Tubularized Incised Plate Research Articles

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.

THE EFFECT OF TOPICAL GENTAMYCIN APPLICATION AT THE URETHRAL STENT TO THE URETHRAL STENT’S BACTERIAL COLONY-FORMING-UNIT COUNTS IN HYPOSPADIAS PATIENTS PERFORMED URETHROPLASTY: A PRELIMINARY STUDY

Objective: To determine the effect of topical gentamycin application at the urethral stent to the stent’s colony-forming-unit (CFU) in hypospadias patients. Material &amp; methods: This study is a double blind prospective randomized controlled study, conducted from November 2016 - August 2017 in Urology Department Hasan Sadikin Hospital Bandung. We include patients with distal until penoscrotal hypospadias who underwent urethroplasty for the first time. The subjects were divided into 2 groups: Group A were patients performed urethroplasty with nasogastric tube (NGT) urethral stents only. Group B were patients performed urethroplasty with NGT urethral stents that were coated with topical gentamycin. Both group were operated by a single surgeon using either Tubularized Incised Plate (TIP) or Onlay Preputial Flap technique. Both group used supra pubic urinary diversion. Both group were given the same preoperative and postoperative intravenous antibiotics and given same dressing. At post operative day 7, the stents were removed and swabbed for bacterial culture and resistance test and colony-forming-unit (CFU) counts. Demographic data is described and, among others were analyzed statistically. Other adverse events and complications were also documented. Results: There were 25 hypospadias patients who were performed urethroplasty (12 patients in Group A and 13 patients in Group B). The median age in group A was 7 ± 2.995 (years old) and the mean age in group B was 6 ± 3.178 (years old). In group A, 1 patient (8.3%) were distal shaft type, 1 patient (8.3%) were middle shaft type, 8 patients (66.7%) were penoscrotal type, 1 patient (8.3%) were proximal shaft type, and 1 patient (8.3%) were subcoronal type. In group B, 3 patients (23.1.%) were distal shaft type, 3 patients (23.1%) were middle shaft type, 5 patients (38.5%) were penoscrotal type, and 2 patients (15.7%) were proximal shaft type. In group A, 6 patients (50%) using TIP, 6 patients (50%) using onlay preputial flap. In group B, 5 patients (38.5%) using TIP, 8 patients (61.5%) using onlay preputial flap. In Group A, Staphylococus haemoliticus was the most common bacterial found in urethral stent swabbed culture (50%), followed by Pseudomonas aeroginosa (16.7%), Acinetobacter baumannii (8.3%), Enterococcus faecalis (8.3%), Morganella morgagnii (8.3%) and sterile cultures (8.3%). In Group B, 38.5% were sterile urethral stents culture, followed by Staphylococus haemoliticus (30.8%), Enterobacter cloacae (7.7%), Staphylococus warneri (7.7%), Staphylococus epidermidis (7.7%), and Moraxella catarrhalis (7.7%). The most sensitive antibiotics in both group were Amikacin, Gentamycin, Meropenem, Cotrimoxazole, and Cefepime. In group A, 11 patients (91.7%) had &gt;100.000 CFU counts, and 1 patient (8.3%) with no colony found. In Group B, 2 patients (15.4 %) had &gt;100.000 CFU counts, 6 patients (46.2%) had &lt;100.000 CFU counts, and 5 patient (38.5%) with no colony found. In group A, there were 3 patients (25%) with urethra-cutaneous fistula, 4 patients (33.3%) with hematoma, and 5 patients (38.5%) without any complications. In group B, there were 2 patients (15.4%) with urethra-cutaneous fistula, 3 patients (23.1%) with hematoma and 8 patients (61.5%) without any complication. Using Mann-Whitney U-test, we found a significant difference of CFU counts formation between the two groups (p=0.001). Statistically, the lesser CFU counts found, the lesser complication were developed (p=0.001). Conclusion: Topical gentamycin application at the urethral stents in hypospadias patients performed urethroplasty significantly reduced CFU counts found at the urethral stents and thus reduced the urethra-cutaneous fistula and hematoma formation.

