Histology of the Urethral Plate: Implications for Hypospadias Repair

Snodgrass, Warren; Patterson, Kathleen; Plaire, J. Chadwick; Grady, Richard W.; Mitchell, Michael E.

doi:10.1097/00005392-200009020-00017

Cited by 41 publications

(42 citation statements)

References 6 publications

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“…Interestingly, an intraoperative biopsy of the urethral plate in the boy with subsequent neourethral contracture showed healthy connective tissue histologically indistinguishable from that of other patients who had no complications. There was no evidence of dysplasia or ®brosis of the urethral plate, which supports our previous conclusion that the plate is comprised of wellvascularized tissues [9], and the different appearance after its incision in both cases was thought to result from de®ciency of otherwise unremarkable connective tissue.…”

Section: Discussionsupporting

confidence: 86%

Tubularized incised-plate urethroplasty for proximal hypospadias

Snodgrass¹,

Lorenzo²

2002

BJU Int

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Objective To report the experience of one surgeon using tubularized incised-plate (TIP) urethroplasty to repair proximal hypospadias in a consecutive series of boys. Patients and methods The records of 33 consecutive patients with midshaft to scrotal hypospadias undergoing TIP repair by one surgeon were reviewed. Dorsal plication was used as necessary for penile straightening, to preserve the urethral plate. Standard TIP urethroplasty was undertaken, and the follow-up included the selective use of neourethral calibration and urethroscopy. Results Plication was necessary in 18 (55%) patients.The incised plate had a supple appearance in all but two boys. The mean (range) follow-up was 9 (1±48) months and included calibration in 16 (48%) and urethroscopy in 13 (39%) patients. Complications were noted in 11 (33%) boys, of whom seven (21%) developed small ®stulae. The two patients in whom the incised plate appeared unhealthy had dehiscence of the repair and contracture of the neourethra with recurrent penile curvature, respectively. There was one meatal stenosis and one short neourethral stricture. Conclusions TIP urethroplasty can be used to repair proximal hypospadias in the absence of severe penile curvature, and if the incised urethral plate has a supple appearance. As with distal hypospadias repair, the procedure creates a normal-appearing penis with a slit-like meatus.

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Section: Discussionsupporting

confidence: 86%

Tubularized incised-plate urethroplasty for proximal hypospadias

Snodgrass¹,

Lorenzo²

2002

BJU Int

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“…Epithelialization probably occurs from the edges to the center, forming a 'carpet' of cells on the tunica albuginea that proliferate to form the new epithelium; this is similar to what occurs in the TIP technique, as previously experimentally demonstrated [24][25][26]. It seems that Group 1 behaved like an extended TIP, in that healing was similar, even without the urethral plate underlying tissue, which is rich in blood vessels and connective tissue [28,29].…”

Section: Discussionsupporting

confidence: 57%

Onlay foreskin flap anastomosed directly to the tunica albuginea: A short-term experimental study in rabbits

Bacelar

Rondon

Mattos

et al. 2015

Journal of Pediatric Urology

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“…[12] Historically, pres ervation of the urethral plate was thought to contrib ute to ventral penile curvature that often complicates hypospadias surgery. However, Snodgrass et al, histologically, found the urethral plate to consist of well vascularized connective tissue comprised of healthy appearing, smooth muscle and collagen with out any fibrous scar or dysplastic tissues [13] . Preserva tion of the urethral plate, which is a fixed structure, prevents formation of a baggy urethra and helps in propulsion of the urine without diverticulum forma tion.…”

Section: Discussionmentioning

confidence: 99%

Onlay free preputial graft for mid and distal penile hypospadias

Gangopadhyay

Sharma

Mongha

2005

J Indian Assoc Pediatr Surg

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Onlay free preputial graft for mid and distal penile hypospadias Onlay free preputial graft for mid and distal penile hypospadias Onlay free preputial graft for mid and distal penile hypospadias Onlay free preputial graft for mid and distal penile hypospadias Onlay free preputial graft for mid and distal penile hypospadias ABSTRACT ABSTRACT ABSTRACT ABSTRACT ABSTRACTTubularized free preputial graft for hypospadias repair had been tried in the past and discarded due to high incidence of graft shrinkage causing stricture formation. We have tried to revive the technique using onlay method thus avoiding stricture formation. The technique was used in 33 subjects (Group A) and compared with 33 subjects in control group (Group B) in whom other techniques of urethroplasty were used. The study was a randomized controlled trial. The mean length of the free preputial graft was 22.06 + 4.68 mm (16-35 mm) and breadth was 9.0 + 1.32 mm (7-11 mm). Fistulae developed in 3 patients in group A out of which one healed spontaneously. In group B, 6 patients had fistula formation. Complications developed in 18% cases in group A and 50% cases in group B. There was significant difference between the cosmetic results (p < 0.05) with 58% excellent results in group A and 27% in group B. Free preputial graft onlay urethroplasty has better functional and cosmetic results. KEY WORDS: Hypospadias, Free preputial graft, Onlay urethroplastyHypospadiology is an over expanding field as none of the current methods of urethroplasty have been proved su perior over the others in terms of achieving the goal of excellent functional and cosmetic results. We have de scribed our experience with free inner preputial full thick ness onlay graft urethroplasty in mid and distal penile hypospadias and compared our results with currently used technique.

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Histology of the Urethral Plate: Implications for Hypospadias Repair

Abstract: The urethral plate consists of epithelium overlying connective tissue. We found no histological evidence of fibrous cords historically considered responsible for chordee.

Cited by 41 publications

References 6 publications

Tubularized incised-plate urethroplasty for proximal hypospadias

Tubularized incised-plate urethroplasty for proximal hypospadias

Onlay foreskin flap anastomosed directly to the tunica albuginea: A short-term experimental study in rabbits

Onlay free preputial graft for mid and distal penile hypospadias

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