Tubularized, incised plate urethroplasty in hypospadias repair: experience at Queen Sirikit National Institute of Child Health.

ABSTRACT

BACKGROUND: Hypospadias is the most common penile anomaly. Many techniques have evolved during the past 150 years to address chordee and construct a neourethra. The current concept of understanding of chordee and emphasis upon preserving the urethral plate have brought hypospadias surgery over the last decade near its ultimate goal of a reconstructed penis that is functional and cosmetically normal. Warren T Snodgrass primarily reported successful urethral plate preservation urethroplasty in 1994. The urethral plate can be primarily tubularized without an additional skin flap after a dorsal midline relaxing incision is made known as tubularized incised plate urethroplasty. It is currently used worldwide by pediatric urologists due to its advantages. The authors also performed this technique and initial experience at Queen Sirikit National Institute of Child Health, Bangkok, Thailand is reported. MATERIAL AND METHOD: 88 of 180 hypospadias boys were treated with tubularized incised plate urethroplasty for primary repair of hypospadias over a 24 month period. All had moderate to severe chordee. Urethral plate preservation is the principle concept of this technique and the entire length of the urethral plate was incised along the midline and the neourethra was tubulized over a 6 or 8 Fr. catheter. The chordee usually disappeared after the penis was degloved. Dorsal plication was performed in mild residual chordee. A subdartos flap was created to cover the neourethra and pressure dressing applied with bactracin gauze for 7 days. The urethral stent was removed on the 7th post-operative day. RESULTS: The tubularized, incised plate urethroplasty was performed in 88 boys, age range from 6 months to 12 years. The operative time was 60 to 100 minutes. Follow-up was up to 18 months. There were 13 distal penile, 60 midshaft and 15 penoscrotal types. All penes had excellent cosmetic appearance, even in complicated cases. The pinhole and large fistulas were noticed in 10 and 3 penes respectively (14%). All fistulas were repaired successfully at a later date. Twenty cases had a mild degree of meatal stenosis of which 18 had good response to self meatal dilatation by their parents and 2 underwent a meatotomy procedure. No urethral diverticulum or stricture was noticed during follow-up. CONCLUSION: Even though high percentages of fistula complications were noticed in the authors' experience, they seemed to be acceptable and easy to correct. This technique seems to be suitable for both distal and proximal hypospadias. The advantages of this technique include its simplicity, low complication rate, very good appearance of the glans penis and normal meatus in most boys. Tubularized incised plate urethroplasty is now the procedure of choice for distal and proximal hypospadias repair.