Tubularized Incised Plate Urethroplasty Research Articles

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.

Tubularized incised plate urethroplasty with or without dilatation in hypospadias repair: a comparative study

Background. After tubularized incised plate (TIP) urethroplasty meatal and urethral dilatation is a common practice. There are some complication of uretheral dilatation like urethral bleeding,urethral perforation and creating a false passage. Moreover dilating the urethra regularly is physically or psychologically painful both for the child and the parents. The aim of this study was to justify the necessity of uretheral dilatation after TIP urethroplasty.Material and Methods. This study was a prospective, comparative study performed in Dhaka Shishu (Children) Hospital from July 2017 to June 2020. Total 60 respondents were participated in this study with maintain inclusion criteria. Respondents with primary distal and mid-shaft hypospadias where TIP urethroplasty was indicated, admitted in Dhaka Shishu Hospital during study period were included. Group 1 was assigned non dilatation group and Group 2 was assigned to regular urethral ditatation group after TIP urethro- plasty. Fistula formation, meatal stenosis and neourethral stricture were compaired between two groups. Informed written consents were taken from legal guardians. Data ware analyzed by SPSS Program.Results. In this study there was no significant difference of ages between two groups. In Group 2 10 %( 3)respondents developed urethrocutaneous fistula, 10% (3) respondents developed meatal stenosis and 3.33% (1)respondents developed neourethral stricture. On the other hand. In Group 1 10% (3) respondents developed urethrocutaneous fistula, 6.66% (2) respondents developed meatal stenosis. None of patient in Group 1 developed neourethral stricture.Conclusion. There was no significant difference in fistula formation, meatal stenosis and neourethral stricture in between regular urethral dilatation group and non-dilatation group after TIP urethroplasty.

Tubularized incised plate urethroplasty with or without dilatation in hypospadias repair: a comparative study

Background. After tubularized incised plate (TIP) urethroplasty meatal and urethral dilatation is a common practice. There are some complication of uretheral dilatation like urethral bleeding,urethral perforation and creating a false passage. Moreover dilating the urethra regularly is physically or psychologically painful both for the child and the parents.The aim of this study was to justify the necessity of uretheral dilatation after TIP urethroplasty.Materials and Methods. This study was a prospective, comparative study performed in Dhaka Shishu (Children) Hospital from July 2017 to June 2020. Total 60 respondents were participated in this study with maintain inclusion criteria. Respondents with primary distal and mid-shaft hypospadias where TIP urethroplasty was indicated, admitted in Dhaka Shishu Hospital during study period were included. Group A was assigned non dilatation group and Group B was assigned to regular urethral ditatation group after TIP urethro- plasty. Fistula formation, meatal stenosis and neourethral stricture were compaired between two groups. Informed written consents were taken from legal guardians. Data ware analyzed by SPSS Program.Results. In this study there was no significant difference of ages between two groups. In Group B 10% (3)respondents developed urethrocutaneous fistula, 10% (3) respondents developed meatal stenosis and 3.33% (1)respondents developed neourethral stricture. On the other hand In Group A 10% (3) respondents developed urethrocutaneous fistula, 6.66% (2) respondents developed meatal stenosis. None of patient in Group A developed neourethral stricture.Conclusion. There was no significant difference in fistula formation, meatal stenosis and neourethral stricture in between regular urethral dilatation group and non-dilatation group after TIP urethroplasty.

The Use of Autologous Platelet Rich Fibrin Membrane as a Second Layer in Snodgrass Repair of Distal Hypospadias

Background: Hypospadias is a common pediatric health problem. Snodgrass [Tubularized Incised Plate Urethroplasty]surgical repair was adopted as the standard technique, although different techniques had been described. However, higher complication rate continues to be a problem. The aim of the work: To evaluate the use of platelet rich fibrin membrane as an intermediate layer in the Snodgrass repair of distal hypospadias. Patients and Methods: Thirty children were included. All were evaluated preoperatively by full history taking, clinical examination and laboratory investigations. Then all were treated by Tubularized Incised Plate Urethroplasty with the use of platelet rich fibrin membrane as an intermediate layer. They then followed up and any early or late complications were registered. Results: Hypospadias was recurrent among 83.3%. Patient age ranged between one and six years and the mean operative time was 67±5.4 minutes; the mean hospital stay duration was 7.0±1.2 days. The success rate was 93.3% and complication rate was 6.7%. Complications were edema in 6.7%, urethro-cutaneous fistula [UCF] in 6.7% and skin infection among 3.3%. Conclusion: The use of a platelet rich fibrin membrane is a feasible and safe intermediate layer for hypospadias surgery in Tubularized Incised Plate Urethroplasty. The procedure is quick and straightforward and has a low postoperative complication.