616 Comparative analysis of treatment strategies for distal and middle hypospadias

To investigate the effects of two different surgical methods on the urethral plate-preserving procedures in distal and middle hypospadias. The clinical data of 136 patients with distal and middle hypospadias were collected and retrospectively analyzed. All patients were treated with penile curvature and urethral plate-preserving urethroplasty or glansoplasty simultaneously. Patients aged from 8 months to 32 years, mean age 13.5 years. After 136 patents were performed with treatments of chordee, the external urethral orifice is located between the coronal sulcus and the root of the penis, about 3-8cm away from the glans posterior-anterior position. And then according to the type of urethroplasty, it was divided into two groups. A group: local flap method (including Onlay / Mathieu and other methods) to repair the urethra in 52 cases, B group: TIP (Tubularized incised plate) 84 cases. All patients then performed with glansoplasty, the new external urethral orifice were retrieved to the penis glans anteroposterior.

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.

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.

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.

Management of hypospadias in Saudi Arabia: A national survey.

Introduction:Hypospadias is one of the most common congenital anomalies of the penis. Different methods of hypospadias management are described in the literature. We try in this study to evaluate the national trends and to compare them with international practices.Materials and Methods:A multiple choice survey was distributed among a sample of national practitioners using a weblink between September and December 2017. It included questions about participants demographics, number of cases operated on per year, perioperative care and preferences, long-term follow-up, and complications. Data were analyzed and compared with international practices.Results:Results of 47 practitioners were evaluated and analyzed in this study. The majority of the participants were pediatric urologists (48.9%) and from the central province (44.7%). Most of the participants prefer to operate on patients between the ages of 1 and 2 years (48.9%) and operate at ≥20 cases per year (76.6%). Tubularized incised plate (TIP) is the preferred technique for distal penile hypospadias repair whereas staged repair is preferred for proximal cases. All participants use a form of a second layer and a stent for their repairs. The majority reported an overall complication rate of ≤10% for distal penile hypospadias (76.1%) and >10% for proximal penile cases (59.6%).Conclusion:This study helped us identify national trends in hypospadias management, which were comparable to the international trends. TIP repair is the preferred technique for distal penile hypospadias repair whereas staged repair is preferred for more complex proximal variants. Although data in this study come from reports of personal experience, it can serve as a backbone for the future prospective studies on this topic.

Efficacy of tubularized-incised plate urethroplasty in the management of adult hypospadias.

GIRIS ve AMAC: Biz bu calismada hipospadiasi olan eriskin hastalarda Tubularized-incised plate urethroplasty onariminin etkinligini ve yapilabilirligini degerlendirmeyi amacladik. YONTEM ve GERECLER: Mart 2013 ve Subat 2016 tarihleri arasinda primer hipospadias tanisi ile tubularized-incised plate urethroplasty onarimi yapilan 12 eriskin hasta calismaya dâhil edildi. Ortalama hasta yasi, eksternal mea yerlesimi, penil egrilik varligi ile ortalama operasyon suresi, cerrahi komplikasyonlar, uretral kateter cikarilma zamani ve hastanede kalis sureleri geriye donuk olarak analiz edildi. Hastalarin tamamina ameliyat sonrasi 6. ayda uroflowmetri yapildi. Cerrahi basari penis ucunda stenotik olmayan yeni uretranin varligi ve uroflowmetride azami idrar akisinin >20 mL/sn olmasi olarak belirlendi. BULGULAR: Ortalama hasta yasi 22.1 yil idi. Ortalama operasyon suresi, hastanede kalis suresi ve uretral katater cikarilma zamani sirasiyla 105 dakika, 3 ve 8,16 gun olarak belirlendi. 2 hastada hafif penis egriligi izlendi. Erken donemde her hangi bir komplikasyon izlenmedi. Ortalama 19 aylik takip doneminde bir hastada uretrokutanoz fistul gelisti. Cerrahi basari %91,6 olarak belirlendi. Ameliyat sonrasi yapilan uroflowmetride fistul gelisen hasta disindaki butun hastalarda azami idrar akis hizi >20 mL/sn idi. TARTISMA ve SONUC: Hipospadiasi olan eriskin hastalarda tubularized-incised plate urethroplasty onarimi, kabul edilebilir kozmetik ve fonksiyonel sonuclar ile etkin ve uygulanabilir bir yontemdir. Turkce Kisa Baslik: Eriskin hipospadiasta TIPU onarimi.

