Retrospective analysis of the results obtained by using Mathieu and TIP urethroplasty techniques in recurrent hypospadias repairs (original) (raw)
Related papers
Reoperative Hypospadias Repair Based on Urethral Plate Status
UroToday International Journal, 2009
The purpose of the study was to determine the suitable procedure for redo hypospadias repair based on the status of the urethral plate. METHODS: Thirty-five patients with failed hypospadias repair were evaluated regarding the status of the urethral plate, the meatus, residual chordee, and the available surrounding tissues. The mean patient age was 5.8 years (range, 2-12 years). At presentation, 25 patients had the meatus at the distal shaft, 8 at the midshaft, and 2 had complete neourethral stricture. The urethral plate appeared healthy and wide in 30 patients and narrow in 3 patients. All patients had a straight penis with single previous repair. The initial procedure was unknown in 15 patients and was the tubularized incised plate (TIP) procedure in 20 patients. Thirty patients underwent reoperation with TIP procedure, 3 had a Mathieu technique, and 2 had onlay island flap. After repair, cosmetic and functional outcomes were evaluated. RESULTS: Mean follow-up was 23.2 months (range, 12-36 months). Complete wound dehiscence occurred in 3 (8.6%) cases that had the TIP procedure; they are awaiting further repair. No fistulae occurred. Twenty-seven patients had a vertical slit meatus at the tip of the glans and 5 had a rounded meatus. Calibration was satisfactory in all cases using 8-10 Fr plastic catheters. Uroflowmetry was done in 15 (46.9%) patients and found to be within normal limits, with a Q mean of 9.53 mL/s (range, 5-16 mL/s). CONCLUSIONS: Redo TIP urethroplasty is effective and safe when the urethral plate is healthy. When the urethral plate is narrow or the neourethra is stenosed, other alternatives should be considered for repair.
2020
BACKGROUND Hypospadias repair is a challenging type of urogenital reconstructive surgery for which different techniques are currently used. The purpose of this study is to determine the outcomes of distal, mid-shaft and proximal hypospadias repair using two new variations of tubularized incised plate (TIP) urethroplasty (TIP-δ and TIP-ελ) and to compare their complication rates with other already known operative techniques made from the same surgical team. METHODS This study included 269 boys with hypospadias. The preoperative meatal site was distal in 179 patients, mid-shaft in 44 and proximal in 46. The average age at the operation was 17 months. The technique applied in distal hypospadias was Mathieu in 77 patients, Snodgrass in 28 and (TIP)-δ in 74. The technique applied in mid-shaft hypospadias was a tubularized island flap (TIF) in 12 patients, onlay island flap (OIF) in 5 and TIP-ελ in 27. The operative technique for proximal hypospadias was TIF in 15 patients, OIF in 10 and ...
Urethroplasty for failed hypospadias repair: A matched cohort analysis
Journal of Pediatric Urology, 2011
To determine the outcome of urethroplasty for failed hypospadias repair and to compare this with a matched cohort of patients treated with urethroplasty for other reasons. Patients and methods: Between January 2000 and August 2007, 25 patients with a failed hypospadias repair were treated with urethroplasty (A). This cohort of patients was matched with a cohort of 25 patients who underwent urethroplasty for other reasons (B). The patients were matched for stricture location, stricture length, duration of follow up and type of urethroplasty. The outcomes were analysed and compared. A P-value < 0.05 was considered statistically significant. Results: There were no significant differences between the two cohorts in stricture location, stricture length, follow up and previous interventions. Patients in cohort A however were significantly younger. The surgical technique used was exactly the same in A and B. Failure was observed in 7 patients (28%) in A compared to 4 patients (16%) in B (P Z 0.45). Conclusions: Although a higher failure rate was observed after failed hypospadias repair, this is not proof of a worse outcome for urethroplasty after failed hypospadias repair due to the lack of statistical significance.
