Assessment of the effect of urethral plate width on outcome of hypospadias repair

Emeka, Chukwubuike Kevin; Obianyo, Nene Elsie; Ekenze, Sebastian O.; Ezomike, Uchechukwu Obiora

doi:10.1016/j.jpurol.2019.09.019

Cited by 17 publications

(16 citation statements)

References 19 publications

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“…Tubularized incised plate (TIP) urethroplasty has become an attractive method worldwide for hypospadias repair since its introduction in 1994 for distal hypospadias and 1998 for mid shaft and proximal hypospadias [1]. Although reports from developed world show excellent outcome of this procedure, the descriptions from many developing countries still show more fistula rates and other complications [2][3][4][5][6]. Moreover, there is still debate about the ultimate outcome of incising a urethral plate and the application of TIP where the urethral plate is narrow.…”

Section: Introductionmentioning

confidence: 99%

Tabularised Incised Plate (TIP) Urethroplasty in Narrow V/S Wide Urethral Plate: A Comparative Study in a Developing Country Perspective

Walid¹,

Minhajuddin²,

Rajib³

et al. 2021

Arch of Pedia Surg

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Introduction: Tubularized incised plate (TIP) urethroplasty is the most commonly performed operation for distal and mid shaft hypospadias. There are controversies in the previous reports regarding the association between urethral plate width and complications in TIP repair. The aim of this study was to compare the impact of urethral plate width in TIP repair on the development of complications in the perspective of a developing country.Methods: It was a prospective comparative study carried out in the department of pediatric surgery, Chittagong Medical College Hospital, Bangladesh from December, 2017 to March, 2019. Patients with distal and midshaft hypospadias were divided into 2 groups: Group A-urethral plate less than 8 mm wide and Group B-urethral plate 8 mm or more wide. Age at surgery, penile characteristics, pre-incision urethral plate width, per-operative factors and development of complications were analyzed. Follow up period ranged from 6 months to 2.5 years.Results: A total of 43 patients (21 in group A, 22 in group B), with a mean age of 6.67 ± 3.38 years underwent TIP repair. Twenty-five (58%) patients had distal penile and 18 (42%) had mid shaft hypospadias. Age correlated with glans size and urethral plate width (P = 0.019 and 0.003, respectively) but there was no significant difference in age between patients with or without development of complications (P = 0.71). Complications developed in 18 (41.87%) patients, 9 in each group. Mean urethral plate width was 7.37 ± 0.84 mm and 7.19 ± 1.17 mm in patients who had successful repair and those developed complications, respectively (P = 0.59). Duration of tourniquet, size of catheter, layers of repair, duration of dressing or catheter were not also associated with UC fistula, the most common complication (P = 0.26, 0.58,0.76, 0.38, and 0.56, respectively). Conclusion:Width of urethral plated was not related to development of complications in TIP repair. Complication rates were high in comparison to other studies and skill development and improvement of other factors are necessary in the developing world to improve outcome.

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Section: Introductionmentioning

confidence: 99%

Tabularised Incised Plate (TIP) Urethroplasty in Narrow V/S Wide Urethral Plate: A Comparative Study in a Developing Country Perspective

Walid¹,

Minhajuddin²,

Rajib³

et al. 2021

Arch of Pedia Surg

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“…Further studies by Sarhan et al, K.E. Chukwubuike et al, and Aboutaleb H confirmed this finding [22, 23]. In a study by Seleim significant connection between urethral plate width and complications was found with a cutoff value of less than 4 mm [24].…”

Section: Discussionmentioning

confidence: 89%

“…This marginal difference wouldn't be practically important from the technical point of view and it is difficult to envision how daily surgical practices would be modified. [22,23]. In a study by Seleim significant connection between urethral plate width and complications was found with a cutoff value of less than 4 mm [24].…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study of Outcomes After Tubularized Incised Plate (TIP) Urethroplasty: a Multivariable Analysis of Prognostic Factors in Children 1-3 Years Old

