Tubularized Incised Plate Urethroplasty Research Articles

The effect of intraurethral dexpanthenol in hypospadias repair: experimental rabbit study

In this study, the authors aimed to research the histopathologic effects of intraurethral use of dexpanthenol for hypospadias repair. Dexpanthenol is a derivative of pantothenic acid, a B complex vitamin. Pantothenic acid is a molecule contributing in the structure of coenzyme A. It decreases the release of myeloperoxidase from granulocytes and inhibits the formation of free oxygen radicals, and it exhibits an anti-inflammatory effect by increasing mitotic activity. The objective of this study is to evaluate the use of dexpanthenol after a tubularized incised plate urethroplasty (TIP) on wound healing, inflammation, and fibrosis. In this study, 18 healthy male New Zealand white rabbits weighing 2500-3000g were used. The 18 rabbits were randomly divided into 3 groups. For the hypospadias model, rabbits had a urethral catheter inserted in the urethra and a ventral midline incision was made from the glans tip to the central line of the penis. Afterward, the incision was closed with Vicryl (7/0) using the continuous suture technique, and urethroplasty was completed. For fourteen days, group I had 0.9% saline solution administered intraurethrally twice per day with a 22G catheter sleeve (control group), group II had one dose of 500mg/kg dexpanthenol (Bepanthene®; Bayer Turk Chemical Industry Limited Company, Turkey) ampoule and one dose of saline solution administered in the same way, and group III had two doses of 500mg/kg dexpanthenol ampoule administered. On the fifteenth day, the penis was degloved and rabbits had penectomy performed with samples sent to the pathology department for histopathological assessment. The degree of fibrosis and inflammation in group I (control group) was more severe than groups II and III. The differences between groups I and II were statistically significantly different for both fibrosis and inflammation (P=0.018 and P=0.041, respectively). The differences between groups I and III were also statistically significantly different for both fibrosis and inflammation (P=0.019 and P=0.011, respectively). Groups II and III were not different significantly for fibrosis and inflammation (P>0.05). This study shows that intraurethral dexpanthenol application has positive effects on fibrosis and inflammation. The main limitations of the study are that the hypospadias model was created surgically and long-term follow-up for fistula formation was not assessed. Administration of intraurethral dexpanthenol after hypospadias repair has positive effects on fibrosis and inflammation.

Replacing a smaller-size catheter after tubularized incised plate urethroplasty may decrease postoperative urethral complications

Objective To investigate the effect of replacing a smaller-size catheter after tubularized incised plate (TIP) urethroplasty on postoperative urethral complications. Methods The data of 116 hypospadias patients underwent TIP urethroplasty performed by the same urologist in our hospital from January 2014 to December 2017 were retrospectively analyzed. The age of patients ranged from 0.5-15.4 years, with the median age of 1.5 years. Meatal location was distal in 47(39.5%), midshaft in 62(52.1%) and proximal in 10(8.4%) patients. Unhealthy urethral plate occurred in 49(42.2%) patients. F8 catheter was used for urethroplasty in 92(79.3%) patients, F10 in 17(14.7%), and F12 in 7(6.0%). According to the pattern of urinary diversion, patients were divided into two groups. Conventional catheter group in 56 patients (group A): the catheter was chosen in as large size as possible for urethroplasty without tension. Replace a smaller-size catheter group in 60 patients (group B): replace a smaller-size catheter after urethroplasty on the basis of group A. There were no statistically significant differences in age, meatal location and catheter size between the two groups (P>0.05). Results The mean follow up was 23 months (range 6-66 months). There were 73(62.9%) cases of orifice overflow during indwelling catheterization. There were 5(4.3%) patients needed further reoperation result from postoperative urethral complications, including 4 cases of fistula and 1 case of meatal stenosis. The process of replacing a smaller-size catheter after urethroplasty in group B was simple and without adverse reactions. There were 15(26.8%) cases of orifice overflow in group A and 58(96.7%) in group B. There were statistically significant differences in orifice overflow between the two groups (P<0.05). There were 5(8.9%) cases of postoperative urethral complications in group A and 0 case in group B. There were statistically significant differences in postoperative urethral complications (P<0.05). Conclusions The process of replacing a smaller-size catheter after TIP urethroplasty in was simple and subsequently contributed to less postoperative urethral complications. The results of replacing a smaller-size catheter after TIP urethroplasty were superior to that of no replacing conventionally. Key words: Hypospadias; Tubularized incised plate urethroplasty; Catheter; Urethral complications

