Double breasting spongioplasty in tubularized/tubularized incise plate urethroplasty: A new technique

Abstract

Introduction:The main disadvantage of currently described techniques of spongioplasty is superimposition of 3 suture lines (neourethra, spongioplasty, and skin closure) which is likely to increase the chances of a fistula. We describe and evaluate the results of a double breasting spongioplasty in urethroplasty.Methods:A prospective study of 60 primary hypospadias was undertaken by double breasting spongioplasty from August 2012 to March 2014. Mobilization of the urethral plate and the spongiosum is done by creating a plane just proximal to the meatus. Double breasting spongioplasty is done after tubularization of urethral plate. First layer of spongiosum is sutured toward lateral side of the neourethra covering the suture line. A second double breasting layer is sutured over the first layer with its suture line toward the opposite side covering the suture line of the first layer; thus avoiding overlapping of suture lines of all the three layers.Results:Age of the patients varied from 10 months to 16 years with a mean and median of 3.73 and 3.50 years, respectively. Hypospadias was distal, mid, and proximal in 38, 10, and 12 cases, respectively. Chordee was noticed in 35 cases and torque in 28 cases. Overall complication rate was 5% and fistula rate was 1.66%.Conclusions:Double breasting spongioplasty avoids superimposition of suture line and adds two layers of spongiosum over neourethra, thus decreases the chances of urethral fistula and gives cylindrical shape to neourethra.

Evaluation of Tubularized Incised Plate Urethroplasty with Spongioplasty–Dartosoraphy Reinforcement in Pediatric Hypospadias: A Randomized Controlled Study

“…Bhat et al, 26 using the double-breasting spongioplasty modification, reported a very low incidence of urethrocutaneous fistula, approximately 1.66%. This rate is significantly lower than what is typically reported in the literature.…”

What's inside

“…Bhat et al . [8] describe another technique where they “double-breast” the spongiosum over the urethral closure plate, avoiding an overlapping suture line. In a prospective study on sixty patients with a mean age of under 4 years, they report a single fistula.…”