Outcome of tubularized incised plate urethroplasty with spongioplasty alone as additional tissue cover: A prospective study

Abstract

Introduction:Additional cover after neourethra formation to decrease the fistula rate, has been described using the dartos, tunica, denuded skin and corpus spongiosum. The use of corpus spongiosum alone to cover the neourethra is infrequent. The objective of this study was to evaluate the efficacy of spongioplasty alone as an intervening layer in the prevention of urethral fistula following tubularized incised plate urethroplasty (TIPU).Materials and Methods:A prospective study was performed including 113 primary hypospadias cases undergoing TIPU with spongioplasty from June 2010 to March 2012. Correction of chordee was carried out by penile degloving alone in 5, mobilization of urethral plate with spongiosum in 22 and combination of both in 45 cases. Intra-operatively, spongiosum was taken to be poorly developed if it was thin and fibrous, moderate if good spongiosal tissue with good vascularization and well-developed if healthy robust spongiosum, which became bulkier than native spongiosum after tubularisation. Spongioplasty was done in a single layer after mobilization of spongiosum, starting just proximal to the native meatus and into the glans distally.Results:The mean age of the patients was 11.53 years. The type of hypospadias was distal, mid and proximal in 81, 12 and 20 cases respectively. Spongiosum was poorly developed in 13, moderate in 53 and well-developed in 47 cases. The mean hospital stay was 8-10 days and follow-up ranged from 6 months to 2 years. Urethral fistula was seen in six patients (11.3%) with moderate spongiosum (distal 1, mid 1 and proximal 4), and three (23.03%) with poorly developed spongiosum (one each in distal, mid and proximal) with an overall 7.96% fistula rate. None of the patients with well-developed spongiosum developed a fistula. Poorer spongiosum correlated with a greater number of complications (P = 0.011). Five out of thirteen cases with poor spongiosum (38.46%) had proximal hypospadias, i.e. more proximal was the hypospadias, poorer was the development of the spongiosum (P = 0.05). Meatal stenosis was seen in two patients (1.76%) with proximal hypospadias, one with moderate and the other with poorly developed spongiosum. More proximal was the hypospadias, greater were the number of complications (P = 0.0019).Conclusion:TIPU with spongioplasty reconstructs a near normal urethra with low complications. Better developed and thicker spongiosum results in lower incidence of fistula and meatal stenosis. More proximal hypospadias is associated with poorer spongiosum. We recommend spongioplasty to be incorporated as an essential step in all patients undergoing tubularized incised-plate repair for hypospadias.

Distal Penil Hypospadias Repair With and Without Dartos Fascia Flap, a Comparative Study.

“…In a recent study by Bhat et al [4], spongioplasty alone has a lower incidence of urethrocutaneous fistula (2.5%) than doing TIP with using Dartos flap (5%).…”

“…Res. 5(10), 1677-1681 1678 hematoma and torque with mobilization of the dorsal Dartos flap its role as an interposing tissue had been questioned [4]. Therefore, the aim of the present study was to evaluate the value of the dartos flap as a second layer for covering neourethra, in preventing urethrocutaneous fistula, infection and meatal stenosis after TIP using spongioplasty.…”

Double breasting spongioplasty in tubularized/tubularized incise plate urethroplasty: A new technique

“…[19] did spongioplasty after mobilization of the spongiosum lateral to medial along with urethral plate and suturing the edges to midline converting the diverting Y spongiosum to I. Bhat et al . [20] have done spongioplasty with the difference from Yerkes et al ., that they did not incise the spongiosum transversely at corona, rather mobilized spongiosum into glans and spongioplasty was done up to distal most part of neourethra which has an added advantage of covering the neourethra with healthy spongiosum to prevent fistula at corona. However, the disadvantages of these techniques are superimposition of suture line of urethroplasty, spongioplasty, and skin closure, and conical shape of neourethra after spongioplasty.…”

Penile degloving and dorsal dartos flap rotation approach for the management of isolated penile torsion

“…Many methods have been described in the literature. Some of the methods dwscribed include penile degloving [6] , dorsal dartos rotation [7] , suturing of pubic periosteum [8] , urethral mobilization [9] and untwisting plication sutures. [10] Slawin and Nagler [11] reported excision of ellipsoid corporal tissue, and plication in the treatment of severe penile torsion.…”