European Urology, 2003
Objective: We evaluated the potential of tubularised incised plate (TIP) urethroplasty in primary and secondary hypospadias repair focusing on the extended application of this procedure, the utility and handling of the urethral plate and operative results. Methods: In this retrospective study, we analysed the medical records of 228 children with different levels of the hypospadiac meatus who underwent a TIP procedure between February 1997 and December 2002. The children were followed a mean of 42 months. Our medical records provided us with details about the location of the hypospadiac meatus, the width of the urethral plate before and after midline incision, primary versus secondary surgery, complications as well as notes on the extended application of the TIP procedure. Results: The overall postoperative complication rate was 7.8%. The overall fistula rate was 5.7%, with 4.1% in primary distal, 9.6% in primary proximal and 7.5% in secondary repair respectively. We had one case of meatal stenosis (0.4%) and one of urethral stricture (0.4%) and 3 cases of glandular dehiscence (1.3%). Due to the encouraging results, the frequency of TIP procedure in hypospadias surgery increased from 33% in 1997 to 82% in 2002. Conclusion: In our study the TIP procedure has emerged as the first-choice technique in primary hypospadias repair-irrespective of the level of the hypospadiac meatus and the width of the original urethral plate. This procedure has also proved to be favourable for many cases at secondary surgery. #
BJU International, 2004
To retrospectively review our experience of the tubularized incised-plate (TIP) urethroplasty over the last 4 years. From 1998 to December 2001, 133 patients (mean age 7 years, sd 4, range 1-22), had a TIP urethroplasty by one surgeon for primary (103) and re-operative (30) hypospadias; the defects included 106 (79%) distal and mid-shaft, and 27 (21%) posterior shaft. The neourethra was covered by a subcutaneous flap in 66 (50%) patients or by corpus spongiosa (spongioplasty) in 31 (23%), with no cover in the remaining 36 (27%). In the last 20 patients (15%) a modified meatoplasty was used; the site and size of the new meatus was predetermined on the glans around a suitable catheter before any incision. Urethral stents were not used after repair in 39 (29%) patients, and regular meatal dilation was used only in patients with voiding difficulty and obvious tendency to stenosis. The presence of complications requiring re-operation and overall general appearance were recorded. The mean (sd) follow-up was 10 (5) months; there were 24 complications in 20 patients (15%), including a small fistula in 12 (9%), complete disruption of the repair in 4 (3%), meatal stenosis in seven (5%) and neourethral stricture in one (0.8%). Complications were not significantly different between primary and re-operative cases, and unaffected by the use of the stents. On univariate analysis complications were significantly higher with running than interrupted sutures, in repairs in the first 2 years of the study, in patients with posterior hypospadias, and in those with no neourethral coverage. However, the last two factors were the only significant independent risk factors in a multivariate analysis. Regular urethral dilatation was indicated in 43 patients (32%). Modified meatoplasty was associated with a significantly lower requirement for regular dilatation (P < 0.05) and no meatal stenosis. In the 113 complication-free patients the operation gave an excellent cosmetic appearance with a vertical slit meatus on the tip of conical glans in 110 (97%); there was slight meatal retraction in the remaining three patients. The TIP repair is a reliable method for treating both distal and proximal penile shaft hypospadias, is suitable for both primary and re-operative cases, and is more versatile than other repairs. Covering the neourethra with a flap or spongioplasty significantly improves the results. Regular urethral dilatation is required in a third of patients but modified meatoplasty obviates the need for regular dilatation and eliminates the risk of meatal stenosis.
Which type of urethroplasty in failed hypospadias repair? An 8-year follow up
Journal of Pediatric Urology, 2013
To report our 8-year follow up for redo hypospadias repair. Methods: A total of 56 patients with previous failed hypospadias repair were included in our study. Patients' data were analyzed regarding age, number of previous repairs, meatal location, procedure performed, operative time and complications. Patients were followed up for 3 to 102 (mean 52) months. Results: Patient age ranged from 15 to 204 (mean 90.7) months. Forty-two patients had a single previous hypospadias repair, eleven had two previous repairs and three had four previous repairs. Of the 56 patients, 16 underwent oral mucosal graft urethroplasty, 15 onlay island flap, 14 parameatal flap, 10 tubularized incised plate urethroplasty, and 1 tubularized preputial flap. Complications were encountered in 16 (28.5%) patients in the form of graft contracture in 3, meatal stenosis in 2, urethral stricture in 2 including the patient with tubularized flap, urethra-cutaneous fistula in 7, bleeding in 1 and skin disruption in 1. The final complication rate was 25%. Conclusions: Decision making in redo hypospadias surgery depends mainly on local tissue availability and the degree of tissue scarring. The characteristics of oral mucosal graft make it suitable for urethroplasty in the absence of local donor tissues. A long-term follow up for redo hypospadias repair is required to assess the late neourethral stricture and residual penile curvature.