Comparative study between two days versus seven days urethral stenting of distal hypospadias after tubularized incised plate urethroplasty

Background: The duration of urethral stenting after tubularized incised plate (TIP) urethroplasty for hypospadias varies among surgeons.Methods: Forty male cases with distal hypospadias aging from one year till the age of six years randomly allocated into two groups for undergoing tubularized incised plate urethroplasty with removal of the urethral stent after two days in one group and after seven days in the other one. The rate of postoperative complications such as urethrocutaneous fistula, urinary retention, meatal stenosis and complete wound dehiscence requiring redo and cosmetic results were compared.Results: The prevalence of post-operative complications and cosmetic results in two studied groups were not significantly different.Conclusions: There is no significant difference between removal of the stent after two days or seven days regarding the incidence of postoperative complications and the cosmetic results.

Comparison of Urethrocutaneous Fistula Rate After Single Dartos and Double Dartos Tubularized Incised Plate Urethroplasty in Pediatric Hypospadias.

Background and objectiveTubularized incised plate (TIP) urethroplasty is an easy and popular technique for repairing hypospadias, however urethrocutaneous fistula (UCF) is a frequently reported complication. Different techniques are used to reduce this complication. We aimed to compare the rate of UCF after single dartos and double dartos TIP urethroplasty in children with distal and mid penile hypospadias.MethodsA randomized controlled trial (NCT 04699318) was conducted in the Department of Pediatric Surgery, Mayo Hospital, Pakistan from August 2017 to February 2018, after ethical approval. After informed consent, a total of 60 patients with distal and mid penile hypospadias who were uncircumcised, had no chordee, and/or previous surgery, were randomly allocated in two groups using computer generated table numbers. Group A underwent single dartos TIP urethroplasty and Group B underwent double dartos TIP urethroplasty. Catheter was removed on day 10 post-operatively in both groups and primary outcome (UCF) was noted after a week of catheter removal. Rate of UCF was compared using chi square and p-value of <0.05 was taken as significant. Data was stratified to check for effect modifiers.ResultsOut of 60 children, eight (13.3%) developed UCF. In Group A, seven (23.3%) developed UCF and in Group B, one (3.3%) developed UCF (p-value 0.02). In both groups, no patient (0%) had urethral disruption, penile torsion, skin necrosis or meatal stenosis.ConclusionAdditional covering of neo-urethra by a double dartos layer significantly reduces fistula rate after tubularized incised plate urethroplasty in both primary distal and mid penile hypospadias.

Urethral plate in tubularized incised plate urethroplasty: how wide is enough?

BackgroundPrevious reports found that a preincision urethral plate (UP) width <8 mm increased the occurrence of urethroplasty complications (UCs) in tubularized incised plate (TIP) hypospadias repair. However, is the classification of the UP width based on an 8 mm cut-off value to predict the outcome of TIP urethroplasty objective enough or universally applicable? The purpose of our study was to assess the effect of the UP width on the outcomes of TIP hypospadias repair in the Eastern population we served.MethodsWe retrospectively reviewed the records of patients who underwent TIP hypospadias repair by the same surgeon between August 2013 and December 2019 in our hospital. Data were collected, including demographics, intrinsic parameters of the penis, surgical parameters and subsequent surgical outcomes. The data were analyzed and the cut-off value of the UP width was calculated using a receiving-operator curve.ResultsPrimary TIP urethroplasty was carried out in 116 patients with a mean age of 35.89±29.40 months. The meatal location was distal in 49 patients, midshaft in 56 patients and proximal in 11 patients. The mean glans width was 12.28±1.36 mm, the mean UP width was 5.74±1.37 mm, the mean neourethral length was 1.96±1.32 cm, and the mean operation duration was 87.52±11.47 min. During a median follow-up of 42 (range: 6 to 80) months, UCs developed in 12 patients, and the UP width was significantly related to the occurrence of UCs (P=0.014). According to the 6 mm cut-off value of the UP width by the receiver operating characteristic curve, patients were divided into two groups. Group A (UP width ≥6 mm) included 69 patients, and Group B (UP width <6 mm), 47 patients. UCs occurred in 3 patients in Group A vs. 9 patients in Group B, P=0.010.ConclusionsUP width is a potential risk factor for UCs after TIP hypospadias repair. Using this technique with an UP width ≥6 mm is sufficient to result in a good outcome of hypospadias repair.