Use of a Stent in Distal Hypospadias Repaired by Tubularized Incised Plate Urethroplasty: A Comparative Study

Purpose: We present our experience of stented and unstented distal hypospadias repaired by tubularized incised plate urethroplasty (TIPU). Patients and Methods: Data of 84 patients who were operated by TIPU method in 2 hospitals were retrospectively analyzed, and they were invited to be included in the study. Sixty-six patients agreed to participate in the study and were divided into 2 groups. Group 1 consisted of 38 boys operated in Sütçü İmam University Hospital on using a stent between 2015 and 2017. Group 2 consisted of 28 boys operated in Private Hospital of Megapark on without a stent between 2016 and 2017. The hypospadias objective scoring evaluation (HOSE) scale was used to compare the groups. Results: The median age was 2.81 years in group 1 and 1.95 years in group 2 (p = 0.243). The mean follow-up duration was 25.74 ± 4.62 and 24.5 ± 4.19 months in groups 1 and 2 respectively (p = 0.268). The HOSE scores were similar in both groups with comparable results (p = 0.622). Conclusions: No difference was observed between the groups in this study, regarding functional and cosmetic outcomes according to the HOSE score. However, the results should be supported by prospective studies with a sufficient number of patients.

Results of urethral plate preservation and use of vascular dartos flap in hypospadias repair

Background: Lower complication rates are observed if urethral plate (UP) is preserved and utilized for reparative surgery of hypospadias.Aim: This study aims to analyze our results of hypospadias repair by UP preservation, and using vascular dartos flap as interposition flap.Materials and Methods: prospective, cohort study of operated cases of hypospadias over 4.5 years' period. Data including age, diagnosis, preoperative testosterone administration, operation, postoperative complications, and assessment of outcome using hypospadias objective scoring evaluation (HOSE) system were collected. We preserved UP as far as possible, for urethral tube construction. We applied meatal advancement and glanuloplasty incorporated (MAGPI) for glanular/coronal hypospadias and tubularized incised plate urethroplasty (TIPU) (Snodgrass) for most other cases. Single dorsal vascular dartos-flap was transposed ventrally as interposition flap in TIPU. Single transurethral catheter 6F/8F size was employed as urethral stent as well as for bladder drainage. At the first review at 2 weeks after getting discharged, all patients underwent urethral calibration and first HOSE-score assessment. Maximum HOSE-score was 16 points and minimum 5.Results: A total of 111 patients with mean (range) age of 34.69 m (11 m– 123 m) were studied. TIPU (n = 49), MAGPI (n = 44), and others (n = 18) were the operations. There were 10 permanent complications; 9 following TIPU (7 (14.3%) single urethrocutaneous fistula (UCF), 1 torsion penis, 1 glans-dehiscence), and 1 following MAGPI (glans-dehiscence). Mean follow-up period was 15 m (range = 3–36 m). HOSE score ≥14 was achieved in 106 (95.5%) cases.Conclusion: The excellent result of MAGPI in our series is due to strict case selection and technical precision. UCF rate of 14.3% in TIPU can be due to the unselected nature of our cases which included small glans diameter and unfavorable UP characteristics.

Tubularized incised plate urethroplasty (Snodgrass procedure) for distal penile hypospadias: A regional center experience