Comparison of interrupted- and continuous-suture urethroplasty in tubularised incised-plate hypospadias repair: A prospective study

ObjectiveTo compare the effect of interrupted- and continuous-suture urethroplasty on complication rates in Snodgrass tubularised incised-plate (TIP) hypospadias repair. Patients and methodsThis was a prospective randomised study comprising 100 boys (age range 1–5 years) with primary subcoronal, distal- and mid-penile hypospadias who underwent repair from October 2010 to March 2015 in a tertiary care hospital. Boys with glanular, recurrent, and proximal hypospadias were excluded from the study. The boys were prospectively randomised into two groups: Group A, comprised 50 boys who underwent interrupted subcuticular suture Snodgrass TIP urethroplasty; and Group B, comprised 50 boys who underwent continuous subcuticular suture Snodgrass TIP urethroplasty. Outcomes were assessed in terms of complication rates and aesthetic appearance during follow-up. ResultsThere was no significant difference in the occurrence of complications between the groups. There were 21 complications, with 10 occurring in Group A and 11 in Group-B. Urethrocutaneous fistula was the most common complication in both groups (six in Group A and seven in Group B), the fistulae were <2 mm in nine patients and 3–5 mm in the remaining four. Partial glans dehiscence occurred in one patient in each group. One patient from each group also had superficial wound infection, meatal stenosis and urethral stricture respectively, all of which were managed conservatively. The resultant urinary stream was single and good in all patients of both groups. ConclusionsThe type of suture technique had no significant effect on complication rates after Snodgrass hypospadias repair and thus the choice of technique depends on surgeon preference.

Modified tubularized incised plate urethroplasty reduces the risk of fistula and meatal stenosis for proximal hypospadias: a report of 63 cases.

To report the feasibility of modified tubularized incised plate (TIP) urethroplasty technique for proximal hypospadias in 63 cases. From January 2004 to March 2010, 63 patients underwent one-stage TIP urethroplasty (modified Snodgrass technique repair) using 2-3 of three covering layers (corpus spongiosum, dartos, and tunica vaginalis). The primary meatus was proximal penile, penoscrotal, scrotal, and perineal in 38, 13, 10, and 2 patients, respectively. All patients had chordee that was corrected with dorsal plication. Glanuloplasty was performed in all cases. Complications and cosmetic results were documented after 6-72months of follow-up. A total of 63 boys with proximal hypospadias underwent Snodgrass hypospadias repair at a mean age of 8.5months (range 6-54). Mean operative time was 210±35min. Patients were followed up with 6-month intervals for up to 6years postoperatively. After 6years of follow-up, nine urethrocutaneous fistulae, four bleeding, four meatal stenoses, and one urethral stricture were reported. Cosmetic result was satisfactory according to parent's opinion and another surgeon. No residual chordee was observed in any cases (without artificial correction). In conclusion, this preliminary report can be estimated as an alternative technique with acceptable complication and cosmetic results for proximal hypospadias correction.