The outcomes of tubularized incised plate hypospadias repair and tubularized incised plate grafting using muccal mucosal graft and preputial free graft

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&gt;0.005). Conclusion Outcomes of TIP grafts have no significant difference than outcomes of TIP technique.

Outcome of Proximal Hypospadias Repair in Children using Standard Surgical Technique with Intermediate Vascularised Flap- ARetrospective Cohort Study

Introduction: Hypospadias is a very common congenital anomaly noted in children with reported incidence of 0.4-8.2% in 1000 live birth. Treatment of hypospadias is urethroplasty, but is a difficult procedure due to complex anatomy, nonavailability of adequate tissue for repair, prolonged postoperative course and increased incidence of complications even in experienced hands. Aim: To highlight the complications and functional outcome of various types of proximal hypospadias using standard surgical technique with intermediate vascularised flap. Materials and Methods: This was a retrospective cohort study conducted from on 31 children, between the age of 2-13 years from June 2020 to August 2020. The children had proximal hypospadias with or without chordee were operated using primary procedure Tubularised Incised Plate (TIP) and staged procedure with cover of intermediate vascularised flap. These children had peno-scrotal, proximal, mid and distal penile hypospadias with meatus placed 1.5 cm proximal from the glans tip. In all cases, an intermediate layer of vascularised flap was put to cover the neourethra. Tunica vaginalis flap was used in 27 cases and dartos flap in 4 cases. The outcomes of surgical procedure, early and late complications with follow-up results were analysed using descriptive statistics of frequency and percentage. Final functional results of the procedures and cosmesis were observed during a two-year follow-up period. Results: Out of the 31 patients, 27 patients had urethroplasty (20 staged procedures and seven TIP) with tunica vaginalis as intermediate layer. Another four patients had TIP urethroplasty with dartos as intermediate layer. Four patients of tunica vaginalis as intermediate layer had early urethrocutaneous fistula (14.8%), one patient (3.7%) required closure of fistula and another three closed spontaneously. Two patients had meatal stenosis (7.4%) and four had slight pulled up ipsilateral testis (14.8%). One patient of TIP urethroplasty with dartos as intermediate layer was reoperated for late urethrocutaneos fistula at corona glandis (25%). Conclusion: The outcome of pediatric urethroplasty was favourable with routine use of intermediate vascularised flap in proximal hypospadias repair.

Long-term outcome of non-stented tubularized incised plate urethroplasty for distal hypospadias repair: a complication analysis.

IntroductionAlthough it is apparently simpler to perform unstented tubularized incised plate (TIP) repair for distal hypospadias repair, consensus on feasibility of the use of unstented repair is still a matter of debate. Evidence reporting that unstented repair outcome is comparable to stented repair, especially in the long-term, is still weak due to reporting outcome inconsistencies, different study designs, inclusion of more than one technique, and inherent variability in meatal locations. Thus, we need a continuous and evolving assessment of the outcome of unstented repair to compile adequate evidence on the advantage of unstented TIP repair in distal hypospadias entity. The aim of this article was to review our long-term results with tubularized incised plate urethroplasty for distal hypospadias repair without a postoperative stent to determine its outcome which might justify its use.Material and methodsAfter a review of 154 patients with distal penile hypospadias, who underwent repair in Minia Urology & Nephrology University Hospital in the period between June 2015 and February 2018, we excluded cases who underwent MAGPI repair, redo cases and patients who failed to complete follow-up. We chose 72 patients who had only 1st time TIP repair and whom we could contact. A total of 44 out of 72 cases with stented repair were assigned to Group A, while 28 cases with unstented repair were assigned to Group B. Success was assessed based on Hypospadias Objective Penile Evaluation (HOPE) score by three separate senior pediatric urology consultants, independent of the surgeon and in the absence of high post-void residual urine (PVR). Average rate was calculated to be compared between both study groups.ResultsThere was no statistically significant difference regarding preoperative meatal location and age at repair and short-term complications. In the long-term; there was no statistically significant difference between the occurrence of urethrocutanous fistula (UCF, 4 vs 2 cases in Group A & B, respectively) and complete disruption (2 cases in each group) with need for redo repair. Results of total mean of HOPE score calculated showed no statistically significant differences between study groups and also failed to showed statistical significance on individual domains of HOPE score.ConclusionsUnstented TIP repair showed a similar outcome to stented TIP repair of distal hypospadias especially in the long-term despite a more troublesome early postoperative period.