Objective: Tubularized incised plate (TIP) urethroplasty has rapidly become the procedure of choice for repair of distal penile hypospadias (DPH) at most of the centers throughout the world. We did some modifications in the original technique to improve the outcome. In this article, the technique of TIP urethroplasty is discussed and literature is reviewed. Materials and Methods: TIP urethroplasty was performed in 250 new cases of DPH from January 2005 to December 2015 in our institute. We included only primary DPH with typical characteristics including stenotic meatus, deep glandular groove, wide urethral plate distally and in middle, and adequate size penis. We did some modification in the original Snodgrass repair to improve our outcome. Neourethra was covered with vascularized pedicled dartos flap from the inner prepuce. Patients were followed up for a mean of 12 months. Results: Age range of the patients varied between 3 and 11 years with majority of them [235 (94%)] below 9 years; 50 (20%) patients had mild-to-moderate chordee, which was corrected by degloving of the penis. We did not require tunica albuginea plication to correct chordee because it was only skin chordee. The mean age of children was 6 years. Mean duration of surgery was 50 min (45–60 min). Postoperative hospital stay was 10 days. Overall complication rate, requiring specific intervention, was 13.2%. Major complications occurred in 30 (13.2%), urethrocutaneous fistula in 15 (6%), meatal stenosis in five (2%), complete dehiscence in three (1.2%), glanular dehiscence in five (2%), and proximal stricture in five (2%) patients. Functional results as judged by the urinary stream were good in 225 (90%) patients. An excellent cosmetic result was seen in 215 (86%) patients. Conclusion: TIP urethroplasty with dartos flap cover is a simple, single-stage procedure for DPH with excellent cosmetic and functional results and is associated with minimal complications. Finally, some of our modifications in the original technique can improve the outcome.

A comparative study between tubularized incised plate urethroplasty with and without fibrin glue

Objective To compare the results of two single-stage hypospadias repairs, namely, tubularized incised plate (TIP) repair with and without fibrin glue as regards fistula formation, penile edema, wound infection, and cosmetic outcome. Background One of the most important factors in reducing the incidence of fistula and other complications is incorporation of an intermediate layer between the neourethra and the skin layer. It may be dartos fascia, tunica vaginalis, and others. The key step is using fibrin sealants as a protective covering layer. Patients and methods Between December 2014 and December 2016, we enrolled 32 male patients into our study at Menoufia University Hospital. The patients will be divided into two groups. The first group included about 18 patients where fibrin glue was applied after construction of a neourethra before closure of the skin. The second group consisted of about 14 patients who were treated by a construction of a neourethra but without the use of fibrin glue. Results The results of group I which underwent TIP urethroplasty with fibrin glue showed an 11% incidence of fistulation. Group II which underwent TIP urethroplasty without fibrin glue showed a 43% incidence of fistulation. Conclusion Applying a clot of fibrin glue between the layers of hypospadias repair will decrease the incidence of the complications after the repair. The fibrin glue results are poorer because of the increase in the rate of infection which will be the cause of fistula and wound dehiscence.

Four Cousins with Hypospadias, Is It Familial or Environmental? (Case Report)

Hypospadias is one of the most common birth defects. However, its etiology remains largely unknown. Genetic and also intrauterine environmental factors have a principal role in causing familial hypospadias. Hypospadias repair is done through several techniques, one of which is Snodgrass technique which has many advantages. The 4 cousins underwent repair with no complications during 6 months follow up period. Methods: Urethroplasty using Snodgrass hypospadias repair of 4 cousins with positive parental consanguinity and absent family history of hypospadias. Results: 4 cousins underwent Snodgrass (Tubularized incised plate urethroplasty) with no complications after 6 months follow up. Conclusion: Although there is high heritability of hypospadias that also aggregates within second- and third-degree relatives, environmental factors may play a principal role in causing familial hypospadias. Hypospadias repair has a long learning curve. The continuous auditing should be done to improve the results.

Our Tubularized Incised Plate Urethroplasty Repair Results for Hypospadias Surgery

Our Tubularized Incised Plate Urethroplasty Repair Results for Hypospadias Surgery

Can Grafted Tubularized Incised Plate Urethroplasty be Used to Repair Narrow Urethral Plate Hypospadias? Its Functional Evaluation Using Uroflowmetry.

Aim:Using uroflowmetry, the aim of this study is to determine the functional results of the grafted tubularized incised plate (GTIP) urethroplasty used to repair poor urethral plate hypospadias.Settings and Design:Seventy-one patients (mean age: 5.7 years, follow-up: 1–5.5 years) were selected from those who underwent surgery using the GTIP technique from 2013 to 2015 at our institution.Methods:Patients included were able to void voluntarily and had no fistula. The flow pattern, maximum urinary flow rate (Qmax), voided volume (vv), average flow rate, and voiding time were measured. The results were expressed as percentiles and interpreted according to Siroky nomogram. The Qmax was considered normal if >25th percentile, as equivocally obstructed when in the 5th–25th percentile, and obstructed if <5th percentile.Results:Hypospadias was distal in 45, mid penile in 17 and proximal penile in 9. The uroflow curve was bell-shaped in 24 (30%), interrupted in 9 (14%), slightly flattened in 31 (46%), and a plateau in 7 (10%). Flow rate nomograms revealed that 49 (68%) were above the 25th percentile, 9 (17%) were below the 5th percentile, and 13 (15%) were between these ranges. Eleven patients showed improvement in the flow curve and maximum urinary flow rate (Qmax) in follow-up uroflowmetry.Conclusion:GTIP repair provides satisfactory functional results. A long-term follow-up is needed to confirm these results.

