Urethral Plate Urethroplasty Research Articles

Comparison between tubularisation of an intact and laterally augmented urethral plate urethroplasty and tubularised incised plate (TIP) urethroplasty for hypospadias repair

Objectives: The aim of this study was to compare the outcome of hypospadias repair by tubularisation of an intact and laterally augmented urethral plate urethroplasty and TIP urethroplasty. Methods: This prospective comparative study was conducted from July 2018 to January 2020 and included 35 patients with primary distal and mid penile hypospadias. All had urethral plate widths of 8–10 mm. Exclusion criteria were mega meatus intact prepuce, previous repair, circumcision, urethral plate of >10 mm or <8 mm in diameter, chordee >30°. In Group A underwent tubularisation of an intact and laterally augmented urethral plate urethroplasty and in Group B underwent tubularised incised-plate (TIP) urethroplasty. The follow up period was 06 months. Results: The success rate without any complication was 88.89% and 76.48% in Group A and B respectively. Meatal stenosis occurred 0% and 11.76% in Group A and B respectively. Wound dehiscence rate was 5.55% and 5.88% in Group A and B respectively. Urethrocutaneous fistula occurred 5.55% and 5.88% in Group A versus Group B. Overall complication occurred 11.11 in Group A and 23.52% in Group B. Conclusion: The outcome of tubularisation of intact and laterally augmented urethral plate urethroplasty was better than TIP urethroplasty. Journal of Paediatric Surgeons of Bangladesh (2019) Vol. 10 (1 & 2): 32-36

Hypospadias with Intact Prepuce: A Spectrum of Anomalies and their Reconstruction.

The aim of the study was to perform a detailed analysis of the clinical characteristics of megameatus with intact prepuce (MIP) and to audit our results of reconstructive surgeries on MIP. Design: Retrospective analysis. Setting: Pediatric surgery department of tertiary level. Subjects, methods: Hospital records and pictures of MIP operated over a 9-year period. Age, size of penis, circumcised or not, shape of glans, external urethral meatus (EUM), urethral plate (UP), chordee, distal urethra, reconstructive surgery, and complications were analyzed. Postoperative result was objectively assessed by Hypospadias Objective Scoring Evaluation (HOSE). Twelve of 254 hypospadias were MIP (incidence = 4.72%). The mean age at operation was 38.25 months (12-87 m). Patients sought circumcision or surgical correction of anomaly. Two patients were precircumcised. MIP was coronal 7, subcoronal 3, and glanular 2. Meatus was wide in 10 and normal in 2. Glans penis was wide in 9 and conical in 3. UP was wide (9), moderately wide (2), or narrow and shallow (1). In two cases of wide deep UP, distal septum was present. Distal urethra was nondilated in all but 1, which had megalourethra. Reconstructive surgery was Tubularized Urethral Plate Urethroplasty (7 cases) or classical Snodgrass (Tubularised incised plate urethroplasty (TIPU), with superimposed vascular dartos flap (5 cases). The megalourethra underwent partial excision and TIPU. Distal UP-septum was incised. Urethral injury (2 cases) and UP injury (1 case) were intraoperative complications. One postoperative complication (ventral glans necrosis) resulted. The mean follow-up period was 4.79 months (1-12 m). In the postoperative follow-up, 11 (92%) had HOSE score 14-16, whereas one had HOSE 13. Some hypospadias cases which have intact prepuce have no megameatus; hence, they cannot be termed MIP. All cases of hypospadias having intact prepuce can be covered by the umbrella term "Hypospadias with Intact Prepuce (HIP);" MIP is a large subgroup under HIP. HIP presents with a spectrum of anomalies of glans, EUM, and UP. Repair by tubularization of UP without or with midline incision gives excellent results.

Application of a free preputial tube graft coupled with urethral plate urethroplasty combined with a Buck's fascia integral covering for the single-stage repair of severe hypospadias.

