Clinical Experience in Hypospadias: Results of Tubularized Incised Plate in 496 Patients

Akbiyik, Fatih; Tiryaki, Tuğrul; Şenel, Emrah; Mambet, Ervin; Livanelioğlu, Ziya; Atayurt, Halil

doi:10.1016/j.urology.2008.06.075

Cited by 32 publications

(20 citation statements)

References 16 publications

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“…Some authors reported 20-30% complications [25]. A lot of efforts were invested in order to reduce the number of complications.…”

Section: Discussionmentioning

confidence: 99%

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Use of BioGlue Surgical Adhesive in Hypospadias Repair

Kocherov¹,

Lev²,

Chertin³

2014

Current Urology

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Purpose: To prospectively evaluate the efficacy of albumin glutaraldehyde tissue adhesive (BioGlue) in the surgical treatment of patients with hypospadias. Materials and Methods: Two groups of 20 patients each who underwent hypospadias repair were included in the study. In the first group we utilized BioGlue as an additional protective layer to the suture line of the neo-urethra, while patients in the second group were operated on utilizing a routine surgical technique. Results: There were no statistical differences between patients from the 2 groups in terms of surgical complications. Urethrocutaneous fistula was revealed in 4 (20%) patients after repair with BioGlue and in 3 (15%) patients from the control group (p = 0.686), suture line breakdown in 4 (20%) and in 1 (5%) patients (p = 0.478), meatal stenosis in 1 (5%) and in 1 (5%) patient (p = 1). Furthermore more patients in the BioGlue group (n = 12, 60%) demonstrated poor cosmetic results compared to the control group where most patients - 19 (95%) had acceptable cosmetic outcomes (p = 0.007). Conclusions: Our data showed no benefits of BioGlue use in hypospadias repair.

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“…Some authors reported 20-30% complications [25]. A lot of efforts were invested in order to reduce the number of complications.…”

Section: Discussionmentioning

confidence: 99%

“…However the complication rate following TIP repair with regards to fistula rate and glans breakdown is still high in some cases [25]. In order to achieve a better sealing effect during formation of the neo-urethra, a number of tissue sealants agents were proposed to facilitate urologic surgery.…”

Section: Discussionmentioning

confidence: 99%

Use of BioGlue Surgical Adhesive in Hypospadias Repair

Kocherov¹,

Lev²,

Chertin³

2014

Current Urology

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“…The technique can be performed for proximal, distal, primary, and secondary hypospadias cases. In the primary cases, a 0%-9% fistula complication rate and 0%-21% meatal stenosis rate have been reported 4 . Parameatal-based flap urethroplasty (the Mathieu procedure) first described by Mathieu 9 is another commonly used standard technique with a complication rate of less than 4% in different series in recent years 10,11 .…”

Section: Discussionmentioning

confidence: 99%

“…The position of the urethral meatus in hypospadias can be glanular, along the penile shaft, scrotal, or perineal 4 . In current practice, hypospadias repairs are performed as outpatient procedures with high success rates 5 .…”

Section: Introductionmentioning

confidence: 99%

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

Öztürk

2010

Acta Cir. Bras.