The role of preoperative intra muscular testosterone in improving functional and cosmetic outcomes following hypospadias repair: A prospective randomized study

There are very few well-designed studies on the role of preoperative testosterone in hypospadias repair. The aims of the current study are to ascertain the efficacy of intramuscular testosterone in increasing the glans width, reducing the complications and improving the functional and cosmetic outcomes. Between January 2013 and December 2016, a total of 200 patients with distal hypospadias were recruited to this prospective randomized study. Only patients with distal hypospadias eligible for a tubularized incised plate (TIP) repair were included. Group 1 did not receive any intervention, and group 2 received three doses of intramuscular testosterone enanthate 2mg/kg at the age of 9, 10, and 11 months. Glans width was measured in millimeters in all patients using calipers at the time of recruitment and at the time of surgery. Within group 2, those who failed to have more than a 2mm increase in size were considered non-responders (group 2a), and the remaining were taken to be responders (group 2b). TIP repair was performed by the same surgeon, and patients were followed up, looking for urethrocutaneous fistula, glans dehiscence, meatal stenosis, etc. Cosmetic evaluation was performed using the Parental Penile Perception Score (PPPS). A total of eight patients dropped out in group 1 (n=92), while six dropped out in group 2 (n=94). In group 2, 17% patients did not respond to testosterone (group 2a; n=16), whereas 83% showed significant increase in glans width (group 2b; n=78). The table compares the functional and cosmetic outcomes between groups. Total complications were significantly less in group 2b (17.9%) than in group 2a (50%). The reoperation rate was significantly less in group 2b (11.5%) than in group 1 (23.1%). A significantly higher number of parents (p=0.03) were satisfied with cosmesis of the glans/meatus in group 2b (71/78; 91%) compared with group 2a (11/16; 69%) or group 1 (72/92; 78%). The overall PPPS was significantly higher (p=0.003) in group 2b (8.88±2.20) than in group 1 (8.03±1.55). Two systematic reviews on the role of preoperative testosterone failed to reach any conclusion. One described a glans width <14mm as a risk factor for urethral complications after hypospadias repair but another did not support this. Our findings reveal that preoperative testosterone significantly increases the glans width thereby reducing the complications and requirement for reoperation. It also improves the cosmetic outcomes and parental satisfaction.

Outcome of Snodgrass urethroplasty by modifying tubularization and dartos layer in Erbil

Background and objective: Snodgrass first described the tubularized, incised plate (TIP) urethroplasty for distal hypospadias repair in 1994. This study aimed to find out whether there is any difference in the fistula rate with single versus double layer tubularization, and the use of ventral versus dorsal dartos layer. Methods: Between May 2009 and July 2014, tubularized incised plate urethroplasty was performed for correction of hypospadias in Erbil for 112 patients with age ranging from 1-32 years. Five patients were excluded from the study because of lack of adequate follow up. Data were analyzed using the statistical package for the social sciences. Results: Urethral fistula occurred in seven cases (6.5%).The use of an additional reinforcing second layer for the tubularization had a significant effect on decreasing the fistula formation (P = 0.05). The fistula rate was slightly lower with dorsal dartos flap (5.4%) than ventral dartos flap (7.8%). Conclusion: The urethral plate, when dissected, should be thick enough to allow for tubularizationin two layers. Both dorsal and ventral dartos flaps are effective in preventing urethral fistula.

TUBULARIZED INCISED PLATE URETHROPLASTY FOR ONE-STAGE HYPOSPADIA REPAIR IN CHILDREN AT HASAN SADIKIN HOSPITAL BANDUNG

Objective: To determine the outcome of tubularized incised-plate (TIP) urethroplasty for one stage hypospadia repair in children. Material &amp; methods: A 7-year retrospective experience at Hasan General Sadikin Hospital Bandung on the outcome of tubularized incised plate for one-stage hypospadias repair in children during 2009-2015. Results: A total of 102 children was undergone one stage hypospadias repair with TIP urethroplasty. The mean age was 6.97 years old. As much as 65 (63.72%) children had distal, and 37 (36.28%) children had proximal hypospadia. The mean length of surgery was 112.56 minutes. Post operative complications was rarely found, consisting of 5 (6.32%) children had urethrocutaneus fistula formation and 11 (13.9%) children had haematoma. 4 (10.81%) children with proximal hypospdia and 1 (1.53%) children with distal hypospadia had urethrocutaneus fistula formation. 4 (6.15%) children with distal hypospadia and 7 (18.91%) children with proximal hypospadia had haematoma. Conclusion: Tubularized incised-plate (TIP) urethroplasty for one stage hypospadia repair in children was highly effective with rare complications comparable with recently published study.

