Introduction:Additional cover after neourethra formation to decrease the fistula rate, has been described using the dartos, tunica, denuded skin and corpus spongiosum. The use of corpus spongiosum alone to cover the neourethra is infrequent. The objective of this study was to evaluate the efficacy of spongioplasty alone as an intervening layer in the prevention of urethral fistula following tubularized incised plate urethroplasty (TIPU).Materials and Methods:A prospective study was performed including 113 primary hypospadias cases undergoing TIPU with spongioplasty from June 2010 to March 2012. Correction of chordee was carried out by penile degloving alone in 5, mobilization of urethral plate with spongiosum in 22 and combination of both in 45 cases. Intra-operatively, spongiosum was taken to be poorly developed if it was thin and fibrous, moderate if good spongiosal tissue with good vascularization and well-developed if healthy robust spongiosum, which became bulkier than native spongiosum after tubularisation. Spongioplasty was done in a single layer after mobilization of spongiosum, starting just proximal to the native meatus and into the glans distally.Results:The mean age of the patients was 11.53 years. The type of hypospadias was distal, mid and proximal in 81, 12 and 20 cases respectively. Spongiosum was poorly developed in 13, moderate in 53 and well-developed in 47 cases. The mean hospital stay was 8-10 days and follow-up ranged from 6 months to 2 years. Urethral fistula was seen in six patients (11.3%) with moderate spongiosum (distal 1, mid 1 and proximal 4), and three (23.03%) with poorly developed spongiosum (one each in distal, mid and proximal) with an overall 7.96% fistula rate. None of the patients with well-developed spongiosum developed a fistula. Poorer spongiosum correlated with a greater number of complications (P = 0.011). Five out of thirteen cases with poor spongiosum (38.46%) had proximal hypospadias, i.e. more proximal was the hypospadias, poorer was the development of the spongiosum (P = 0.05). Meatal stenosis was seen in two patients (1.76%) with proximal hypospadias, one with moderate and the other with poorly developed spongiosum. More proximal was the hypospadias, greater were the number of complications (P = 0.0019).Conclusion:TIPU with spongioplasty reconstructs a near normal urethra with low complications. Better developed and thicker spongiosum results in lower incidence of fistula and meatal stenosis. More proximal hypospadias is associated with poorer spongiosum. We recommend spongioplasty to be incorporated as an essential step in all patients undergoing tubularized incised-plate repair for hypospadias.

Introduction:Physicians frequently encounter questions by parents regarding the normal size of a child's penis. We evaluated normal variations of penile dimensions, correlation of penile length with height, weight, and body mass index (BMI) of boys and analyzed the differences in penile dimensions from those reported from other countries.Materials and Methods:A cross-sectional study was conducted at our institution during October 2012-December 2012. A total of 250 subjects (birth to 10 years) were evaluated and divided into 10 groups with 1-year interval taking 25 children in each. Penile dimensions measured twice by a single observer with Vernier calipers included the length of flaccid penis fully stretched and diameters at mid-shaft and corona. Diameters were multiplied by pi (π = 3.14) to calculate circumferences. Mean, standard deviation, and range were calculated. Height, weight, and BMI were noted and statistically correlated with the penile length using the Pearson correlation coefficient. Data were compared with similar studies reported on other populations in the past and individually evaluated with every study using Student's t-test.Results:The mean values for the penile length, mid-shaft circumference, and coronal circumference were 3.34, 3.05, 3.29 cm during infancy, 4.28, 3.86, 4.11 cm during 4-5 years, and 5.25, 4.78, 5.05 cm during 9-10 years, respectively. The penile length increased with advancing age in successive age groups, but it did not have a direct correlation with either height, weight, or BMI. Penile dimensions in North Indian children were found to be statistically smaller in comparison with most studies from other countries.Conclusion:We provide the normal range and variations of penile dimensions in North Indian children.

Objective: The aim of our study was to compare the results of tubularized plate urethroplasty with interposing healthy tissue spongioplasty alone and spongioplasty with dorsal dartos flap to assess the role of dartos flap in prevention of fistulae. Patients and Methods: A retrospective study was performed on 80 patients, aged 4 months to 27 years who underwent hypospadias repair using the Snodgrass technique. The patients were assigned to two groups. In group I (40 patients) the neourethra was covered with spongioplasty only, and in group II (40 patients) the neourethra was covered with spongioplasty plus dartos flap. Integrity of the urethral plate was maintained in all the cases. The ventral curvature & torsion was corrected by penile de-gloving, mobilization of the urethral plate and spongiosum and mobilization of the proximal urethra if needed. The results were analysed in view of complication rates. The average period of hospital stay was 7 days & follow-up varied from 8 months to 28 months with a mean of 14 months. Results: In group I, hypospadias were distal penile in 31 (77.5%), mid-penile in 4 (10%) and proximal/peno-scrotal in 5 (12.5%) patients. In group II, hypospadias were distal penile in 17 (42.5%), mid penile in 9 (22.5%) and proximal/peno-scrotal in 14 (35%) patients. Sixty five percent in group I and 80% in group II had ventral curvature but the difference was not statistically significant. Good functional results were achieved in 97.5% patients in group I and in 95% patients in group II which were statistically similar (p value-0.585). Urethral fistula was encountered in 2.5% in group I & in 2 cases (5%) in group II. Meatal stenosis was noted in 7.5% each in both groups, which responded to urethral dilatation. One patient in group II had complete disruption. There was no statistically significant difference in early and late complications in both groups (p value-0.812). Conclusions: Spongioplasty with healthy spongiosal tissue is strong enough and is effective waterproofing as an * Corresponding author. A. Bhat et al. 42 interposition layer. However, more prospective studies in different hands are needed to omit the step of dorsal dartos interposition.

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The objective of this article is to evaluate the role of different variables affecting the results of tubularised incised plate repair for hypospadias.We prospectively evaluated 125 patients of TIPU repair from April 2009 to October 2011. Study parameters were age, severity of hypospadias, degree of curvature and torsion, size of penis and glans, width of urethral plate, development of spongiosum and complication rate. Patients were classified into five groups by age; Group I-6 months to 2 years, Group II-2 to5 years, Group III-5 to10 years, Group IV-10 to 15 years and Group V-older than 15 years. Results were analyzed with reference to different variables.Age ranged from 6 months to 26 years (mean 8.8 years). Complication rate when comparing group V and youngest patients (groups I & II) was 20% Vs 3.6% (p=0.08), and when comparing older children (G-III and IV) with youngest patients (group I & II) was 15% Vs 3.6% (p=0.135). More severe hypospadias had higher complications (30% in proximal, 5.7% in distal (p = 0.001). The complication rate was 3.6%, 38.8% and 35.7% respectively in cases with mild, moderate and severe curvature (p = 0.001). Complications were higher in patients with poor spongiosum and higher age (p = 0.001) and in patients with narrow urethral plate (p = 0.0001). Follow up period was from about 10 months to 2 years (mean = 20 months).Urethral fistula and stricture were the most commonly reported complications. Important factors in outcome of TIPU repair were the degree of curvature, width of urethral plate development of spongiosum, age of child and severity of hypospadias. The development of urethral plate and spongiosum is directly proportional to the complication rate. Complications increase significantly with the increasing age of the patient.