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Dartos flap coverage of the neourethra following repair for primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas. It is a safe approach 1Emprego de um retalho pediculado do músculo dartos para cobertura da neouretra na cirurgia primária de hipospádias, reoperações de hipospádias e correção de fístulas uretrocutâneas ABSTRACT Purpose: Urethrocutaneous fistula and neourethral dehiscence are frequently seen complications of hypospadias surgery requiring reoperation. In this study we report the experience of one surgeon with dartos flap coverage in primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas repair. Methods: A total of 23 patients underwent hypospadias and urethrocutaneous fistulas repair from January 2006 to May 2009. Fourteen patients were operated on for primary hypospadias repair at our institution and 9 patients were admitted for hypospadias complications such as failed hypospadias repair and urethrocutaneous fistula. In all the patients, the dartos flap was dissected and transposed to cover the neourethra. Operative results were recorded. Results: The primary surgical procedure was a one-stage repair in 61% (n = 14); tubularised incised plate (TIP) urethroplasty in 43% (n = 6) and a Mathieu procedure in 57% (n = 8). Urethrocutaneous fistulas complicating the previous initial hypospadias repair were anterior in 33% (n = 2), middle in 33% (n = 2) and proximal in 33% (n = 2). Repair of the fistula was successful on the first attempt in all patients. The reason for redo surgery in 3 patients was complete dehiscence and the patients had distal shaft hypospadias. Conclusion: Dartos flap coverage of the neourethra seems to be an effective method of reducing the fistulous complication rate following primary and secondary hypospadias repair. Key words: Hypospadias. Fistula. Surgical Flaps. Scrotum. RESUMO Objetivo:Fístulas uretrocutâneas e deiscências são complicações frequentes na cirurgia das hipospádias necessitando reoperações. Este estudo é baseado na experiência pessoal de um cirurgião utilizando um retalho pediculado do músculo dartos para cobertura da neouretra na correção primária de hipospádias, reoperações de hipospádias e correção de fístulas uretrocutâneas. Métodos: Vinte e três pacientes foram operados sendo 14 submetidos a cirurgia primária de hipospádia e 9 a reoperações por insucesso da correção primária ou por fístulas uretrocutâneas. Em todos os pacientes, um retalho pediculado do músculo dartos foi mobilizado e utilizado para recobrir a neouretra. Resultados: Para a cirurgia primária da hipospádia foi utilizada técnica de correção em um só tempo (n=14): uretroplastia tubularizada com incisão da placa (TIP) em 43% (n=6) e técnica de Mathieu em 57% (n=8). As fístulas uretrocutâneas resultantes de correções primárias anteriores eram de localização anterior em 33% (n=2), média em 33% (n=2) e proximal em 33% (n=2). A correção das fístulas uretrocutâneas resultou em sucesso em todos os pacientes. Três pacientes necessitaram de reoperação por deiscência ...

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“…We excluded patients over 14 years old and patients with a follow-up of less than 6 weeks. Based on previous reports, 8,11,12 we selected 4 potential risk factors for complications and included them in our analysis: age, stenting, initial meatal position, and surgeon experience.…”

Section: Methodsmentioning

confidence: 99%

Learning curve for TIP urethroplasty: A single-surgeon experience

Rompré

Nadeau

Moore

et al. 2013

CUAJ

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Cite as: Can Urol Assoc J 2013;7(11-12):e789-94. http://dx.doi.org/10.5489/cuaj.1376 Published online December 5, 2013. AbstractIntroduction: We evaluate the influence of surgeon experience and other clinical factors on the success of primary hypospadias repair, using the tubularized incised plate urethroplasty (TIPU) technique. Methods: We retrospectively reviewed pediatric cases of primary hypospadias repair performed by a single pediatric urologist (soon after his fellowship training) using TIPU between July 2002 and January 2011. The surgical techniques (including the fact that the procedure was an outpatient one) were the same for each patient. The overall complication rate (CR) was analyzed for the following factors: patient age, use of a stent, meatal position, and surgeon experience. All significant covariates on univariate analysis or with a clinical relevance were entered into a multivariable logistic regression model. A non-linear model was created to estimate the change in the CR over the years. Results: Pediatric patients (median age 1.4 years old) presenting with distal (n = 251), midshaft (n = 22) or proximal (n = 30) hypospadias and with a minimum 6-week follow-up (median 13 months) were included. Most patients (87%) had a urethral stent postoperatively (mean duration 9.8 days). In total, 96 patients had 133 complications: 27 meatal stenosis, 25 meatal coronal migrations, 22 urethrocutaneous fistulas and 59 other complications. Of these, 53 patients underwent a second operation. On multivariate analysis, the only factor increasing the CR was a non-distal meatus.The non-linear model demonstrated a significant learning curve with a decreasing CR over the years. The limitations of this study are its retrospective nature and lack of long-term follow-up. Conclusions: When using TIPU, the CR significantly increases as the meatal position gets more proximal; the learning curve stabilizes after about 50 to 75 cases.

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Clinical Experience in Hypospadias: Results of Tubularized Incised Plate in 496 Patients

Cited by 32 publications

References 16 publications

Use of BioGlue Surgical Adhesive in Hypospadias Repair

Use of BioGlue Surgical Adhesive in Hypospadias Repair

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

Learning curve for TIP urethroplasty: A single-surgeon experience

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