To assess the outcome of a free preputial tube graft coupled with urethral plate urethroplasty combined with a Buck's fascia integral covering (BFIC) for the single-stage repair of severe hypospadias in children. A retrospective study was performed on 40 children with hypospadias who were treated in our hospital from December 2017 to February 2022. The inclusion criteria were as follows: (1) the patient had proximal hypospadias, or penile curvature over 30° after degloving the penis; and (2) the patient underwent surgery for hypospadias for the first time. A free preputial tube graft coupled with urethral plate urethroplasty combined with a Buck's fascia integral covering was performed, and all patients were followed up for more than 6 months. After degloving the foreskin, the urethral orifice was retracted to the perineum and scrotum in 20 cases, penoscrotal in 8 cases, and penile in 12 cases. Single-stage repair was achieved without complications in 34 (85%) patients. The remaining six patients experienced postoperative complications: urethrocutaneous fistula occurred in five cases and glans dehiscence with urethrocutaneous fistula in one case. No urethral diverticulum occurred in any case. A neomeatus with a vertically oriented slit-like appearance was achieved at the tip of the glans in all cases, with one exception. The single-stage operation with a free preputial tube graft coupled with urethral plate urethroplasty combined with a Buck's fascia integral covering in the treatment of severe hypospadias achieves favorable functional and cosmetic outcomes.

The Use of Preputial Dartos Flap in the Primary Repair of Distal Hypospadias: A Single-centre Experience.

An additional flap during the tubularization of incised urethral plate urethroplasty (TIPU) is believed to minimize the postoperative complications. It is still debatable whether using an additional flap is worth the risk given the hazards associated with doing so. This study aims to re-evaluate the benefits and drawbacks of TIPU with or without a preputial dartos (PD) flap. We assessed the results of patients with distal hypospadias who underwent surgery in our institute over the past 2 years. The urethral plate's width, thickness, and depth, the periurethral tissue's quality, and the width of the glans at the mid-glans level determined whether the neourethra was covered with a PD flap or left uncovered. Data on intra-operative blood loss, operating time, length of hospital stay, postoperative complications, and outcome were analysed. There were 96 patients: 58 received an extra PD flap, whereas the other 38 did not. In the flap group, ventral skin necrosis was a prevalent problem, whereas meatal stenosis predominated in the no-flap group. Both the flap group (25.66%) and the no-flap group (23.86%) experienced comparable postoperative complications (P = 0.503). In comparison to the no-flap group, the flap group showed statistically significant differences (P<0.001) in intra-operative blood loss (22.10 ± 6.96 vs. 10.34 ± 3.02 mL), operating time (96.34 ± 6.661 vs. 71.39 ± 9.76 min), and hospital stay (10.04 ± 0.87 vs. 8.47 ± 1.64 days). The additional PD flap does not always affect the result of TIPU in terms of complications.

Tips and Tricks in the Management of Megameatus Intact Prepuce Variant of Hypospadias: A Review Article

Introduction: Hypospadias is congenital anomalies with various spectrum and variants, presenting with abnormal urethral meatus short of the native tip of the glans. megameatus intact prepuce is a rare variant of glanular hypospadias seen in about 3-6 % of hypospadias cases. The main features of megameatus intact prepuce are large urethral external meatus with deep with deeply grooved glans penis and the preputial skin is usually present and intact with no chordae. Seven named procedures for megameatus intact prepuce were discussed. Methodology: We use the following search engines for out study where we found the following articles and reviews as follows in Scopus search, we found 26 articles, in AJOL we there were 7 articles and in PubMed Central Search we found 32 articles, then in Google scholar the search revealed 388 articles, 45 articles were reviewed and summarised and 7 established procedures were discussed. Results: Seven named established procedures for megameatus intact prepuce variant of hypospadias were summarized and discussed and include Pyramid Procedure, Glanular Approximation Procedure, Tubularised Urethral Plate Urethroplasty, Tubularised Incised Urethral Plate Procedure, Mathieu Technique, Cutaneous advancement procedure and The Inframeatal Vascularised Flap Procedure. DISCUSSION: The Surgical procedures for repair of megameatus intact prepuce is technically challenging not only for the surgeon but the anesthethiogist alike because the patients are paediatric with small organs, therefore appropriate instruments and proper timing of the surgical intervention is paramount. Duckett and Keating et al in their study identified the first challenge is to identify those patients who truly need surgical repair. In a study by Marc Cendron et al they found out that the features identified as important in the decision-making process were (1) meatal opening close to or below the coronal margin; (2) A deep glans cleft; (3) a wide, splayed-out glans; and (4) an abnormal urinary stream if witnessed. in a study by Duckett JW, Keating MA, Hatch DA et at and Austin Hill G, Wacksman J they reported a satisfactory outcome with the various described surgical procedures. Conclusion: The tip and tricks of the surgical procedures of megameatus intact prepuce rare variant of hypospadias is a review article to aimed to improve on the surgical outcome including normal conical appearance of the glans, a urethral meatus of normal caliber, and a single, normal urinary stream with no symptoms and to minimise the complications such as urethrocutenous fistula as extracted from the expert’s vast experience and modifications of the existing techniques, in our study we summarised the experts seven established techniques and the modifications to achieve the desired objectives.

