Further Experience with One-Stage Hypospadias Repair

2002

Objectives To report further experience of hypospadias repair using the tubularized-incised urethral plate (TIP) technique and to evaluate the role of postoperative neourethral dilatation as a method of preventing complications. Patients and methods The study included 64 patients (aged 2±18 years) who underwent TIP repair of hypospadias; 47 required a primary and 17 a secondary repair. After removing the stent they were randomized into two groups; group 1 (38 patients) underwent regular neourethral dilatation for 12 weeks and group 2 (26 patients) did not. Patients were followed for a mean (range) of 28 (6±52) months. Results The functional and cosmetic results were excellent in all patients in group 1, except for slight meatal regression in one patient (3%). In group 2, 17 patients had excellent results; eight (31%) were re-operated upon to correct complications, six developed a ®stula (four of which were associated with meatal stenosis) and two developed a neourethral stricture. Conclusions TIP urethroplasty is a versatile technique that provides an excellent functional and cosmetic outcome. Regular urethral calibration after repair should be considered as an integral part of the technique, to prevent neourethral and/or meatal stenosis with subsequent ®stula formation.

Section: Discussionmentioning

confidence: 99%

Further experience with the tubularized‐incised urethral plate technique for hypospadias repair

2002

“…Surgical techniques for the repair of hypospadias are being developed continuously, implying that no single procedure is considered a panacea for hypospadias. Hypospadias arises by a failure of the urethral fold to fuse, and thus surgical techniques based on tubularization of the urethral plate with no skin grafts have been described [ 1–6]. The innovative technique of the tubularized‐incised urethral plate provides a narrow urethral plate wide enough for easy tubularization and provides a vertically orientated and a cosmetically normal neomeatus [ 7–10].…”

Section: Discussionmentioning

confidence: 99%

“…Sadlowski et al . [ 2] extended tubularization of the urethral plate to the proximal part of the glans. Firlit [ 3] described tubularization of the intact urethral plate up to the tip of the glans, either alone or with a Duplay urethroplasty.…”

Section: Introductionmentioning

confidence: 99%

“…Sadlowski Snodgrass et al [9] reported satisfactory functional and cosmetic results in a large series (148 patients). The et al [2] extended tubularization of the urethral plate to the proximal part of the glans. Firlit [3] described tubu-same authors extended the use of that technique for the repair of midpenile and penoscrotal hypospadias; the larization of the intact urethral plate up to the tip of the glans, either alone or with a Duplay urethroplasty.…”

mentioning

confidence: 99%

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Tubularized‐incised urethral plate urethroplasty: is regular dilatation necessary for success?

1999

Objectives To report the results of the tubularized-incised taneously. Dilatation was instituted in all the remaining patients and no fistula or meatal stenosis occurred. urethral plate repair of hypospadias. Patients and methods Twenty-seven patients (mean ageOther complications included haematoma formation in one patient, urinary tract infection in another and 8 years, range 6-18) had their hypospadias corrected using the tubularized-incised urethral plate technique. frequent bladder spasm in two. Conclusions The tubularized-incised urethral plate Five patients had glanular, 16 had coronal, and two had recurrent hypospadias after a failed Mathieu repair, urethroplasty is a simple and versatile technique that provides an excellent cosmetic appearance of the glans. and four patients required a second-stage repair. The urethral plate was incised in the midline and tubularizedIt can be applied not only for the primary repair of distal hypospadias, but also for re-operation of recurover a suitably sized stent. In patients who required second-stage repair a Thiersch-Duplay neourethra was rent hypospadias. The technique is ideal for constructing a glanular urethra when the Thierschconstructed from the hypospadiac orifice to the corona and the glanular urethra was constructed by tubularizDuplay operation is used to repair posterior hypospadias. Regular urethral dilatation is important in preation of the incised urethral plate. Results The functional and cosmetic results were excelventing adhesions between both sides of the incised plate, which can result in meatal stenosis and fistula. lent. Of the first seven patients, four had a small fistula associated with meatal stenosis. By regular dilatation

“…These omissions make the authors’ conclusions dubious and unreliable. In most cases of hypospadias the urethral plate can be tubularized with no midline incision [8,9]. I concur with other authors [5,6] who report that plate incision does not increase the true width of the final neourethra over that of the tissue already present.…”

mentioning

confidence: 58%

Regular dilatation is unnecessary after tubularized incised–plate hypospadias repair

2002

CorrespondenceOpen vs laparoscopic donor nephrectomy in renal transplantation Sir, We read with interest the recent article on this subject in the European Urology Update Series [1] and agree with the authors that laparoscopy will make kidney donation more attractive, thus increasing the donor pool and reducing organ shortages. The authors do not mention the prospective randomized controlled trial of hand-assisted laparoscopic live donor nephrectomy vs open surgical live donor nephrectomy [2]. This trial reported 47% less analgesic use, a 35% shorter hospital stay, a more rapid return to non-strenuous activity by 33%, a quicker return to work by 23%, and 73% less pain 6 weeks after the hand-assisted than after the open procedure. Compared with 'pure' laparoscopy, hand-assistance seems to have three advantages, i.e. a shorter warm ischaemia time (and thus less delayed graft function), fewer ureteric complications and a shorter operating time. Although the hand-assisted device adds to the total cost, it is a small price to pay for these clinical advantages. The midline incision used for inserting the hand is small (roughly the surgeon's glove size in cm) and less painful than a flank incision. It seems to be the way forward for live-donor nephrectomies, particularly in view of the above randomized trial. The one criticism of the trial [2] was the lack of blinding, as was used in the randomized, single-blind comparison of laparoscopic vs small-incision cholecystectomy, which showed no advantage in the laparoscopic group [3]. To the pedantic surgeon and critic this will continue to be the subject of debate in the future. P. Dasgupta, MSc(Urol), MD, DLS, FRCS(