Failed hypospadias in paediatric patients

Cimador, Marcello; Vallasciani, Santiago; Manzoni, Gianantonio; Rigamonti, Waifro; Grazia, Enrico De; Castagnetti, Marco

doi:10.1038/nrurol.2013.164

Cited by 70 publications

(76 citation statements)

References 109 publications

(125 reference statements)

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“…8,10 Our revision rates are in keeping with published reviews, even with our exclusion of meatal and glanular lesions. Unfortunately, we were not able to demonstrate a decrease in the need for further surgery, but still feel that our modification has several benefits.…”

Section: Discussionsupporting

confidence: 79%

A modification of the TIP procedure for distal hypospadias: The burrowing technique

Wishart

Metcalfe

2014

CUAJ

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Introduction: The tubularized incised plate urethroplasty (TIP) hypospadias repair is a commonly performed procedure for hypospadias. Multiple series document excellent cosmetic outcome in conjunction with low complication rates. We describe a modification that we have named the "burrowing technique." We believe that this technique facilitates dissection of the glans, which improves mobility, decreases tension with closure, and potentially improves outcomes. Methods: A retrospective review was performed of 193 coronal or mid-shaft hypospadias repairs by a single surgeon. The first 98 were performed using the TIP procedure, then the burrowing technique was developed and a subsequent 95 were analyzed for outcomes using this modification. Urethral plate characteristics and glandular size did not influence the choice of surgical technique. Cases were selected to allow for a "learning curve," and were consecutively accrued. None of the boys had undergone prior hypospadias surgery. Proximal 2 stage repairs and distal (glanular) repairs were excluded. Results: A total of 193 boys underwent repair, 98 with the traditional TIP procedure and 95 using the burrowing modification. In total, 37 (19.2%) patients required re-operation for either fistulas or dehiscence; 23 (23.5%) in the non-burrowing group and 14 (14.7%) in the burrowing group, odds ratio 0.54 (p = 0.10). Conclusions:The TIP procedure has revolutionized the management of distal hypospadias. The burrowing modification increases glandular mobility simplifying the procedure and demonstrates a non-statistically significant trend in reducing reoperation rates.

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Section: Discussionsupporting

confidence: 79%

A modification of the TIP procedure for distal hypospadias: The burrowing technique

Wishart

Metcalfe

2014

CUAJ

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“…We then successively replaced this method with the Tubularized Incised Plate (TIP) repair [2][3][4], which has become the most used technique worldwide. The reason for the change was the high complication rates in our series [5,6] as well as in others reported in the literature [7].…”

Section: Introduction Backgroundsupporting

confidence: 45%

Tubularized Incised Plate (TIP) Repair Improves Outcome of Hypospadias Repair

Winberg

Anderberg

Arnbjörnsson

2016

J Surg

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. There were no changes in the suture material used. The operative interventions were performed by two pediatric surgeons with 24 and 11 years' experience in hypospadias surgery respectively. All complications were handled by the same team of surgeons.The main outcome measure was any complication calling for a reoperation: a fistula, rupture and/or stricture, during the period from the operative intervention until August 2016, the endpoint of the study. The Methods of Operation Mathieu repairDuring a Mathieu procedure [1] a skin flap based towards the meatus [8] is turned 180 degrees and sutured into incision on both sides of the glanular groove and along the tip. Curvature is corrected when present. The prepuce is then partially divided and mobilized to create an outer layer. Tubularized Incised Plate repair (TIP)When a TIP repair [2] is performed a U-shaped skin incision is made along the edges of the urethral plate and the penis is degloved. The urethral plate is widened by a midline incision along its length and then tubularized over a stent. A pedicle of subcutaneous tissue is dissected from the ventral or dorsal penile skin and used to cover the neourethra. Finally, the glanular wings, mucosal collar and ventral penile skin are closed in the midline. Statistical considerationsA clinical significant relevance was set at a decrease in the complication rate with 20% units. The intention was to study independent cases and controls with 1 control(s) per case. Prior data indicate that the probability of exposure among controls is 0.3. If the true probability of exposure among cases is 0.1, we will need to study 72 case patients and 72 control patients to be able to reject the null hypothesis that the exposure rates for case and controls are equal with probability (power) 0.8. The Type I error probability associated with this test of this null hypothesis is 0.05. We will use a continuitycorrected chi-squared statistic or Fisher's exact test to evaluate this null hypothesis. Methods: Over a period of six years, the Mathieu procedure was replaced by the Tubularized Incised Plate (TIP) repair as the most favored method of grade 1-2 hypospadias repair at our clinic. All operated boys were prospectively registered during those years. Two three-year-periods were outlined with equal number of patients: 2010-2012 and 2013-2015, but with the preferred method of repair reversed. The end point was any complication calling for a reoperation. Hans Winberg*, Magnus Anderberg and Einar Arnbjörnsson Main results:In the first period 69 boys were operated whereof 50 Mathieu and 19 TIP. 35 (51%) boys required a reoperation. In the second period 73 boys were operated whereof 19 Mathieu and 54 TIP. 15 (21%) required a reoperation, P < 0.01. Research limitations:The study is prospective but the technique preferred was the choice of the surgeon. Follow up will be continued due to acknowledged accumulation of complications over time. Conclusion:Method seems to matter. Advantage TIP. We are not aware of any other prospective study follo...

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“…Both postoperative oedema and poor wound healing may contribute to the array of complications after hypospadias repair. Also, it should be noted that the pathophysiologies of urethral stricture, urethrocutaneous fistula, and diverticulum are all thought to be closely associated with urethral obstruction [7]. Therefore, we hypothesised that the caudal block could be associated with any type of complication, and a composite outcome was used as the primary endpoint.…”

Section: B Haydarmentioning

confidence: 99%

Caudal anaesthesia safety for hypospadias repair

Haydar

2016

Anaesthesia

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Failed hypospadias in paediatric patients

Cited by 70 publications

References 109 publications

A modification of the TIP procedure for distal hypospadias: The burrowing technique

A modification of the TIP procedure for distal hypospadias: The burrowing technique

Tubularized Incised Plate (TIP) Repair Improves Outcome of Hypospadias Repair

Caudal anaesthesia safety for hypospadias repair

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