Hinging the Urethral Plate in Hypospadias Meatoplasty

Rich, Mark A.; Keating, Michael A.; Snyder, Howard M.; Duckett, John W.

doi:10.1016/s0022-5347(17)39161-9

Cited by 124 publications

(58 citation statements)

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“…Tubularization of the urethral plate for distal hypospadias was popularized by several authors after its first description by Thiersch in 1869 [1,12,13]. In 1989, Rich et al [14] first described an incision in the glanular urethral plate to obtain a cosmetically acceptable vertical slit meatus for Mathieu repair, and this was subsequently adopted for the entire length of the urethral plate as a complement to the Thiersch-Duplay urethroplasty for distal hypospadias, by Snodgrass in 1994 [6]. The urethral plate is a well-vascularized tissue with a rich nerve supply, and an extensive muscular and connective tissue backing [15].…”

Section: Discussionmentioning

confidence: 99%

“…Although the Mathieu repair produces good functional results it is criticised for its poor cosmesis of the meatal configuration, which is often not ideal. Meticulous care at meatoplasty or the adoption of a shallow midline incision before meatoplasty, or the MAVIS manoeuvre, will produce a natural vertical slit-like glanular meatus [8,14,28].…”

Section: Discussionmentioning

confidence: 99%

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Distal hypospadias: which repair?

2002

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Objective To compare the function, complications and cosmesis after a modified Thiersch-Duplay and Mathieu unstented urethroplasty. Patients and methods Over a 5-year period 381 consecutive patients (not randomized) with distal hypospadias were evaluated. A modified ThierschDuplay with dorsal incised urethral plate tubularization (group A) was undertaken in 170 (45%) and a parameatal based flip-flap Mathieu hypospadias repair (group B) in 211 (55%). No urinary diversion or stent was used in any of the 381 patients. Results In both groups the mean (SD) follow-up was 3.1 (1.4) years. All 381 patients voided spontaneously after surgery and none developed urinary retention needing catheterization. In groups A and B, respectively, the overall late complications were 12 (7.1%) and 32 (15.2%) (P=0.001), with urethrocutaneous fistula in six (3.5%) and 26 (12.3%; P=0.001); secondary surgery for fistula repair was successful in all boys in A and 89% in B. The glanular meatus was a vertical slit in all in group A and 86% in B (P=0.02). In both groups, 71% of the children who are now toilet-trained and standing to void have a good calibre, single and straight urinary stream in a forward direction. Conclusions Stenting or urinary diversion is unnecessary after distal hypospadias surgery. The functional results were good in those standing to void. A more natural vertical slit-like glanular meatus was easily created using the modified Thiersch-Duplay urethroplasty, with a lower fistula rate.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Distal hypospadias: which repair?

2002

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“…12 Later, Snodgrass advanced this concept by extending the incision of the urethral plate from the meatus to the tip of the glans.4This maneuver allowed construction of anew urethra from the existing urethral plate. It was suggested that healing may occur through re-epithelialization of the relaxing incision without obvious scarring, allowing the incised edges to remain separated.…”

Section: Discussionmentioning

confidence: 99%

Comparative study of two different procedures for primary hypospadias repair

Tawfiq¹,

Saood²,

Abdulla³

2017

Int Surg J

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INTRODUCTIONHypospadias is a congenital defect due to incomplete tubularization of the urethral plate leading to abnormal location of the meatus anywhere along the ventral aspect of penile shaft and down on to the perineum. In the majority of cases (over 80%), the meatus is located distal to the midshaft.The objective of this study was to surgery in hypospadias is to achieve a functional penis with a normal cosmetic appearance. The commonest repairs to correct distal hypospadias are the Thiersch-Duplay, Mathieu, Mustarde, meatal advancement and glanuloplasty (MAGPI) and tubularized incised plate (TIP) urethroplasty.1-4 Of these procedures Mathieu and Snodgrass urethroplasty (Snodgrass repair) have been widely practiced. Snodgrass being now the preferred method since it creates a vertical slit-like normal appearing meatus, unlike a horizontally oriented and rounded meatus ('Fish mouth') produced by the meatal based (Mathieu) flap repair. This procedure allows ABSTRACT Background: Different modalities of procedures for hypospadial repair have been described in the literature. Data about the outcome of two main different procedure of repair are scares from Iraq. The aim of this study is to compare the results of these two methods of hypospadias repairs. The present study compared two single stage hypospadias repairs, namely, tubularized incised plate (Snodgrass) repair and Mathieu's repair. Methods: It involved 50 patients diagnosed with penile hypospadias, from March 2011 to April 2015 at the Department of Surgery, Al-Karama Teaching Hospital. After a detailed history, local examination was performed with reference to the site of meatus, shape of glans, and presence of chordee, patients were randomly assigned as Group A of 26 patients in whom Snodgrass repair was accomplished and Group B having 24 patients in whom Mathieu's repair was performed. On follow-up, the patients were examined for the position of meatus, shape of meatus, urinary stream, urethra-cutaneous fistula, and stricture formation. Results:The results showed that the mean age of presentation was 7±6 years (range 1-13years). The mean operative time was 90±15 (75-105) minutes and 60±15 (45-75) minutes in Snodgrass and Mathieu's repair respectively. Complications after surgery were urethero-cutaneous fistula in 2(7.69%) and 4 (16.67%), meatal stenosis in 1(3.84%) and 2(8.33%), wound infection in 4(15.38%) and 3(12.5%) cases in Snodgrass repair and Mathieu repair, respectively, wound dehiscence was equal in Snodgrass repair and Mathieu repair. Conclusions: It can be concluded that the cosmetic results were excellent with Snodgrass repair with a normal looking slit like meatus.

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“…Rich et al,(1989) first described an incision in the urethral plate to obtain a cosmetically acceptable vertical slit-like meatus for the Mathieu repair. (8) This was subsequently adopted for the entire length of the urethral plate as a complement to the Thiersch-Duplay urethroplasty for distal hypospadias reported by Snodgrass. (2)(3)(4)(5) The dorsal relaxing incision over the urethral plate results in a neourethra of more than 10 F (2-5) and does not seem to compromise the blood supply of urethral plate.…”

Section: Discussionmentioning

confidence: 99%

Versatility of Tubularized Incised Plate Urethroplasty in Management of Different Types of Hypspadias

Al-Saied¹

2011

Current Concepts of Urethroplasty

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Hinging the Urethral Plate in Hypospadias Meatoplasty

Cited by 124 publications

References 2 publications

Distal hypospadias: which repair?

Distal hypospadias: which repair?

Comparative study of two different procedures for primary hypospadias repair

Versatility of Tubularized Incised Plate Urethroplasty in Management of Different Types of Hypspadias

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