Double dartos flap layer in tubularized incised plate urethroplasty to prevent urethrocutaneous fistula in uncircumcised patients with distal hypospadias / 亚洲男科学杂志(英文版)

Urethrocutaneous fistula may complicate hypospadias repair. We noticed that double-layered preputial dartos flaps added to tubularized incised plate urethroplasty can reduce the risk of urethrocutaneous fistula. The aim of this study was to compare the outcomes of tubularized incised plate urethroplasty with double-layered preputial dartos flaps to with single-layered local fascial flaps in preventing urethrocutaneous fistula. A retrospective cohort study was conducted between January 2017 and December 2020 at Jordan University Hospital (Amman, Jordan). Boys who were aged between 6 months and 5 years, diagnosed with distal hypospadias, and not circumcised were included. The primary outcome was the occurrence of urethrocutaneous fistula in patients who underwent tubularized incised plate urethroplasty with a double-layered fascial flap. The results showed a total of 163 boys with distal hypospadias; among them, 116 patients underwent tubularized incised plate urethroplasty with a single-layered fascial flap, and 47 underwent tubularized incised plate urethroplasty with a double-layered fascial flap. The development of urethrocutaneous fistula was higher in the group receiving tubularized incised plate urethroplasty with a single-layered fascial flap than in the group receiving tubularized incised plate urethroplasty with a double-layered fascial flap after 1 month, 6 months, and 12 months (6.9% vs 0, 10.3% vs 0, and 5.2% vs 0, respectively), and the difference after 6 months was statistically significant (P = 0.02).

Complications Of Hypospadias Surgery Experience In A Tertiary Hospital

Background:To review the types of operations done for hypospadias to analyze the results and complications of different operations.Material And Methods:Patient case file and operation theater records of 40 pediatric patients from august 2020-July2021 used to obtain the required data.The age at surgery, types of hypospadias at presentation, types of operations done, complications, and results of surgeries were analyzed over a 1-year period. Result:This study in the pediatric age group showed the most common type of hypospadias being distal penile (45%) for which most common surgery being performed is Snodgrass (TIPU) (69%) with no acute (80%) and chronic complication (75%) at time of discharge. Complications rate highest when used for distal hypospadias(3-33 %). Commonest complication noted in literature is urethro-cutaneous fistula (29%). Also fistula rate is higher when TIPU is used for posterior hypospadias. Conclusion:Despite most challenging surgery in hypospadias, one may achieve desirable results by selecting appropriate surgical approaches in these patients. Careful selection of patients and attention to detailed technical factors may help reduce the complication rate. TIPU remains good option for most patients with anterior hypospadias.

Replacing a smaller-size catheter after tubularized incised plate urethroplasty may decrease postoperative urethral complications / 中华泌尿外科杂志

Objective To investigate the effect of replacing a smaller-size catheter after tubularized incised plate (TIP) urethroplasty on postoperative urethral complications.Methods The data of 116 hypospadias patients underwent TIP urethroplasty performed by the same urologist in our hospital from January 2014 to December 2017 were retrospectively analyzed.The age of patients ranged from 0.5-15.4 years,with the median age of 1.5 years.Meatal location was distal in 47 (39.5％),midshaft in 62 (52.1％) and proximal in 10(8.4％) patients.Unhealthy urethral plate occurred in 49 (42.2％) patients.F8 catheter was used for urethroplasty in 92 (79.3 ％) patients,F10 in 17 (14.7％),and F12 in 7 (6.0％).According to the pattern of urinary diversion,patients were divided into two groups.Conventional catheter group in 56 patients (group A):the catheter was chosen in as large size as possible for urethroplasty without tension.Replace a smaller-size catheter group in 60 patients (group B):replace a smaller-size catheter after urethroplasty on the basis of group A.There were no statistically significant differences in age,meatal location and catheter size between the two groups (P ＞ 0.05).Results The mean follow up was 23 months (range 6-66 months).There were 73(62.9％) cases of orifice overflow during indwelling catheterization.There were 5 (4.3％) patients needed further reoperation result from postoperative urethral complications,including 4 cases of fistula and 1 case of meatal stenosis.The process of replacing a smaller-size catheter after urethroplasty in group B was simple and without adverse reactions.There were 15 (26.8％) cases of orifice overflow in group A and 58 (96.7％) in group B.There were statistically significant differences in orifice overflow between the two groups (P ＜ 0.05).There were 5 (8.9％) cases of postoperative urethral complications in group A and 0 case in group B.There were statistically significant differences in postoperative urethral complications (P ＜ 0.05).Conclusions The process of replacing a smaller-size catheter after TIP urethroplasty in was simple and subsequently contributed to less postoperative urethral complications.The results of replacing a smaller-size catheter after TIP urethroplasty were superior to that of no replacing conventionally.

Tubularized Incised-plate Urethroplasty: Expanded Use in Primary and Repeat Surgery for Hypospadias / 대한비뇨기과학회지

PURPOSE: Tubularized incised-plate (TIP) urethroplasty has recently been successfully applied to all varieties of hypospadias, and also employed for those with no abundant local skin flap following failure of a hypospadias repair. We evaluated the impact of TIP urethroplasty on primary and repeat hypospadias repairs. MATERIALS AND METHODS: Between January 2000 and December 2002, 17 primary and 6 repeat hypospadias repairs were performed by a one surgeon using TIP procedures. We retrospectively analyzed age at surgery, surgical outcomes and complications following correction of a hypospadias. RESULTS: Of the 17 primary hypospadias repairs, the mean patient age and follow-up period were 10, ranging from 0.8 to 34 years, and 13.8, ranging from 2 to 33 months, respectively. The average urethral plate width was increased after a midline incision from 6.8mm to 14.3mm in length. Early complications developed in 7 patients (41.2%), including 4 fistulas, 2 meatal stenoses and 1 wound infection, while there were 3 cases of complications that had to be corrected (17.6%), including 1 meatal stenosis and 2 fistulas. Of the 6 repeat hypospadias repairs, the mean patient age and follow-up period were 10.7 years ranging from 2 to 21 years, respectively and 12.5, ranging from 2 to 33 months, respectively. Two fistulas (33.3% complication rate) developed following the repeat TIP repairs. CONCLUSIONS: TIP urethroplasty is a versatile operation, which can give excellent functional and cosmetic results in patients requiring primary or revisional hypospadias surgery. However, the TIP procedure should not be indicated in repeat hypospadias surgery if the urethral plate has been resected, or is obviously scarred.