Histology of the Urethral Plate: Implications for Hypospadias Repair

The comparison of belt-fuqua and “TIPU” techniques in proximal penile hypospadias cases: retrospective analysis of 65 cases

“…However, based on their study of subepithelial biopsies from the urethral plate in 17 hypospadias cases, Snodgrass et al [12] demonstrated that, contrary to well-established belief, this tissue consists of well-vascularized smooth muscle and collagen. No fibrotic bands and dysplastic tissue were observed, thereby refuting the view that urethral plate was the only cause of penil curvature and chordee.…”

Is tubularization of the mobilized urethral plate a better alternative to tubularization of an incised urethral plate for hypospadias repair?

“…This drastic change in the approach has been due to the observations made by a few workers that the urethral plate does not contribute to chordee [1,2]. This observation was supported by the histological evidence that the urethral plate is a well vascularized tissue rather than fibrous tissue as was earlier thought to be [3]. These concepts have revolutionized the increasing utilization of the onlay flaps (while preserving the urethral plate) for the hypospadias repair and in the last decade, tubularization of the incised urethral plate (TIPU) [4].…”

“…6 feeding tube, for a cosmetically pleasing meatus. The mobilization of the urethral plate is very simple once the right plane is reached and its vascularity is maintained from the proximal spongiosal branches of the urethral artery [3]. Suturing the mobilized glanular wings by adjusting sufficient length below the neo-meatus allowed an apparent neomeatal placement at the tip of the glans.…”

Reconstructing forked corpus spongiosum to correct glans droop in distal/midshaft hypospadias repair

“…Using optical microscopy and conventional staining techniques, the researchers performed biopsies of 17 urethral plates of boys with hypospadias, which demonstrated well-vascularized connective tissue composed of smooth muscle and collagen. 16 The researchers found no histological evidence of fibrous cords historically considered responsible for chordee. Consistent with this view, Eron et al 17 stated that extensive blood vessels, glands, and smooth muscle were present under the urethral plate in the hypospadias specimens that they examined.…”