Comparative study between classic Snodgrass (TIP) and glans approximation for repair of hypospadias

Background:Hypospadias is one of the commonest congenital anomalies of the male genital system, affecting approximately 1 of every 300 , In addition to the abnormal position of the urethral meatus on the ventral penile surface, it may also be associated with ventral curvature of the penis (chordae) , There are many techniques which have been used to extend the urinary channel to the correct location. Today the most common operation, known as the tabularized incised plate or “TIP”. This procedure can be used for all distal hypospadias repairs , Modified glanuloplasty is a modified technique for glanuloplasty in cases repaired with TIP. Aim of the work:To report the outcomes in a large series using a tubularized incised plate (TIP) urethroplasty (Snodgrass) and compare them with those using glans approximation ( wingless glanuloplasty ) . Methods:The study was conducted on (60) patients with penile hypospadias with different degree (coronal & DPH & MPH) ,Our comparative study contained two groups and two techniques for repair Group [A] : 30 patients were repaired with (TIP) Group [B] : 30 patients were repaired with (GAP) A detailed history and a careful general examinationwas carried out for all patients. Local examination was done to define the following items ;Shape of the glans penis ,Presence of the prepuce (circumcised or not) , Presence of chordae and/or rotation ,Caliber and direction of urinary stream , Position and size of the meatus , Associated anomalies, Routine laboratory investigations will be done for all cases. Results:From march 2013 to march 2014 (60) children's were included in this study With age ranging from 8 m to 12 years With mean age 5.5 ±.9 years for (A) With mean age 5.3±.8 years for (B) , As regard types of hypospadias About 18 children's (30%) were presented with coronal hypospadias and 28 children's (46.7%) were presented with DPH and about 14 children's ( 23.3%) were presented with MPH,Blood loss was higher in group (a) than group ( b) which was statistically significant,As regard operative time comparison between group (A) and group (B) we found that the mean operative time for group (A) was 79±5 Min , And the mean operative time for group (B) was 65±5 Min which was statistically significant .Successful cosmetic and functional results were reported in 26 (86.7%) patients for group (A) but were reported in 27 patients ( 90% ) for group (B) . Failure rate was reported in 4 (13.3 %%) patients for group (A) in form of glandular dehiscence in two patients (6.6%) that repaired after 3 months with the same technique without recurrence and sub coronal fistula reported in another 2 patients (6.6%) that repaired using multilayer closure after 3 months , Failure rate was reported in 3 ( 20 %) patients for group (A) in form of glandular dehiscence in one patient (1.3%) that repaired after 3 months with the same technique without recurrence and sub coronal fistula reported in another 2 patients (6.6%) that repaired using multilayer closure after 3 months . The success rate and failure rate data between group (A) group (B) was statistically insignificant . Conclusion:Approximated glanuloplasty has many advantages, lower operative time, lower blood loss, no need for tourniquet and is a technically easy, reliable, for the repair of a very select group of patients with hypospadias

Pre-incision urethral plate width does not impact short-term Tubularized Incised Plate urethroplasty outcomes

