Tubularized incised-plate urethroplasty for secondary hypospadias repair

Reoperation for failed hypospadias has been considered to be seriously bothersome because abundant penile skin does not tend to remain for urethroplasty or for penile shaft skin coverage. In this study we evaluated the results of tubularized incised plate [TIP] urethroplasty [Snodgrass technique] in a series of secondary hypospadias repair in children. From March 2003 to September 2004, a total of 28 patients with hypospadias in whom repair had failed, underwent a re-operative TIP urethroplasty. The patients age ranged from 2 to 14 years. The number of prior repairs ranged from one to five repairs. Before this treatment the meatus was at the distal shaft in 16 cases, mid shaft in 9 and proximal shaft in 3. Preoperatively, the associated complications were fistulas in 7 patients and residual chordee in 4. In 5 cases the fistulas were incorporated into the hypospadiac openings and treated as a longer defect. The urethral plates were subjectively, surgically altered or unaltered in 8 and 20 respectively. In 17 patients [group A] the previous repair[s] did not involve dissection of the urethral plate [unaltered] nor was there a fistula. The remaining 11 patients were classified as group B. The neourethra was then reconstructed as the Snodgrass technique. The mean follow up period was 10 months. There were 11 complications in 7 patients [25%], including a small fistula in 4 [14%] and meatal stenosis in 7 [25%]. All complications occurred in group B except for 2 cases of meatal stenosis which occurred in group A and treated with simple dilatation. We conclude that TIP urethroplasty is a viable option for the treatment of previously failed hypospadias repair. It was highly effective in patients with a surgically unaltered urethral plate