Appraisal of hypospadias repair at University of Nigeria Teaching Hospital Enugu

Background: Hypospadias repair is one of the most common urologic surgeries performed in male children. Various surgical repairs and modifications of existing ones have evolved over the past decades. Notable among them is the Snodgrass tubularized incised plate (TIP) procedure. We document an appraisal of hypospadias repair performed at the University of Nigeria Teaching Hospital (UNTH) Enugu within a period of 6 years. Aim: The aim of this article is to determine the common presentations, repair, and outcome of hypospadias at UNTH. Materials and Methods: This is a retrospective study. Case notes of all patients who had surgeries for hypospadias between January 2013 and January 2019 were retrieved and data extracted. The data were analyzed using SPSS version 23. Results: Sixty-one operations were carried out on 51 patients within the 6-year period. The ages of the patients at the time of surgery ranged from 6 months to 27 years with a median age of 3 ± 4.9 years. The most frequent type was coronal hypospadias occurring in 25 patients (41%). The rarest forms were perineal hypospadias and proximal penile hypospadias seen in one patient (1.6%) each. Five patients (8.2%) each were seen with failed hypospadias repair and urethrocutaneous fistula. Fifty-four (88.5%) were single-stage operations and 7 (11.5%) were staged procedures. The most common surgery performed was Snodgrass TIP urethroplasty done in 38 patients (62.3%). Thirty-six patients (59%) had no complication, whereas 25 (41%) had complications. The common complications were urethrocutaneous fistula in 14 patients (23%) and surgical site infection in five patients (8.2%). Conclusion: Snodgrass TIP was noted to have a good outcome for the repair of hypospadias in UNTH.

Megameatus intact prepuce and associated anomalies

Objective: Megameatus intact prepuce is described as subset of megalourethra or distal hypospadias by several authors. Despite suggested different operative techniques, some authors prefer not to operate this variant of penile anomaly. We aimed to evaluate 31 patients operated due to megameatus intact prepuce and associated anomalies .&#x0D; Material and methods: Thirtyone patients operated between 2008-2018 for MIP were evaluated retrospectively. All data were collected from hospital records. Patient age, application reasons, raphe anomalies, associated genitourinary and extragenitourinary pathologies, operative techniques, and postoperative complications were analyzed. &#x0D; Results: Mean age was 50 months (8-128 months). Ten of the patients had raphe anomalies. Genital raphe hyperpigmentation was seen in 1 patient, raphe deviation and bifurcated raphe was seen in6 and 3 patients respectively. Genitourinary anomalies were detected in 7 patients, bilateral undescended testes in 1 patient, penile chordee in 2 patients, ureteropelvic junction obstruction in 2 patients, penoscrotal web in 1 patient, nocturnal enuresis in one patient. Tubularized incised plate urethroplasty (TIPU) (n=5), tubularized urethral plate urethroplasty (TUPU)(n=16) and meatoplasty (n=10) were the operative techniques.&#x0D; Conclusion: . Co-occuring raphe anomalies should arise awareness of MIP among the clinicians who are engaged with the children’s medical conditions and also the possible anomalies especially in the societies which circumcision is not traditionally required. Further studies with large number series needed for better understanding of this pathology.

MAGPI under local anaesthesia without catheter as an alternative to standard TIP procedure in distal hypospadias repair.