A novel onlay urethroplasty for hypospadias with mild chordee after degloving: modified for complete removal of scar tissue underlying the urethral plate and for long-term outcomes.

Urethral plate (UP)-preserving urethroplasty is simple and has few complications, but it may affect the development of penis in the long term and lead to recurrent chordee. In this study, we used obliquely cut UP to repair hypospadias with mild chordee after degloving (15°-30°) and compared the results with onlay urethroplasty to explore its rationality and feasibility. Between April 2018 and October 2020, 108 hypospadias patients underwent onlay urethroplasty or modified onlay urethroplasty. Clinical data were prospectively collected, and medium-term outcomes were assessed at follow-up. The complications were compared between the two groups. Forty-four patients underwent the modified onlay procedure (Group I), with follow-up time (mean ± standard deviation [s.d.]) of 23.2 ± 4.5 (range: 17-31) months. Sixty-four patients underwent a standard onlay procedure (Group II), with follow-up time (mean ± s.d.) of 39.7 ± 3.9 (range: 32-46) months. There was no difference in age at surgery. The urethral defect length and operative time were longer in Group I. Six cases of fistula and one case each of stricture and diverticulum were reported in Group I. In Group II, 11 cases of fistula and one case each of stricture and diverticulum were reported. The complication rates were 18.2% and 20.3% in Group I and Group II, respectively (P &gt; 0.05). These medium-term follow-up results demonstrate that the modified onlay procedure (oblique cut UP urethroplasty) is a safe and feasible technique for hypospadias with mild chordee after degloving. Compared with standard onlay urethroplasty, this modified procedure is conducive to the complete removal of scar tissue underlying the UP without increasing the risk of surgical complications.

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.

Identification of risk factors associated with numerous reoperations following primary hypospadias repair

Complications remain the top evaluation priority subsequent to hypospadias repair. Complications vary in further management, and usually require one or more reoperations. Patients and/or their parents concern not only with the success rate of reoperation, but also with the risk of numerous reoperations. To identify the risk factors associated with numerous reoperations following primary hypospadias repair. Data were collected retrospectively from patients who underwent reoperations for complications following primary hypospadias repair at a single institution from August 2008 to October 2017. A total of 507 patients required reoperations following 2754 primary hypospadias repairs. Eventually, 486 patients were eligibly included with a median age of 2.2 years. The median follow-up period was 6.5 years. Preserved urethral plate urethroplasty for primary repair (including Snodgrass, Onlay and Mathieu techniques) was performed in 307 (63.2%) patients, Duckett technique was performed in 121 (24.9%) patients, and staged urethroplasty (including staged Duckett, Byars and Bracka techniques) was performed in 58 (11.9%) patients. The complications included 302 fistulas, 108 dehiscence, 50 urethral strictures, 18 meatal stenosis, 38 diverticula, 24 mild recurrent ventral curvature and 23 severe recurrent ventral curvature. A total of 363 (74.7%) patients needed 1 reoperation, 87 (17.9%) needed 2 reoperations, 19 (3.9%) needed 3 reoperations, and 17 (3.5%) needed >3 reoperations. Ordinal logistic regression demonstrated that severe recurrent ventral curvature, urethral stricture, dehiscence and primary staged hypospadias repair increased the risk of numerous reoperations, with odds ratios of 75.991-fold, 36.967-fold, 11.765-fold and 3.074-fold, respectively. In contrast, diverticulum decreased the risk, with an odds ratio of 0.443-fold. Our data demonstrated significant heterogeneity in the risk of numerous reoperations for each complication. Severe recurrent ventral curvature conferred the highest risk of numerous reoperations, followed by urethral stricture, dehiscence. In additional, our data showed an increased risk of numerous reoperations following primary staged repairs. Identification the risk factors confers advantages in the assessment of postoperative outcomes and anticipation of future reoperations. Severe recurrent ventral curvature, urethral stricture, dehiscence and primary staged hypospadias repair were associated with numerous reoperations following primary hypospadias repair.