Roshandel

Rashed

Badr

et al. 2020

Preprint

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Background: Tubularized incised plate (TIP) urethroplasty as the most common hypospadias repair method, aims to achieve normal functioning of the penis along with cosmetic reconstruction. However, there are remaining questions toward anatomical prognostic factors affecting the results of surgery. Lack of age-matched controls or controlling for meatal location, employment of several surgical techniques or multiple surgeons, or age heterogeneity of the study population are the problems affected the results of the current body of literature. Objective: This prospective study aimed to evaluate the preoperative factors to predict future complications associated with hypospadias repair outcomes in males aged between 1-3 years and performed by a single surgeon with employing multivariate analysis. Patients and methods: A prospective cohort of 101 males aging from 1 to 3 years with distal to mid-shaft hypospadias were consecutively selected for TIP repair. The urethral plate dimensions in erect and flaccid states, penile length, glans diameter, and chordee were evaluated individually before reconstruction. After surgery and during follow-up visits, the subsequent transient and persistent complications were recorded. Results: Postoperatively, the acute transient events were observed in 42 cases (41.6%) and the persistent complications in 16 cases (15.8%). The uncomplicated group had a higher percentage of patients with distal meatal location than the complicated group (P=0.01%). Furthermore, fistula formation was notably higher in the group with acute surgical site infection (P<0.001). The analysis also showed the width of the urethral plate to be inversely associated with the development of complications (P=0.03). Conclusion: By performing TIP by a single surgeon on a homogenous study population and eliminating the impact of severe chordee as a potential cofounding variable, this study prospectively found that out of the anatomical specifications, pre- and postoperative factors, the urethral meatus location was the only significant and independent predictor of the development of complications in young children with midshaft to distal hypospadias. Finally based on the inverse association of width with the complications we hypostatized that a combination of urethral width and depth should be considered in the investigation of prognostic factors for hypospadias repair outcomes.

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“…We used 8 mm in the present study because urethral plate width 8mm or greater is essential for creation of adequate neourethra and successful hypospadias repair (16), while, Da Silva et al1 (15) in their study had 41.9% of their patients in the narrow urethral plate group and 58.1% in the wide urethral plate group.…”

Section: Snodgrass In 1994 Reported His Own Technique Of Tubularized mentioning

confidence: 93%

“…Nguyen et al (9) and Aboutaleb et al (6) in their studies also used 8 mm as the dividing line. Urethral plate of more than 8 mm is associated with good cosmetic outcome (16,17) On the assessment of the functional outcome, 20 (83.3 %) patients in group A had good urinary stream while twenty patients 12 (85.7%) in group B had good urinary stream. Statistical analysis showed that there is a statistically signi cant difference between the 2 groups (p value of 0.05).…”

Section: Snodgrass In 1994 Reported His Own Technique Of Tubularized mentioning

confidence: 99%

The effect of pre-incision urethral plate width and glanular width on the outcome of Tubularized Incised Urethral plate repair surgery in distal penile Hypospadias, A prospective study

Elbaky

Taha

Nabeeh

et al. 2020

Preprint

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Objective:To determine the cosmetic and functional outcomes of hypospadias repair in relation to the width of the urethral plate in addition to granular width and configuration.Materials and methodsThe study was a prospective evaluation of patients operated for hypospadias after approval of ethical committee a formal consent were taken from parents. The urethral plate width (UPW) and glans width (GW) of the patients were measured preoperatively using standard calipers. The width of the urethral plate was correlated to the cosmetic outcome (using hypospadias objective penile evaluation [HOPE]) and functional outcome (using the urinary stream) of hypospadias repair.All patients were managed via the same technique using Snodgrass tubularized incised plate repair (TIP). All operations were performed by a single surgeon. All intaoperative data were recorded. All patients were followed up for 1 year. Success was deﬁned as slit shaped meatus at the tip of the glans with no stenosis, ﬁstula or diverticulum.Results:All 38 patients were evaluated at 6 months and 1 year follow up. The mean age at surgery was 4.5 ± 2.1 years. Overall, the mean ± SD of UPW was 10.92 ± 1.24 mm. a 24 patients (61.5 %) (Group A) had a urethral plate width of less than 8 mm while 14 patients (35.9 %) (group B) had a urethral plate width greater or equal to 8 mm. the mean ± SD of GW was 9.52 ± 1.56 mm. Success was documented in 36/38 patients (94.3%).The only complication was Fistula in two patient (6.7 %), glans dehiscensce in three patients (10%). Success rate was not statistically different in correlation of UPW and GW (p=0.5).The only statistically signiﬁcant difference between all patients was a longer operative time in the patients with deficient urethral plate compared to others with adequate urethral plate (p= 0.005). The urinary stream was straight in 32 boys and sprayed in 6. Overall, mean ± SD HOPE score was 39.1 ± 8.83. A significant correlation found between the cosmetic outcome of the two groups and HOPE score (p = 0.06).Conclusions:The pre-incision urethral plate width and glanular width was not correlated with the TIP outcome. A better HOPE score is associated with wide urethral plate.

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Assessment of the effect of urethral plate width on outcome of hypospadias repair

Cited by 17 publications

References 19 publications

Tabularised Incised Plate (TIP) Urethroplasty in Narrow V/S Wide Urethral Plate: A Comparative Study in a Developing Country Perspective

Tabularised Incised Plate (TIP) Urethroplasty in Narrow V/S Wide Urethral Plate: A Comparative Study in a Developing Country Perspective

A Prospective Study of Outcomes After Tubularized Incised Plate (TIP) Urethroplasty: a Multivariable Analysis of Prognostic Factors in Children 1-3 Years Old

The effect of pre-incision urethral plate width and glanular width on the outcome of Tubularized Incised Urethral plate repair surgery in distal penile Hypospadias, A prospective study

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