To evaluate the surgical outcomes of meatal advancement and glanuloplasty incorporation (MAGPI) and tubularised incised plate (TIP) urethroplasty. We retrospectively reviewed the patient records who had hypospadias repairing surgery between March 2017 and March 2020 in terms of age, meatal position, operative and anaesthesia techniques and surgical outcomes. Hypospadias repair was performed in 85 patients. TIP urethroplasty was performed in 17 patients where MAGPI was performed in 63 patients. Preoperative meatal stenosis was present in 10. Coronal glanular and subcoronal hypospadias were present in 65 and 15 patients respectively. Mean operative time was 41.3±28min. The mean duration of the catheter was 7.56days. A significant chordee was present in 35 patients where 45 patients had no chordee. The overall success rate was 93.75%. MAGPI ended up with an unfavourable result in 1 and TIP urethroplasty in 4. Postoperative urethral stenosis was seen in 1. Of those who ended up with an unfavourable result, 4 were with subglandular hypospadias. Urethral catheter required in 4 of those who failed, whereas 1 had no catheter following surgery. Therefore, MAGPI is a useful method in selected glandular and subglandular hypospadias repair with favourable surgical outcomes including no stent requirement.

Narrow urethral plate augmentation in anterior and middle hypospadias repair: Onlay flap VS. Inlay graft. A prospective randomized comparative study

The measurement of the urethral plate width (as an objective parameter) and its effect of this width on the results of tubularized incised plate urethroplasty (TIPU) have been reported in two series and both authors reported that a urethral plate width<8mm is associated with higher complication rates. The augmentation of the urethral plate either by dorsal inlay graft urethroplasty (DIGU) or Onlay flap has been compared with the original TIPU in different degrees of hypospadias with better surgical results in augmented cases. To evaluate the surgical results of longitudinal Onlay preputial flap (LOF) vs (DIGU) techniques in augmentation of the narrow urethral plate. Primary anterior and middle hypospadias cases with narrow urethral plates were randomly allocated into two groups; group one operated by DIGU and group two operated by (LOF). The Success rate, individual complication rate, and operative times were compared. 39 cases completed the study. No significant differences in patients' characteristics were detected. In the DIGU group, one case (5.3%) complicated with fistula and glandular dehiscence wherein in the LOF group, 7 cases (35%) Complicated with 5 fistulae, 2 glanular dehiscences, one flap loss, one diverticulum (p= .02). No significant differences in the rates of individual complications. Variables affecting the success of hypospadias repairs are many. Urethral plate quality is an important variable among these variables. The definition of urethral plate quality is usually subjective. In the DIGU group, only 1/19 (5.3%) case had two complications, fistula and glandular dehiscence. Mouravas etal., in their comparative study between TIPU and G-TIP without mention of urethral plate width reported a significant reduction of the overall complications and urethral stenosis without significant reduction in fistula rate. In their G-TIP group, only 2 cases out of 24 (8.3%) were complicated with one fistula and one glandular dehiscence where in the TIPU group, 7 cases (30.4%) were complicated with one glandular dehiscence and 6 cases with urethral stenosis. In the LOF group, fistula in 5/20 cases (25%) was the commonest complication followed by glandular dehiscence in 2 cases (10%). Diverticulum and flap loss occurred in one case for each (5%). In the multivariate analysis of 474 patients' cohort by Spinoit etal., there were no significant differences between the risk of re-intervention after TIP and Onlay flap in anterior and middle hypospadias (25.8% vs. 18.8%), and (22.2% vs. 20%) respectively. Our data suggest that augmentation of the narrow urethral plate with DIGU has a better surgical outcome than with LOF. No significant difference in cosmetic outcomes detected.

Comparative Study Between Tubularized Incised Plate Urethroplasty and Transverse Prepuceal Only Island Flap Urethroplasty for the Management of Distal Penile Hypospadias