Catheter-induced urethral injury and tubularized urethral plate urethroplasty in such iatrogenic hypospadias

BackgroundCatheter-induced urethral erosion can involve meatus, glans and any extent of penile shaft. These injuries cause a lot of psychological, social and sexual trauma to the patient. Though the use of condom drainage system can render this spinal cord injury patient effectively dry, but can lead to penile or urethral complications. Many of these patients are kept on indwelling catheter. Long duration catheterization, poor catheter care in such paraplegic patients and other morbid patients may lead to urethral erosions. We conducted a prospective study of catheter-induced urethral injury from July 2014 to February 2016 in our tertiary care centre. The demographics, past history of illness, catheter material, and duration of catheterization, securing of catheter, local examination findings and associated comorbidities were recorded. Factors leading to urethral erosion were evaluated. And patients, who were fit and were willing for surgery, underwent tubularized urethral plate urethroplasty after 4–6-week supra-pubic diversion. The objective of the study was to evaluate factors of urethral erosion, and the results tubularized urethral plate urethroplasty in iatrogenic hypospadias.ResultsWe had twelve patients of catheter associated urethral injury in the study period. Age of the patients varied from 34 to 95 years with a mean of 61.25 years. Duration of catheterization ranged from 6 to 24 months with a mean duration 10.9 months. Catheters used were silicon coated, not secured to abdomen and had comorbid condition of neurological or cardiac origin in all patients. Long duration of catheter, poor quality of catheter and poor catheter care such moribund with poor body resistance patients were the main causative factor for urethral erosion. Urethral injuries varied from erosion of distal 2 cm to entire ventral urethra till penoscrotal junction with or without penile torque. Six of these patients underwent tubularized urethral plate urethroplasty with good cosmetic and functional postoperative outcome.ConclusionPatients of spinal cord injury, patients with comorbid condition like diabetes mellitus and ischaemic heart disease, poor catheter care and long duration catheterization are likely to have severe urethral injury. Extent of injury may vary from meatal erosion to erosion of entire ventral urethra till penoscrotal junction leading to iatrogenic hypospadias. These patients either may be put on clean intermittent catheterization or supra-pubic catheterization. Results of tubularized urethral plate urethroplasty in such iatrogenic hypospadias are very good.

Dorsal vertical island flap urethroplasty in children with hypospadias: a single center’s experience 75 patients

ObjectiveTo assess the results and complications of dorsal vertical island flap (DVIF) urethroplasty.MethodsA total of 175 children were operated on for hypospadias. Out of these, 41 with proximal hypospadias with...

Results of tubularized urethral plate urethroplasty in Megameatus Intact Prepuce.

Objective:The megameatus variant of anterior hypospadias with an intact complete foreskin occurs in approximately 1%–3% of hypospadias. Hence, the objective of the study was to evaluate the results of tubularized urethral plate urethroplasty (TUPU) in megameatus intact prepuce (MIP).Materials and Methods:A retrospective study (June 1996–June 2015) of MIP from our hypospadias registry was conducted. All patients with megameatus, either with an intact prepuce or with one previously removed, were included in the study. Case sheets of clinical records, investigations, clinical photographs, and videos were reviewed. Patients were classified into, glanular, coronal, subcoronal, and distal penile. TUPU were done. Patients were called for follow-up at 1, 3, 6, and 12 months postoperatively, and then yearly for the assessment of the cosmetic appearance and fistula, meatal stenosis, or other complications.Results:Of 1026 patients with hypospadias, we identified 13 cases of megameatus variant of hypospadias; three of the 13 had been circumcized previously. Glanular approximation was done for the one patients of the glanular variant, and another had frenuloplasty. These two patients were excluded from the study. Incision in the inner preputial skin was closed in 10 patients to have an intact prepuce. Follow-up period varied from 6 months to 4 years (median follow-up 2½ years). None of the patients developed complications such as fistula, meatal stenosis, and/or wound dehiscence.Conclusions:Surgical correction of MIP in the era of increased cosmetic awareness is justified. Excellent results are obtained with TUPU and along with spongioplasty and frenuloplasty because of availability of wide urethral plate and well-developed spongiosum in these patients. TUPU should be the preferred procedure in cases of MIP.