Outcomes of mid-penile hypospadias repair using two different techniques

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

Comparison of dartos flap and dartos flap plus spongioplasty to prevent fistula in tubularized incised plate urethroplasty

Introduction: Hypospadias is one of the most common congenital anomalies and more than 300 operation techniques have been described for primary hypospadias. The complication rate varies with the complexity of the repair and the surgeon’s experience level. To decrease fistula rate, an additional tissue cover after neourethra reconstruction has been described using various tissues. This technique of spongioplasty with dartos flap interposition allows a better quality of the intermediate layer, with the object of preventing fistula. Aims and Objectives: The aim of our study is to evaluate the role of paraurethral spongial tissue plus dartos flap using an additional tissue cover to prevent fistula formation in patients who underwent urethroplasty with the Snodgrass technique. Materials and Methods: It’s a prospective study, performed on 60 patients aged 15 months to 144 months who underwent mid penile and distal hypospadias repair using the Snodgrass technique. The patients were assigned to one of the two groups. In Group I (30 patients), neourethra was covered with dartos flap, and in Group II (30 patients), the neourethra was covered with dartos flap plus spongioplasty. Results: Urethral fistula were encountered in twelve cases (40%) in Group I, and five cases 16.7%) in Group II (p value 0.045). Conclusions: Considering the results of this study, approximation of the corpus spongiosum along with dartos flap as an intermediate layer in urethral coverage as part of Snodgrass technique reduces the rate of fistula formation. This procedure can be applied easily and effectively to prevent the formation of fistula. Journal of Paediatric Surgeons of Bangladesh (2017) Vol. 8 (1): 5-10

Effect Of Intraoperative Cystofix Device on Postoperative Complications In Distal Hypospadias Cases

Objective: To investigate the effect of suprapubic diversion on postoperative complications in distal hypospadias repair performed with tubularized incised plate urethroplasty (TIPU). Materials and Methods: Twenty-three patients with distal hypospadias who were treated with TIPU in Van Training and Research Hospital were evaluated retrospectively. Patients were divided into two groups as follows; Group I consisted only stented patients while Group II was consisted of patients with both anterior urethral stent and suprapubic diversion. Post-operative complications were documented and statistically compared thereafter. Results: Eleven patients who had only urethral stenting constituted Group I, while 12 patients with anterior urethral stent and cystofix were group II. Statistical analysis revealed less early and late post-operative complications in the suprapubic diversion group compared to only stented group. Conclusion: We think that suprapubic diversion in distal hypospadias cases treated with TIPU is a method that can be preferred in terms of less complication rates and more patient comfort than urethral stent alone.

Median raphe deviation, association with hypospadias and clinical significance: A case report and literature review

Here, we present a case of hypospadias and median raphe deviation with literature review. A 4-yearold patient presented with subcoronal hypospadias and treated by using tubularized incised plate urethroplasty technique. Additionally, a longitudinal dorsal dartos flap was harvested and transposed to the ventral side by the buttonhole maneuver. The ventral view of the patient penis showed a 15 degree deviation to the right side of the center.

The experimental study on the tubularized incised plate (tip) urethroplasty in children on the central India

Background: The main objective of the present study is assessment of the tubularized incised plate (TIP) urethroplasty. The present study was done in experimental research design.Methods: We had started Tubularized incised plate urethroplasty as developed by Warren Snodgrass in all boys having coronal sub-coronal, distal, mid, and proximal hypospadias where urethral plate is intact.Results: Out of 37 patients 17 patients developed fistulas at different sites, 10 patients had coronal fistula, 2 distal penile and one mid-shaft fistula. 2 patients who had fistula closure with urethroplasty for distal urethra by TIP developed reopening of fistula. 7 patients had thinning of stream out of which 3 patients developed immediate post-operative. It was managed by meatal dilatation. 4 patients complained thinning of stream after l0 days to one month. All patients were advised meatal dilatation. Stream improved later on in 6 patients. In 7 patients fistulas also closed spontaneously.Conclusions: It is also found and concluded that the total number of the complication rate between primary and re-operative in TIP method is very low; it means TIP method is very useful and effective.