Two reports have found that urethral plate (UP) widths <8mm before tubularized incised plate (TIP) incision increased urethroplasty complications. The present study measured pre-incision UP width in consecutive boys undergoing TIP to determine if it affected outcomes. The present study followed the method previously used by Holland and Smith, and Sarhan etal. to measure UP width before creating glans wings or performing midline plate incision in consecutive patients with primary hypospadias and ventral curvature <30°, who all underwent TIP repair (Summary Fig.). Glans width at its widest point was also measured. Multiple logistic regression assessed urethroplasty complications (fistula, glans dehiscence, meatal stenosis/urethral stricture, diverticulum) based on pre-incision UP width, glans width, patient age, and meatal location. The UP widths were determined in 224 consecutive primary TIP repairs during 2012-2015: 200 distal, 11 midshaft, and 13 proximal. The UP width was <8mm in 192/224 (86%) patients. Mean pre-incision width was 6.1mm (SD 1.5, range 2-11), without difference in UP widths according to meatal location (P=0.06). Mean post-incision UP width was 12mm (SD 2.2, range 10-16). Mean change in width after incision (delta/original UP width) was 116% (SD 63, range 20-250). There was follow-up in 186 patients for a mean of 6 months. Urethroplasty complications (five fistulas, six glans dehiscence) were diagnosed in 11 (6%): 9/165 distal, 1/9 midshaft, and 1/12 proximal repairs. There was no difference in those <8 vs ≥8mm (11/160 vs 0/26, P=0.17). Similarly, UP width was not different between patients with and without urethroplasty complications. Multiple logistic regression in these 186 patients - including meatal location, UP width, glans width, and age - found only glans width <14mm was associated with increased odds of urethroplasty complications (OR 19.2, 95% CI 3.5-106, AUC=0.799). The data show that pre-incision UP width is not an independent risk factor for urethroplasty complications. However, it is possible that technical factors, such as how deeply the dorsal incision is made or size of the urethral stent, might contribute to this finding by other authors. After watching the TIP repair, Smith stated that the plate incision was deeper than he made. Sarhan etal. reported a mean change of 57% in UP width after incision, whereas the present one was double at 116% (i.e. from 6mm pre-incision to 12mm post incision), and they used an 8-Fr catheter. While they stated that they incised the plate deeply, the lower percentage increase in width suggests that it was not as deep as was recommended. The UP width before incision did not increase urethroplasty complications. Surgeons do not need to measure or categorize the UP to determine suitability for TIP repair, as long as the plate incision is made deeply to the corpora.

A Critical Analysis of Stented and Unstented Tubularized Incised Plate Urethroplasty Through a Prospective Randomized Study and Assessment of Factors Influencing the Functional and Cosmetic Outcomes

To compare, functionally and aesthetically, stented and unstented tubularized incised plate urethroplasty (TIPU). In addition, predictors of repair success were investigated. One hundred ten children with distal hypospadias were included in this study. The length and width of the urethral plate (UP) and transverse glans diameter (TGD) were measured. Patients were randomized into two groups: stented and unstented TIPU. Postoperative assessment of pain was done using Face, Legs, Activity, Cry, Consolability (FLACC) scale, and cosmetic outcome was evaluated using hypospadias objective scoring evaluation. Uroflow was assessed at 6 months in toilet-trained boys. Complications were graded by the Clavien classification system. In 93 cases, Face, Legs, Activity, Cry, Consolability score, hospital stay, and dressing time were in favor of the unstented group, whereas hypospadias objective scoring evaluation score and uroflow parameters were comparable. TGD and UP width varied significantly between successful and failed cases. Cutoff values of 13.5 mm and 8.5 mm for TGD and UP width, respectively, are required for successful outcome. Acute urinary retention was 12.8% after unstented repair. Detrusor spasm was 47.8% after stented and 8.5% after unstented repair. In both groups, urethrocutaneous fistula of 5.4%, glanular dehiscence of 1.1%, and meatal stenosis of 5.4% were found in cases with small TGD and narrow UP. Unstented TIPU evades the associated drawbacks of the stent along with lower postoperative pain, hospital stay, and dressing time. Even without a postoperative stent, the complication rate in infants with distal hypospadias is low, and short-term functional and aesthetic outcomes were not compromised.

Mathieu technique with incision of the urethral plate versus standard tubularised incised-plate urethroplasty in primary repair of distal hypospadias: A prospective randomised study