Preputial reconstruction in hypospadias repair

In principle, the prepuce can be reconstructed during hypospadias repair, but the procedure has not gained wide acceptance and preputial reconstruction (PR) is surrounded by several controversies. A review is provided of the technique for PR, how PR combines with the other steps of hypospadias repair, the risks of complications related to the urethroplasty and specific to PR, and the results of PR with particular regard to the relevance for the patient and his family. PR can be important for patients requiring hypospadias repair and their parents. It can be performed in almost all patients with distal hypospadias except perhaps those with the most asymmetrical prepuces or severe ventral skin deficiency. PR does not seem to increase urethroplasty complications, but combination of PR with tubularisation of the urethral plate urethroplasty seems to offer the best chance of success. Specific complications occur in around 8% of patients and include partial or complete dehiscence of the prepuce and secondary phimosis. To prevent the latter, the reconstructed prepuce should be easily retractile at the end of surgery. Technical modifications can help to achieve this goal. Cosmetically, reconstructed prepuces are not fully normal, but the abnormality could be less important for a patient and his parents that the complete absence of the prepuce. On the basis of the evidence summarised above, an algorithm for PR in patients with distal hypospadias is proposed. PR can be offered to the vast majority of distal hypospadias patients, although some modification of the technique for hypospadias repair can be required. Retractility of the reconstructed prepuce at the end of surgery seems paramount for final success.

One-stage lingual augmented urethroplasty in repair of distal penile hypospadias

ObjectivesTo evaluate the outcome of augmentation of shallow urethral plate by lingual graft in repair of distal penile hypospadias. Patients and methodsBetween June 2008 and May 2011, the procedure was performed on 23 patients with mean age 2.3 years (range 1–3). All patients had distal penile hypospadias; 11 sub coronal and 12 coronal. The urethral plate was less than 8mm in all patients and 3 of them had history of previous hypospadias surgery. All procedures were carried out under general anesthesia using 4× magnifying loupe. After penile degloving and dorsal incision of the urethral plate, the lingual graft was harvested and sutured to the edges of the incised urethral plate from the hypospadias opening to the tip of the penis. The neourethra was closed and an intervening flap was fixed over the neourethra as a barrier against fistula formation. ResultsSuccess rate was 87% as 20/23 patients were cured without any permanent complication throughout the follow up period. None of patients suffered meatal stenosis or required regular urethral dilatation. Three patients developed urethrocutaneous fistula, of which two closed spontaneously and one required surgical repair 6 months later. Two patients had failed procedures and delayed re-intervention was performed due to complete loss of the graft in one of them and repair disruption following infection in the other. Two patients had post-operative pain in the graft harvesting site which disappeared within days. ConclusionThe one-stage lingual augmented urethral plate urethroplasty offers promising outcomes for repair of distal penile hypospadias with narrow urethral plate.

Regular Dilatation in Tubularized-Incised Urethral Plate Urethroplasty for Prevention of Fistula Formation