African Journal of Urology
Abstract Objective Most studies published in the literature report on the results of tubularized incised plate urethroplasty (TIPU) for hypospadias repair in children. Hence, the objective of this study was to evaluate the results of TIPU repair in adults. Patients and methods The records of 60 adult patients with primary hypospadias treated with TIPU between April 2009 and May 2012 were reviewed. All the procedures were done by the same surgeon under similar conditions and using the same kind of instruments and suture material. On clinical examination, the meatal location, as well as the presence/absence of chordee and penile torsion was assessed. The quality of the spongiosum and the width of the urethral plate were evaluated intraoperatively. The postoperative complications and results were recorded and the data were analyzed. Results The patients’ age ranged from 16 to 27 years with a mean of 21 years. Out of the 60 cases, 43 (72%) had distal penile, 7 (11%) mid-penile and 10 (17%) proximal hypospadias. Penile torsion was present in 10 (17%) cases with 80% having a torsion ≤45° and 20% having a torsion of 45–90°. Ventral chordee ranging from 30° to 90° was present in 14 (23%) cases. Chordee correction was possible by penile de-gloving in 4 (29%) patients (2 with distal and 2 with mid-penile hypospadias), by further mobilization of the urethral plate with the corpus spongiosum in 3 (21%) and by proximal urethral mobilization in another 6 (42%) patients with proximal hypospadias. One (7%) patient also required tunica albuginea plication. The urethral plate was wide in 22 (37%), average in 26 (43%) and narrow in 12 (20%) patients. Fifty percent of the patients with a narrow urethral plate developed complications, compared to 15% of the patients whose urethral plate had an average width and none of the patients with a wide urethral plate. The spongiosum was well developed in 38 (63%) patients, while in 11 (18%) patients each the spongiosum was moderately and poorly developed. The complication rates were significantly higher (55%) in patients with a poorly developed spongiosum as compared to those with a well-developed spongiosum. The overall complication rate was 17% including fistula in 10% of the patients (2 patients with mid-penile and 4 patients with proximal hypospadias). Meatal stenosis was found in 4 patients with distal hypospadias (7%) who responded well to meatal dilatation. The fistula cases required surgical repair with a success rate of 100%. Mean hospitalization and follow-up were 9 days and 6–24 (median 37) months, respectively. Conclusions Complications encountered in the present study were urethral fistula and meatal stenosis with a higher incidence in patients with proximal hypospadias than reported in the literature. The important factors for the outcome of TIPU were the severity of hypospadias, the degree of curvature and the development of the spongiosum and urethral plate. Proximal hypospadias with a poor urethral plate and severe curvature in adults is not suitable for TIPU. In such cases, single-stage flap urethroplasty or two-stage buccal mucosal urethroplasty should be considered instead.
2020
Background: Hypospadias is a common congenital anomaly, affecting approximately 1 of 300 live male births making hypospadias the second most common birth defect in boys after cryptorchidism. there are more than 100 techniques for urethral reconstruction among these techniques the tubularized incised urethral plate (TIP) which was proposed by Snodgrass in 1994 has been the most popular technique for the repair of primary hypospadias. Objective: To study the difference between tubularized incised urethral plate and tubularized incised plate with preputial graft in hypospadias repair. Patient and methods: This prospective randomized study included sixty patients suffering from hypospadias who was admitted to the urology department of Menoufia and Kafr El-Sheikh University Hospitals from December 2018 to June 2020 which were randomized into two groups; group I underwent the classic TIP repair and group II underwent TIP repair with inlay preputial graft. Operative details, postoperative ...
Objective: Tubularized incised-plate urethroplasty (TIPU) is one of the techniques to repair distal hypospadias. We investigated the effect of the experience of the surgeon on overall success in terms of cosmetic and functional outcomes in TIPU.Materials and methods: Records of 123 patients were retrospectively evaluated. Each session was performed based on surgeon status related with experience on TIPU by two surgeons. Surgeons was divided into three groups: chief (C.G.) with specific experience in hypospadias surgery (1); urologist with at least five years experience performing TIPU (2); and urology residents with at least three years experience as first surgeon or first assistant (3). Eight groups were created according to the operation team, in which the first number the first surgeon (FS) and the second number the first assistant surgeon (FAS); group I: 1-3, group II: 1-2, group III: 3-2, group IV: 3-1, group V: 2-2, group VI: 2-1, group VII: 3-3, and group VIII: 2-3. Results: ...
Arab journal of urology, 2017
To compare the effect of interrupted- and continuous-suture urethroplasty on complication rates in Snodgrass tubularised incised-plate (TIP) hypospadias repair. This 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. There 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...