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

Ratan, Simmi K.; Ratan, John; Rattan, Kamal Nain

doi:10.1007/s00383-008-2312-8

Cited by 8 publications

(5 citation statements)

References 15 publications

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“…Another mechanism by which complications occur after the TIP procedure is the tendency for contraction and shrinkage of the two raw area surfaces after the dorsal midline incision in the process of healing [16][17][18] . As a result, the width of the dorsal incision decreases after complete epithelialization, which is why a narrow urethral plate is associated with urethral stenosis after the TIP procedure [19,20] . Similarly, these kinds of contraction and shrinkage increased the tension on the ventral suture line during primary healing, and postoperative urethral stulas are more likely to occur.…”

Section: Discussionmentioning

confidence: 99%

Widening of narrow urethral plates with lateral skin in TIP hypospadias repair: single center series

Xu,

He,

Wang

et al. 2024

Preprint

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Background To compare the outcomes of hypospadias repair using tubularized incised plate (TIP) urethroplasty and modified TIP with lateral skin to widen the urethral plate (WTIP). Materials and methods Data were obtained from pre-pubertal boys who underwent primary hypospadias repair between May 2018 and July 2023. The cases were divided into two groups; one group underwent TIP with urethral plate ≥ 6 mm width and the other group with urethral plate width < 6 mm underwent WTIP. WTIP urethroplasty was performed by widening incisions on the outer margins of the urethral plate to incorporate penile and glandular skin lateral to the urethral plate to facilitate tubularization. Complication rates and urinary functions were compared. Results A total of 157 patients were enrolled in this study. Eighty-eight cases with narrow urethral plate were subjected to WTIP urethroplasty, and the rest were subjected to TIP urethroplasty. The preoperative glans width in WTIP group was less than that in TIP group (P < 0.001), and 44.3% had midshaft meatus in WTIP group compared to 17.4% in TIP group (P < 0.001). However, the incidences of postoperative complications (17.6% vs. 21.6%, P = 0.550) were not statistically different between the TIP and WTIP groups. In addition, both groups did not differ significantly in postoperative uroflowmetry assessment. Conclusions The described technique helps to create an adequately caliber aesthetic neomeatus and facilitates tubularization, especially in hypospadias with a narrow urethral plate. Our data suggest that augmentation of a narrow urethral plate with WTIP has a similar surgical outcome to that of the TIP procedure in patients with a wide urethral plate.

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Section: Discussionmentioning

confidence: 99%

Widening of narrow urethral plates with lateral skin in TIP hypospadias repair: single center series

Xu,

He,

Wang

et al. 2024

Preprint

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“…On application of stepwise binary logistic regression, Ratan et al . [ 7 ] showed that unfavorable local anatomical factors and urine leakage are strong risk factors for urethrocutaneous fistula. They showed local infection as the moderate risk factor for the development of urethrocutaneous fistula.…”

Section: Discussionmentioning

confidence: 99%

Glans anthropometry for preputial reconstruction in hypospadias

Sharma,

Memon

et al. 2023

J Indian Assoc Pediatr Surg

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Background: Cases of hypospadias present for poor stream or cosmetic appearance. The main aim is to provide a visibly normal phallus. Preputial reconstruction is technical. A properly planned reconstruction based on anthropometry may improve the result. We are presenting our experience of reconstruction based on glans anthropometry. Aim: The aim of the study was to evaluate the importance of glans anthropometry in preputial reconstruction in cases of hypospadias. Materials and Methods: All cases of hypospadias operated between June 2014 and March 2022 were included. Glans width was measured at the base. The marking sutures for preputial reconstruction were taken at distance thrice the glans width at base. Those requiring religious circumcision along with repair, associated significant chordee, catheter came out before 2 weeks, or history of any previous penile surgery were excluded. All the cases were subjected to urethroplasty, meatoplasty, and preputioplasty. The results obtained were analyzed. Results: One hundred and forty-eight out of 159 cases formed the study group. There were 31 glanular, 42 distal penile, 58 mid–penile, and 17 proximal penile hypospadias. Mean glans width at base was 16 mm (range: 11–21 mm). Mean distance of marking suture at prepuce was 38 mm (range: 33–63 mm). Mean follow-up was 12 months (range: 1–36 months). Mean age at presentation was 23 months (range: 14–72 months). Mean operating time was 50 min (range: 45–60 min). Fistula at the base of preputioplasty was seen in four. Dehiscence of preputioplasty was seen in six. Meatal stenosis was seen in three cases. Conclusion: Preputial reconstruction improves the cosmetic appearance of the hypospadiac penis. Reconstruction based on glans anthropometry improves the result and avoids complications.