Dear Editor, Tubularization of an entirely incised urethral plate is reported to have satisfactory functional and cosmetic results even in proximal hypospadias (1). In this technique, the urethral plate is divided into two epithelial strips that are approximated in the midline ventrally however; the roof and the side-walls are formed by raw surface that will eventually be covered by epithelium of plate regenerating (2). The stenosis of the neomeatus was associated with post-operative fistula (1). In our experience, thirty five patients (mean age 2.5 years, range 2–10 years old), whose hypospadias were corrected using the tubularized-incised urethral plate technique, were followed-up. Ten had coronal, and twenty five had mid shaft hypospadias. The urethral plate was incised in the midline and tubularized over a proper stent. A local anaesthetic gel containing lidocaine hydrochloride was applied and the neourethra gently dilated using a Nelaton catheter of the same size as the intra-operative stent. This manoeuvre prevented adhesions between the raw surfaces of the incised urethral plate. Of total 35 patients, ten patients had a small fistula associated with meatal stenosis. By regular dilatation of the urethra, six fistulae resolved spontaneously and the remaining patients cured surgically. Other complications included hematoma formation in five patients and urinary tract infection in two patients. Jordan and Schlossberg (3) explained the cause of post-operative meatal stenosis as epithelial apposition is prevented by separating both sides of the wound, healing occurs by secondary intention and the epithelium progresses slowly from the edges of the wound to cover the raw surface. The natural tendency of wounds to contract will aid epithelial apposition; limits the size of the area requiring epithelialization and promotes stenosis that make the urethroplasty developed fistula. The most reliable method to counteract the process of urethral wound contraction is long-term and regular dilatation of the urethra (4-6). Neourethral dilatation is easy, relatively painless and can be administered at home by parents for 1–2 weeks. Older children, adolescents and young adults were able to perform daily dilatation themselves with no problems. Regular urethral dilatation is important in preventing adhesions between both sides of the incised plate, which can result in meatal stenosis and fistula.

Preputioplasty associated with urethroplasty for correction of distal hypospadias: A prospective study and proposition of a new objective scoring system for evaluation of esthetic and functional outcome

ObjectiveMost surgical procedures for correction of hypospadias involve the removal of foreskin resulting in a circumcised penis. We report our experience and the medium-term results in the reconstruction of the foreskin during the correction of distal hypospadias. Materials and methodsBetween January 2007 and December 2011, 445 patients aged between 8 and 120 months underwent surgical correction of hypospadias. In 354 out of 445 patients, we performed the reconstruction of the foreskin. Urethroplasty was performed according to either the TIPU (tubularized incised urethral plate urethroplasty; Snodgrass) technique (233/354, 66%) or MAGPI (meatal advancement glanduloplasty incorporated) procedure (121/354, 34%). In 91 out of 445 patients urethroplasty was performed using classic TIPU technique and they were circumcised. The cosmetic and functional results were evaluated using the Hypospadias Objective Penile Evaluation (HOPE) scoring system. ResultsAt a 12 months follow-up, 300 patients (84.7%) had retractable foreskin while 54 patients (15.3%) required postoperative steroid application. We had a total complication rate of 8.7%. As for preputioplasty, 16 patients (4.5%) had partial or total dehiscence of the reconstructed foreskin, one patient was circumcised for persistent phimosis (0.2%). As for urethroplasty complications, we recorded 11 fistulas (3.1%) and three stenosis (0.9%). The complication rate of the control group of circumcised patients was of 3.3% (2 fistulas [2.1%] and 1 stenosis [1.2%]). ConclusionsOur experience shows that foreskin reconstruction can be performed successfully in selected patients with distal hypospadias. However, preputioplasty add an additional 4.7% complication rate. As for the complications of urethroplasty, it seems that preputioplasty does not increase the incidence of complications on the urethra reconstruction. We propose a new objective scoring system (modified HOPE score) for evaluation of esthetic and functional outcome.

Preserved urethral plate urethroplasty for failed hypospadias repair: report of 249 cases

Preserved urethral plate urethroplasty for failed hypospadias repair: report of 249 cases

Long-Term Followup of Visual Internal Urethrotomy for Management of Short (Less Than 1 Cm) Penile Urethral Strictures Following Hypospadias Repair

