were requested to attend for review in an independent clinic. The parents were interviewed and the patient was examined to determine meatal location, meatal size, glanular configuration, urinary stream, straightness of erections, cosmesis, and the presence or absence of cutaneous sinus tracts or a urethral fistula. Sixty patients were identified. Forty-nine were reviewed in person, 10 were reviewed by telephone and one could not be traced. The median age at surgery was 13 months (range: 6-144 months), with a median follow up of 27 months (range: 2-33 months). A glanular meatus was achieved in 57 patients (97%) and a conical glanular configuration was achieved in 58 patients (98%). The urinary stream and erections were straight in 54 (89%) and 58 patients (98%), respectively. Suture sinus tracts were present in 14 (24%) patients. Six patients (10%) developed a urethral fistula and three (5%) developed meatal stenosis. A good or satisfactory final cosmetic and functional result was achieved in 58 patients (98%). The results of TIP urethroplasty are satisfactory at New Children's Hospital with the benefit of a cosmetic final outcome similar to a circumcised penis.

PRESERVATION OF THE THIN DISTAL URETHRA IN HYPOSPADIAS REPAIR

We report our experience with preserving the thin distal urethra lacking corpus spongiosum for the treatment of hypospadias. From January 1997 to October 1999 we treated primary hypospadias in 77 boys with a mean age of 4 years 10 months. After degloving the penile skin a segment of thin distal urethra lacking corpus spongiosum was noted in 18 patients (23.4%) with a mean age of 3 years 5 months. The thin distal urethra was preserved and incorporated as part of urethroplasty (group 1). The procedure was primarily completed by tubularized incised plate urethroplasty. We also performed tubularized incised plate urethroplasty in 31 boys (40.3%) with a mean age of 5 years 2 months who had normal coverage of the corpus spongiosum of a hypospadiac urethra (group 2). We compared the results of treatment in these 2 groups. The remaining 28 patients (36.4%) treated with other methods were excluded from study. In group 1 the distance from the original meatus to the urethra covered by healthy corpus spongiosum was 4 to 20 mm. (mean 8.2). If the thin distal urethra had been excised, the urethral meatus would have been relocated more proximal in these boys. Mean followup in groups 1 and 2 was 9.9 and 7.6 months, respectively. Postoperatively there were 2 (11.1%) urethrocutaneous fistulas in group 1 and 4 (12.9%) in group 2. Tubularized incised plate repair was successful in all 10 cases (100%) of distal hypospadias in group 2, and in 15 of 18 (83.3%) and 17 of 21 (81%) of proximal hypospadias cases in groups 1 and 2, respectively. There was no statistically significant difference in the success rate of hypospadias repair in the groups. We noted a significantly thin distal urethra in 23.4% of our cases of primary hypospadias. Mean length of the thin distal urethra was 8.2 mm. Preserving the thin distal urethra may simplify the operative procedure without compromising the surgical results of tubularized incised plate urethroplasty.

TUBULARIZED INCISED PLATE HYPOSPADIAS REPAIR FOR PROXIMAL HYPOSPADIAS

Purpose We report a multicenter experience using tubularized incised plate urethroplasty for proximal hypospadias. Materials and Methods From August 1993 to December 1996 tubularized incised plate urethroplasty was performed in 27 boys 6 months to 3 years old with mid shaft and penoscrotal hypospadias. In 7 other boys complex reconstruction combined the tubularized incised plate technique for the glanular urethra with other repairs for the proximal urethra. Results Tubularized incised plate surgery created a functional neourethra even in penoscrotal hypospadias. Complications of the primary repair developed in only 3 of 27 patients (11%). No complications were attributed to use of the technique for the glanular urethra in complex repairs. Conclusions Tubularized incised plate urethroplasty is a versatile operation that corrects proximal hypospadias defects with few complications and superior cosmetic results.

Tubularized Incised Plate Hypospadias Repair: Results of a Multicenter Experience

Purpose We report a multicenter experience using tubularized incised plate urethroplasty to correct distal hypospadias. Materials and Methods A total of 148 patients underwent repair by 6 pediatric urologists at different institutions in the United States and Europe. Results Tubularized incised plate repair created a functional neourethra with a vertically oriented meatus. Complications, including meatal stenoses and fistulas, occurred in 10 patients (7 percent). Conclusions Tubularized incised plate urethroplasty can be performed in most cases of distal hypospadias. Cosmetic results are superior to those of other popular techniques.