Use of tubularized incised plate urethroplasty for secondary hypospadias repair or repair in circumcised patients

Abstract

Purpose: To retrospectively review our experience of the tubularized incised plate (TIP) urethroplasty in a series of reoperative hypospadias repairs or circumcised children. Materials and Methods: Between September 2001 and September 2007, 17 children (mean 4.6 years, range 7 months to 15 years), were referred for hypospadias re-operation. Some of these patients had previously undergone circumcision and missed hypospadias. In all cases, the TIP urethroplasty was covered with an additional layer of subcutaneous tissue or dartos flap. The original location, associated complications and results were recorded. Results: There were 4 (30.7%), incidences of complications of TIP re-operation, 2 meatal stenosis, one stenosis with small fistula and one dehiscence. Re-operation was necessary in only one patient of our series (7.6%) and the others were cured by dilatation. No complications occurred in the circumcised patents. Conclusion: Using TIP urethroplasty as described by Snodgrass, is a suitable method for treating primary and re-operative cases. It can also be used successfully in patients, who do not have a healthy skin flap and in circumcised patients when there is a lack of foreskin.

Tubularized incised plate urethroplasty for hypospadias reoperation: a review and meta-analysis

“…Pieretti and colleagues (19) reported a high success rate for employing the TIP technique on 48 circumcised patients. This high success rate was reported by other surgeons as well (17,20).…”

“…Snodgrass believed that using the TIP technique had no contraindications in contrast to Nguen et al (6) and Cakan et al (17), who believed that the complications are not related to the previous incision on the urethral plate. In contrast, Eliçevik et al (20) concluded that a 'redo third redo' operation should be avoided due to the increased rate of complications by the TIP's secondary repair.…”

Mathieu repair of distal and midshaft hypospadias: risks and benefits of foreskin reconstruction versus circumcision

“…These problems are common with reoperations, because urethral reconstruction is required in these cases, but only a small amount of penile foreskin is available. 15 Use of vascularized preputial or penile skin is advised for the repair of complicated hypospadias. In the case of insufficient or unavailable genital skin, it may be necessary to choose extragenital tissues, such as buccal, skin, or bladder mucosa, in order for achieving a successful repair.…”

Dartos flap coverage of the neourethra following repair for primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas: it is a safe approach

“…These problems are the main difficulty in re-operations, because in these cases urethral reconstruction is required, but only a small amount of penile foreskin is available. On the other hand, the vasculature of previously operated tissues may be suboptimal, resulting in further complications 5,6 . In this study we report the experience of one surgeon on dartos flap coverage in primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas repair.…”