Selecting the right method for hypospadias repair to achieve optimal results for the primary situation

Abstract

Background Over the past two decades, Snodgrass tubularized incised plate (TIP) urethroplasty has become one of the dominant surgical techniques with wide applications and excellent cosmetic results. However, TIP has many limitations. We performed a retrospective study at our department and assessed the outcome of the inlay internal preputial graft for extending the applications of TIP.MethodsBetween January 2009 and December 2013, we performed a retrospective study consisting of approximately 508 primary distal and moderate cases. Patients with primary distal hypospadias who had mild or no chordee and good penile development were divided into the following 3 groups based on their procedures: (1) classic TIP hypospadias repair group (n = 198); (2) inlay buccal mucosa graft group (n = 150); and (3) inlay internal preputial graft group (n = 160). The median age was 1.6 years (range 1–4 years). Our data were analyzed statistically by the Chi square test with P < 0.05 indicating significant differences. ResultsThe mean follow-up period was 18 months (range 6‒24 months). In the classic TIP group, the incidence of urinary fistula and meatal stenosis were both 3.0 % (6/198); in the inlay buccal mucosal graft group, the incidence of urinary fistula was 3.3 % (5/150), and the incidence of stenosis was 2.7 % (4/150); and in the inlay internal preputial graft group, the incidence of urinary fistula was 3.1 % (5/160), and the incidence of meatal stenosis was 4.4 % (7/160). The success rates of each group were as follows: the classic TIP group has a success rate of 93.9 % (186/198); the inlay buccal mucosa graft group had a success rate of 94.0 % (141/150); and the inlay internal preputial graft group had a success rate of 92.5 % (148/160). There were no statistically significant differences between the 3 groups with respect to complication rates.ConclusionsAs the inner foreskin Snodgraft does not appear to be worse than the buccal mucosa graft, it is a good method for hypospadias repair, and this method is not inferior to TIP.

A comparative study between Snodgrass and urethral advancement methods in the repair of distal penile Hypospadias

“…Later, TIP has become mainstream internationally as the optimal surgical option. 5 Any technique to repair distal hypospadias should be simple, easy, and could result in satisfactory functional and cosmetic outcomes. Despite continued refinement of numerous repair techniques, there is no satisfactory technique in terms of complications and cosmesis.…”

Are there any benefits of using an inlay graft in the treatment of primary hypospadias in children? A systematic review and metanalysis

“…Of the 1753 patients who underwent a primary hypospadias repair, 1334 (76%) were distal and 419 (24%) were proximal. In the intervention group (DIGU), the type of graft was preputial in 12 studies, only one single arm study reported the use of a lingual graft [7] and one NRS study reported a subgroup with buccal mucosal graft [8].…”

“…A total of 5 NRSs (1 prospective [10] and 4 retrospective studies [8,10e13]) including 908 patients met the inclusion criteria. Two of the studies included distal hypospadias only [10,11], one study included proximal hypospadias [12] only and two included both distal and proximal hypospadias [8,13]. All the NRS studies used preputial grafts with the exception of one study with two intervention groups, one of which included a buccal graft [8].…”

Urethral plate quality assessment and its impact on hypospadias repair outcomes: A systematic review and quality assessment

“…However, a limited number of studies have looked in detail the impact of such variables on the postoperative outcomes [5,6]. Preservation of the UP has been considered the landmark for the majority of techniques for distal hypospadias repairs, especially for the tubularized incised plate (TIP) and Thiersch Duplay's urethroplasty, the most frequently utilized procedures [1,7].…”