Introduction: The optimal treatment of hypospadias remains controversial. Severaltechniques have been described, but the best approach remains unsettled. Objective:To compare the outcomes of two popular methods, Tubularized incised plateurethroplasty (TIPU) and Transverse preputialonlay island flap (TPOIF) for the correctionof distal penile hypospadias. Materials and method: This prospective interventional study was conducted in theDepartment of Urology, Dhaka Medical College Hospital, during the period of September2015 to March 2017. 40 patients with distal hypospadias with minimum or no chordeeand no previous history of circumcision or hypospadias surgery were allocated into twogroups by simple random sampling with equal number of distribution. In Group-A, patientswere subjected to correct the defect by TIPU procedure while in Group-B, they wereoperated by TPOIF urethroplasty technique. In this study, the outcomes of theaforementioned procedures were compared in terms of operative time, surgicalcomplications and cosmetic outcome. Result: Mean age and meatal position of the patients in Group-A and Group-B werecomparable. The mean operation time of Group-B (100.78 ±16.66 min) was higher thanGroup-A (89.98 ±19.80 min). Complications in terms of UCF and meatal stenosis werehigher in Group-A than in Group-B, 26.31% vs. 16.67% and 36.84% vs. 5.56%respectively, but were lower for wound disruption, 0% vs. 11.11%. Although differencebetween the groups was not statistically significant in case of UCF and wound disruption(p value &gt;0.05), it was significant in meatal stenosis (p value &lt;0.05). Cosmetic outcomeof most of the cases in Group-A was good (61.11%), whereas it was poor in Group-B(78.77%). Conclusion: It seems that both techniques can be used for the correction of distalpenile hypospadias with apparently similar outcomes. However well controlled randomizedstudy with adequate sample size may reveal more divergent outcomes for the twotechniques. Bangladesh Journal of Urology, Vol. 22, No. 1, January 2019 p.47-54

A single center experience of Hypospadias Repair in Dar es Salaam, Tanzania

Background: Hypospadias is one of the common congenital anomaly that affects children. It can present classically with abnormal ventral opening, chordee and dorsal hood however isolate hypospadias do also exist. Hypospadias repair is one of the commonly performed surgical procedures at Muhimbili National Hospital (MNH) and the outcome of repair is influenced by several factors. Our study aimed to assess the Profile and Early Outcome of Hypospadias repair at Muhimbili National Hospital. Methodology: This was a cross sectional study which involved all children with hypospadias aged ≥6 months and underwent first repair recruited by convenient sampling at Muhimbili national Hospital from March 2018 to January 2019 with a follow up of 30 days from surgery. We excluded children who had Repair before, those who underwent hypospadias repair and died within 24 hours post-operative. Mothers of each participating patient gave an informed consent. Data were collected by a standardized questionnaire and analyzed by using SPSS program version 20. Results: Sixty-three children were enrolled in the study with mean age of 3.7 years. Majority of our patient had Subcorona hypospadias with Snodgrass tubularized incised plate urethroplasty being the common surgical technique. Thirty-seven (58.7%) patients had successful hypospadias repair while 26(41.3%) had complications. The most commonly found early complications were surgical site infection, hematoma, oedema, flap necrosis, urethrocutenous fistula, urethral stricture, wound dehiscent and meatal stenosis. Age&gt;3.5 years at repair, previous circumcised, type and duration of urine drainage&lt; 7 days, type of dressing and changing the 1st dressing &lt; 3 days were found to influence complications rate. Conclusion: Hypospadias is still the common pediatric urological condition with Snodgrass technique being preferred for repair. The outcome of the repair can be influence by different factors regardless of the technique of repair.

Tubularized Incised Plate Urethroplasty for the Repair of Distal Hypospadias: A Simple Versatile Technique

Objective: To observe the outcomes of tubularized incised plate urethroplasty in the primary management of distal hypospadias Materials and Methods: Total 70 patients of age group 2 to 10 years with distal hypospadias were selected for this study from January 2008 to December 2015. They were treated with tubularized incised plate urethroplasty. All patients were followed up immediately and at 4th, 8th and 12th weeks after operation. Results: The satisfactory cosmetic and functional outcomes were observed in 58 patients (82.85%).Urethrocutaneous fistula developed in 10 patients (14.70%) patients and 6 patients (8.82%) were found to develop meatal stenosis. Two patients (2.94%) developed stricture urethra. Overall complications occurred in 20 patients (29.41%). Conclusions: This study demonstrates that tubularized incised plate urethroplasty had excellent cosmetic and functional outcomes and fewer complications in the primary management of distal hypospadias. Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.65-69

Redo hypospadias repair by a single surgeon after failed hypospadias surgeries: Experience from a developing country