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“…Moreover, the two raw surfaces of the dorsal midline incision of the urethral plate usually have a natural tendency to contract and shrink – not scar contracture – to re-approximate to each other minimising the raw area needs epithelial creeping and covering [19] , [20] , [21] , [22] . Thus, the width of the dorsal incision of the urethral plate decreases after complete healing, which can result in neourethral and/or meatal stenosis [20] , [23] , [24] . Thus, the healing of the TIP neourethra is unpredictable; it seems that this process may exert tension on the ventral suture line affecting its primary healing ( Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the healing of the TIP neourethra is unpredictable; it seems that this process may exert tension on the ventral suture line affecting its primary healing ( Fig. 3 ) [20] , [21] , [22] , [23] , [24] , [25] .…”

Section: Discussionmentioning

confidence: 99%

Tubularised incised-plate versus tubularisation of an intact and laterally augmented plate for hypospadias repair: A prospective randomised study

Elbakry¹,

Hegazy²,

Matar³

et al. 2016

Arab Journal of Urology

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ObjectivesTo compare the outcome of hypospadias repair using tubularised incised-plate (TIP) urethroplasty and tubularisation of an intact and laterally augmented urethral plate.Patients and methodsThis prospective randomised study included 370 patients with primary distal hypospadias. All had urethral plate widths of 8–10 mm and a glans of ⩾15 mm. Exclusion criteria were previous repair, circumcision, a wide urethral plate of >10 mm or a narrow plate of <8 mm in diameter, a small glans of <15 mm in diameter, chordee of >30°, and hormonal stimulation. Patients were randomised into two groups: Group 1 (185 patients) underwent TIP urethroplasty and Group 2 (185 patients) underwent tubularisation of the intact plate with lateral augmentation of the urethral plate using penile skin. The follow-up period was 12–28 months.ResultsThere were 172 evaluable patients in Group 1 and 177 in Group 2. The urethroplasty was successful in 83.2% and 94.4% in Groups 1 and 2, respectively. Complications occurred in 16.8% in Group 1 and 5.6% in Group 2 (P = 0.001). Meatal stenosis occurred in 7% and 3.4% in Groups 1 and 2, respectively (P = 0.130). There were statistically significant differences in the wound dehiscence, fistula, and re-operation rates of Group 1 versus Group 2, at 6% versus 0%, 9.8% versus 2.8%, and 13.4% versus 5.6%, respectively. The presence of mild chordee did not affect the complication rate (P = 0.242). The mean (SD) operative time was 56.7 (8.9) min in Group 1 and 93.7 (8.3) min in Group 2 (P < 0.001).ConclusionThe outcome of tubularised intact and laterally augmented plate is better than classical TIP urethroplasty of hypospadias. Further trials are mandatory to extend the indications of the technique.

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

Abstract: Though the authors have an initial limited experience with this procedure, the procedure is likely to have a promising future due to its versatility and utilization of the entire urethral tissue.

Cited by 8 publications

References 15 publications

Widening of narrow urethral plates with lateral skin in TIP hypospadias repair: single center series

Widening of narrow urethral plates with lateral skin in TIP hypospadias repair: single center series

Glans anthropometry for preputial reconstruction in hypospadias

Tubularised incised-plate versus tubularisation of an intact and laterally augmented plate for hypospadias repair: A prospective randomised study

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