Age-related changes in urinary flow following dorsal inlay graft urethroplasty for hypospadias in early childhood: Potential improvement over 11 years of age

One of the goals of hypospadias repair is to create a neourethra with normal urinary stream and normal growth. Several studies have reported that dorsal inlay graft urethroplasty (DIG) has wide indications for various clinical phenotypes of hypospadias, with good short-term outcomes and few complications. However, there have been no reports that evaluated both short-term and long-term functional outcomes using uroflowmetry in patients with DIG. The aim was to investigate whether uroflowmetry parameters change with time following DIG for hypospadias in early childhood. Uroflowmetry parameters after DIG for hypospadias in childhood were retrospectively evaluated and compared between two defined ages at follow-up: 4-6 years and 11-13 years. Maximum urinary flow (Qmax) under the 25th percentile on the Miskolc nomogram was defined as obstruction. To evaluate the shapes of uroflow quantitatively, the flow index (FI) was used. The FI cut-offs for the flow shapes were defined as tower >1.253, plateaus <0.659; bells were between these two values. Thirty-four patients met the inclusion criteria. The median operative age was 1.8 years (range 1.0-4.9 years). The median follow-up time was 10.3 years (range 7.2-12.3 years). The mean±SD Qmax at the two follow-up times increased with time, from 9.2±3.7 to 18.8±7.8. The mean±SD FI changed from 0.53±0.19 to 0.85±0.31. Both Qmax and the FI were significantly improved (p<0.001, p<0.001, respectively). There were significantly fewer patients with obstruction evaluated by the Miskolc nomogram at 11-13 years of age (n=11, 32.4%) than at 4-6 years (n=31, 91.2%) (p<0.001). Plateau shapes assessed by the FI were seen in 24 (70.6%) patients at 4-6 years and 10 (29.4%) patients at 11-13 years (Table). The number of patients with plateau shapes was significantly decreased (p=0.001). Only one report noted long-term outcomes and spontaneous uroflowmetry resolution after tubularized incised plate urethroplasty. The current report is the first to present the short-term and long-term uroflowmetry outcomes after DIG. In addition, the FI was used for the first time to evaluate uroflowmetry after hypospadias repair. It was found that the uroflowmetry parameters improved spontaneously over 11 years of age following DIG for hypospadias in early childhood. Uroflowmetry parameters improved spontaneously over 11 years of age following DIG for hypospadias in early childhood.

690 - Preputial dartos fascia flap as a secure layer in tubularized incised plate urethroplasty for repair of uncircumcised patients with distal hypospadias

690 - Preputial dartos fascia flap as a secure layer in tubularized incised plate urethroplasty for repair of uncircumcised patients with distal hypospadias

689 - Inlay internal preputial graft urethraoplasty vs tubularized incised plate urethroplasty for primary distal hypospadias

689 - Inlay internal preputial graft urethraoplasty vs tubularized incised plate urethroplasty for primary distal hypospadias

Outcome of standard tabularized incised plate urethroplasty repair using dartos flap and tunica vaginalis flap in of hypospadias cases