Background: Hypospadias surgeries are often complicated with fistulas, meatal stenosis and disruptions. We report our series of redo surgeries for failed primary repairs. Methods: We prospectively observed all the redo hypospadias repairs done by the principal author between 2013 and 2017. Thiersch-Duplayurethroplasty was done if the urethral plate was adequately wide and intact; tubularized incised plate (TIP) urethroplasty was performed if the urethral plate was intact but, narrower than 8 mm; 2 stage procedures were done with oral mucosal graft (OMG) if the urethral plate was deficient or scarred with significant chordee. Result: There was a total of 31 patients. Age ranged from 18 months to 15 years (mean 8.05 ±4.27 years). Sixteen (51.61%) patients underwent only one surgery, 10 (32.26%) patients underwent 2 surgeries, 2 patients (6.45%) underwent 3 surgeries, and 3 patients (9.68%) underwent 4 surgeries prior to presenting to us before our redo surgeries.We had performed TIP urethroplasty in 16 (51.61%) patients, meatal based flap urethroplasty in 12 (38.71%), OMG followed by urethroplasty in 2 (6.45%), and repair of urethra-cutaneous (UC) fistula in 1 (3.23%) patient. Ten (32.26%) Complications occurred in 8 (25.80%) patients. Unsuccessful repair was noted in 03 (9.67%) patients (UC fistula 1, glans dehiscence with UC fistula 1, and glans dehiscence 1). Conclusion: Thiersch-Duplay and TIP repair can be successfully performed in redo hypospadiassurgeries with acceptable complication rate. OMG graft can be reserved for cases with gross scarring of the urethral plate. Keywords: Failed hypospadias repair; Tubularized incised plate urethroplasty; Thiersch-Duplay; Outcome

Inner Prepuce Preserving ‘Bird-Winged Coronal-Collar Skin ReArrangement’ Modification of Tip Urethroplasty

Objective: To describe the ‘Bird-Winged Coronal-Collar Skin re-arrangement modification’ of the Tubularized Incised Plate (TIP) urethroplasty to preserve the inner preputial skin on the ventral surface of the penile shaft. Material and Method: Study Group: Prospective review of the results of a single surgeon with Bird-Winged Coronal-Collar skin re-arrangement modification of TIP urethroplasty (n=111; mean age 4.9 years) of distal (n=76) and mid-penile (n-35) hypospadias (mean follow-up 37 months). Control Group: Retrospective review of a single surgeon’s results of distal and mid-penile hypospadias repair with standard TIP urethroplasty (2007-11). Outcome parameters (to compare non-inferiority of the modified technique): Urethro-cutaneous fistula (UCF) at voiding trial and follow-up at 3 months, wound infection, complete dehiscence, local edema, meatal stenosis and quality of urinary stream. Statistical analysis was done with the Fischer Exact Test. Results: With this technique, the authors could provide an inner preputial cover on the ventral/ ventro-lateral aspects of distal penile shaft in all but one patient (complete dehiscence). The results of ‘bird-winged coronal-collar skin re-arrangement’ modification were not-inferior/ comparable to those of standard TIP urethroplasty. Conclusions: The modification is technically feasible and reproducible and the overall results of urethroplasty were not inferior to the standard TIPS procedure.

Using prepucial mucous to cover neourethra in TIP urethroplasty: 4 years experience in a tertiary paediatric hospital of Bangladesh

Background. Hypospadias has a wide spectrum of penile abnormality requiring surgical correction. Most of the cases are of anterior variety and the surgical technique depends on constructing a neo urethra. Snodgrass or Tubularized Incised Plate (TIP) urethroplasty is one of the most popular techniques of urethroplasty which depends on the existing healthy, adequate and intact urethral plate. Different tissues have been described to cover the neourethra as second layer in literature. In this study we modified the TIP urethroplasty by covering the neourethra with 2 layers of pedicled prepucial mucosa or Dartos flap. Objective. To see the outcome of modified Snodgrass or TIP urethroplasty in anterior mid and proximal penile hypospadias. Materials and method. Total 88 patients were operated by modified Snodgrass technique or modified TIP urethroplasty from January 2012 to July 2016. Coronal, subcoronal, distal penile, mid penile and proximal penile hypospadias were included in the study. Every patient underwent modified TIP urethroplasty and outcomes were assessed. Results. The mean age of the patients were 28.34±14.98 months, ranges from 6.5 to 65 months. 9 (10.2%) patients of our series develop urethrocutaneous fistula, 5 (5.68%) patients develop meatal stenosis and 1 (1.1%) patient developed neourethral stricture. Conclusion. TIP urethroplasty is a versatile method to correct penile hypospadias. Covering of the neourethra with prepucial mucosa secure the neourethral anastomosis. The author declares that there is no conflict of interest. Key words: Hypospadias, TIP urethroplasty, Prepucial mucosa.