We reviewed the results of direct vision urethrotomy for short (less than 1 cm) penile urethral strictures following hypospadias surgery. Patients with less than 1 cm anterior penile urethral strictures located proximal to the meatus underwent direct vision urethrotomy. Based on the type of initial urethroplasty patients were randomly divided into treatment with direct vision urethrotomy vs direct vision urethrotomy plus clean intermittent catheterization for 3 months. Success was defined as absent obstructive voiding symptoms and a normal urine flow 2 years following the last patient instrumentation. Of patients with urethral strictures following hypospadias repair 44% (32) had previously undergone tubularized graft urethroplasty and 56% (40) had previously undergone flap urethroplasty, including a tubularized island flap in 18, an onlay flap in 11 and urethral plate urethroplasty in 11. Direct vision urethrotomy alone was performed in 51% of patients (37), and direct vision urethrotomy and clean intermittent catheterization were performed in 49% (35). Success with the 2 methods was similar, that is 24% (9 of 37 patients) vs 22% (8 of 35). Following direct vision urethrotomy all patients with tubularized graft urethroplasty showed failure (0 of 32). Success was noted in 11% of patients (2 of 18) with tubularized island flap urethroplasty compared to 72% (8 of 11) with onlay urethroplasty and 63% (7 of 11) with urethral plate urethroplasty (each p <0.05). The addition of clean intermittent catheterization to direct vision urethrotomy does not improve the likelihood of success. Direct vision urethrotomy for short (less than 1 cm) urethral stricture usually fails following any type of tubularized graft or flap urethroplasty but it had moderate success following onlay flap and urethral plate urethroplasties.

Tubularized-Incised Plate Urethroplasty in Adults

No AccessJournal of UrologyUrological Survey: Trauma, and Genital and Urethral Reconstruction1 Dec 2005Tubularized-Incised Plate Urethroplasty in Adults Allen F. MoreyM.D. Allen F. MoreyAllen F. Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)68979-1AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Tubularized-Incised Plate Urethroplasty in Adults." The Journal of Urology, 174(6), p. 2265 © 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 174Issue 6December 2005Page: 2265 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.MetricsAuthor Information Allen F. Morey More articles by this author Expand All Advertisement PDF DownloadLoading ...

Biochemical analysis of urethral collagen content after tubularized incised plate urethroplasty: an experimental study in rabbits.

The aim of the present study was the biochemical analysis of tissue hydroxyproline levels in incised urethral plates in order to show the total collagen content after the Snodgrass operation in the hypospadiac rabbit model. The study comprised 21 male New Zealand rabbits, (2.2-2.4 kg). The animals were randomly allocated to three groups each containing seven rabbits as follows: group 1, the ventral urethra was completely excised and a model of hypospadias formed. A full-thickness incision was made on the distal dorsal urethra, a feeding tube was placed as an urethral catheter and both urethral wings were sutured ventrally. Group 2, inserting an iris knife into the urethra, the ventral wall was incised mimicking an urethrotome. Group 3 consisted of normal control rabbits to determine the basal tissue hydroxyproline level. A slight increase in the hydroxyproline level was observed in the ventral part of the urethral tissue compared to the dorsal part in both groups 1 and 2; however, these differences were not significant. After the Snodgrass operation in the rabbit model, no significant differences were observed in the hydroxyproline levels of the dorsal and ventral parts of the urethra or between these and of the controls. Further studies are required in order to determine the mechanism underlying urethral healing through normal re-epithelization without excess collagen deposition after incised urethral plate urethroplasty.

Tubularized incised plate urethroplasty for proximal hypospadias.

Numerous surgical procedures have been used to correct distal hypospadias. Among them, the tubularized incised plate urethroplasty (Snodgrass procedure) has become a mainstay for the repair of distal hypospadias. We applied the procedure to proximal hypospadias. Three patients with proximal hypospadias underwent a tubularized incised urethral plate urethroplasty. The location of the meatus was proximal penis in one, penoscrotal margin in one and scrotum in one. A perimeatal incision was made and the two paramedian incisions were extended to the tip of the glans. The skin of the penile shaft was dissected free to the penoscrotal junction and bands of fibrous tissue were excised until the corpus spongiosum proximal to the meatus was completely exposed inside the scrotum. The urethral plate was then incised in its midline from the tip of the glans to the hypospadiac meatus and was tubularized without tension. The neourethra was covered with a pedicle of subcutaneous tissue dissected from the dorsal skin or the scrotal skin to avoid fistula formation. The tubularized incised urethral plate urethroplasty was carried out successfully in one stage on three patients with proximal hypospadias. The Snodgrass procedure is suitable for correcting hypospadias in patients with a healthy urethral plate. It is also suitable in patients with proximal hypospadias.