Background: Hypospadias, with prevalence of 1 per 300 live births, is a congenital malformation caused by incomplete fusion of urethral folds, in which the meatal orifice opens on the inferior surface of the penis. The commonest complication of hypospadias surgery is fistula formation which requires re-operation. Several techniques of providing vascularised soft tissue cover to neourethra have been described. They include de-epithelized skin, corpus spongiosum, dartos fascia and tunica vaginalis. The purpose of our study was to compare outcomes of standard tubularised incised plate urethroplasty (TIP) repair using dartos flap and TVF in of hypospadias cases.Methods: This study was carried out in the Department of Surgery (Paediatric Surgery Division) of Pt. JNM Medical College and associated Dr. BRAM Hospital, Raipur in patients diagnosed to had distal, mid penile and proximal penile type of hypospadias. The study was carried out during the period from February 2016 to September 2017. Total no of cases studied was 55. All admitted patients for primary Snodgrass repair were randomized into two groups by Simple Random method to avoid selection bias. Group A of 27 patients were prospectively selected for repair using TVF for soft tissue cover. Group B of 28 Patients, comparable in age and type of hypospadias, who underwent TIP repair using dartos flap as soft tissue cover. Descriptive statistics were employed to characterize the data.Results: Patients were from 1 year to 13 years of age at time of surgery for hypospadias. Mean age being 4.69+3.15. There was almost equal number of patients in both groups of flap. Both groups were comparable in terms of age and type of hypospadias. Overall, dartos flap group had significantly higher rate of urethrocutaneous fistula formation than tunica vaginalis flap. In TVF group only one patient (3.7%) developed skin necrosis while in Dartos group 5 patients (17.86%) developed skin necrosis. Both TVF group and Dartos group had one patient with residual torsion.Conclusions: In present study we have noted higher rate of fistula formation and skin necrosis in dartos flap group as compared to tunica vaginalis. Tunica vaginalis flap definitely have an edge over preputial dartos flap and we would recommend its use as waterproofing second layer in hypospadias cases.

A 1-year randomized controlled trial to compare the outcome of primary repair of hypospadias with vascular cover using tunica vaginalis flap with those using preputial dartos fascia.

Background:Tubularized incised plate (TIP) urethroplasty is the most common technique noted to correct hypospadias. However, urethrocutaneous fistula (UCF) is still one of the most common complications of this technique. Several techniques of providing vascularized flaps to the neourethra have been recommended to decrease this complication rate. The aim of the study was to assess the outcome of primary repair of hypospadias using tunica vaginalis (TV) flap with those using preputial dartos (PD) fascia.Patients and Methods:Children diagnosed with hypospadias between the age group of 9 months to 18 years, who fulfilled the criteria were randomly divided into two groups by computerized randomization technique. Initially, TIP urethroplasty was done. Children with PD vascular cover were included in Group A and those with TV vascular cover were included in Group B. All the patients were followed up for a minimum of 6 months after surgery.Results:Two (10%) patients in Group A developed UCF and one (5%) patient developed stricture urethra in the follow-up period. None of the patients developed UCF in the Group B. One (5%) patient had stricture urethra in Group B. Two (10%) patient developed meatal stenosis in Group A. Two (10%) patient in Group B developed meatal stenosis.Conclusions:TV flap could be an alternative to PD flap as a vascular cover of neourethra in patients undergoing primary hypospadias repair by TIP urethroplasty.

Comparative study between tubularized incised plate urethroplasty with and without dorsal inlay graft

Objectives The aim of this study was to compare the results of two single-stage hypospadias repairs, namely, tubularized incised plate (TIP) repair with and without dorsal inlay preputial skin graft urethroplasty as regards meatal stenosis, urethral stricture, and cosmetic outcome. Background The most commonly performed operation to repair distal hypospadias is the TIP repair. The key step is midline incision of the urethral plate, which widens a narrow plate and converts a flat groove into a deep plate groove, ensuring a vertical, slit neomeatus and a normal-caliber neourethra. At times in cases of distal hypospadias, the urethral plate is very narrow and needs to be augmented or substituted for further tubularization. We report our experience with primary single-stage dorsal inlay urethroplasty using inner preputial skin grafts. Patients and methods This study included 30 patients less than 10 years old who presented with primary distal types of hypospadias with narrow urethral plate at the Department of Plastic Surgery, Menoufia University Hospital and were divided into two groups: group A included 14 patients operated by TIP without dorsal inlay graft and group B included 16 patients operated by TIP with dorsal inlay graft. Patients who had undergone circumcision, previous hypospadias repair, or who had a deeply grooved urethral plate were excluded. Results A total of 16 children underwent primary dorsal inlay preputial graft urethroplasty, of whom one (6.2%) child had partial wound dehiscence, two (12.5%) of the children had meatal stenosis, and one (6.2%) of these children developed urethral stricture; 14 children underwent TIP urethroplasty, of whom two (14.3%) children had wound dehiscence, four (28.6%) of the children had meatal stenosis, and four (28.6%) of these children developed urethral stricture. Conclusion Primary dorsal inlay inner preputial graft urethroplasty successfully fulfills all traditional hypospadias repair criteria. It offers a viable, safe, rapid, and easy option in the management of proximal hypospadias with a narrow urethral plate.