ObjectiveTo compare outcomes of the Mathieu incised-plate (Mathieu-IP) technique vs the standard tubularised incised-plate (TIP) technique for primary management of distal hypospadias. Patients and methodsBetween April 2012 and August 2015, 66 patients (aged 15–60months) with primary distal hypospadias were randomly allocated to two groups. Group 1 included 34 patients who underwent Mathieu-IP repair and Group 2 included 32 patients managed using the TIP technique for primary management of distal hypospadias. Postoperatively, all patients were examined weekly up to 1month and then at 3 and 6months. Perioperative data, complications and outcomes of both procedures were statistically analysed and compared. ResultsThere were no statistically significant differences in patient demographics between the groups at baseline. There was no statistically significant difference in the mean (SD) operative time between Groups 1 and 2, at 95 (7.6) and 91.2 (8.1) min, respectively. There was no statistically significant difference in the shape of the urine stream at micturition or the neomeatus between the groups postoperatively. The rate of postoperative fistula was significantly higher in Group 2 (TIP) compared to Group 1 (Mathieu-IP), at 18.7% vs 2.9% (P=0.004). There was no postoperative meatal stenosis in Group 1, which did occur in five patients (15.6%) in Group 2 (P=0.002). ConclusionThe Mathieu-IP technique appeared to be better than the standard TIP technique with regard to postoperative fistula formation and meatal stenosis, and with acceptable cosmesis.

THE EFFECT OF PERIOPERATIVE AND PROPHYLACTIC ANTIBIOTICS AGAINST THE INCIDENCE OF UTI AND SURGICAL SITE INFECTIONS AFTER HYPOSPADIAS SURGERY

Objective: The aim of this study is to analyze the effect of perioperative and prophylactic antibiotics against the incidence of urinary tract infections (UTI) and surgical site infections (SSI) after hypospadias surgery (hypospadias repair operation). Materials &amp; Methods: This study is an observational study of explanation with 24 hypospadias patients (2 groups) during the period of October 2015 to February 2016. Samples were divided into two groups, 12 patients received prophylactic antibiotics and 12 patients received perioperative antibiotics (random sampling). Inclusion criteria included patients with glandular hypospadias to proximal penile hypospadias, aged 6 months until 15 years and underwent hypospadias surgery with one surgical technique namely Tubularized Incised Plate (TIP). The examination of urine culture and evaluation of the wounds were performed on day 4, 10, and 20 day after surgery to determine the incidence of urinary tract infections and surgical site infections. Results: There is no significant difference in the incidence of UTI on on day 4, 10 and 20 in perioperative group and prophylaxis group with p=0.282 and p=0.500 at day 4 and 10 (p&gt;0.05). There is no significant difference in the incidence of SSI on day 4, 10 and 20 in the group of perioperative antibiotic and prophylactic antibiotic with p=0.680 and p=0.217 at day 4 and 10 (p&gt;0.05). Conclusion: There is no effect of the prophylactic antibiotic as well as perioperative antibiotic treatment on the incidence of UTI and SSI

Experience with tubularized incised plate urethroplasty in distal and mid penile hypospadias

Background: Whilst hypospadias is a common congenital defect in boys its aetiology largely remains unknown. The objective of this study was to evaluate the results of tubularized incised plate (TIP) urethroplasty in distal and mid-penile hypospadias repair. Patients and Methods: This was a prospective clinical study conducted in the Department of Pediatric Surgery over a period of 42 months (January 2012 to June 2015). All patients with distal and mid shaft hypospadias who underwent TIP urethroplasty in our department were studied. The patients were followed up for a period of 1 year after surgery. Results: Fifty eight patients (N = 58) with hypospadias (29 distal and 29 mid penile) were included in the study. The mean age at presentation was 4.5 years (range 3–7 years). The mean operative time was 70 min (range 55–90 min). The mean duration of postoperative stay was 11 days (range: 10–14 days). Overall 15 patients (25.86%) developed complications. Urethrocutaneous fistula (UCF) developed in 10 (17.24%) patients. Meatal stenosis occurred in six (10.34%) patients. Five patients (8.62%) developed flap necrosis and dehiscence of glans occurred in two patients (3.44%). The difference in complication rate between different types of hypospadias was not statistically significant (P > 0.05). There was no statistically significant difference in cosmetic and functional outcome between two groups operated by TIP urethroplasty. Conclusion: TIP urethroplasty is a simple and effective technique of repair for distal and mid-penile hypospadias in properly selected patients. It offers good functional and cosmetic results.

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

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