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Comprehensive analysis of tubularized incised‐plate urethroplasty in primary and re‐operative hypospadias
Author(s) -
ElSherbiny M.T.,
Hafez A.T.,
Dawaba M.S.,
Shorrab A.A.,
Bazeed M.A.
Publication year - 2004
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2004.04781.x
Subject(s) - medicine , meatal stenosis , hypospadias , urethroplasty , surgery , glans , fistula , stenosis , meatus , chordee , urethra , urethral stricture , penis , radiology
OBJECTIVE To retrospectively review our experience of the tubularized incised‐plate (TIP) urethroplasty over the last 4 years. PATIENTS AND METHODS 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. RESULTS 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. CONCLUSION 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.