Outcome of spongioplasty alone as second layer of tubularised incised plate urethroplasty in patients with hypospadias

Abstract

Background Spongioplasty alone or in combination with local tissue flaps can be used as a second layer for the prevention of complications of tubularised incised plate urethroplasty (TIPU) of hypospadias repair. It can be used when wide urethral plate and well-developed robust spongiosum are present. This study aims to review the success rate and complications of TIPU performed utilising spongioplasty alone as a second layer in Type 3 well-developed robust spongiosum. Methods This is a retrospective observational study conducted between January 2015 and December 2019 at a tertiary care centre. A total of 21 patients aged 4–15.4 years with primary hypospadias having a Type 3 well-developed robust spongiosum, Glans score ≤ 2, Meatal score ≤ 4, and Shaft score ≤ 3 underwent TIPU using spongioplasty alone as a second layer. The hospital stay ranged from 10 to 14 days and follow-up from 12 to 36 months. Results Hypospadias was distal in 12 (57.1%), mid in 5 (23.8%), and proximal penile in 4 (19.1%) patients. The mean Glans Meatus Shaft score was 6.1 (G = 1.25, M = 2.95, S = 1.9) with a range of 3–9. An early post-operative complication of preputial oedema and bladder spasm developed in 1 (4.7%) patient each. Meatal stenosis developed in 1 (4.7%) patient. None developed urethrocutaneous fistula. At 3 months all patients had good urinary flow (> 15 ml/s) and good cosmesis. All the patients/parents (in case of minors) were satisfied with the result. Conclusion Spongioplasty alone as the second layer after TIPU for primary penile hypospadias in patients with well-developed robust spongiosal tissue is associated with minimal, easily manageable complications.

Outcome Of Spongioplasty As A Standalone Covering Layer After Urethroplasty In Distal Hypospadias

“…About three quarters of our chordee cases (which was mild ranging from zero to ten degrees) were successfully managed by only penile degloving (6) , but one quarter needed adjunct dorsal plication (9) . Post-operative meatal issues (stenosis/ sprayed urinary stream) were encountered in 6.6% of patients in this study which was comparable to related reports (4% meatal retraction (16) , 1.4% meatal stenosis (18) , 5.8% meatal stenosis (15) and 4.7% meatal stenosis (19) ). In this study we fortunately succeeded to treat all meatal abnormalities using only regular calibration (12) but this treatment modality alone wasn't sufficient in managing some of other authors' meatal issues cases correcting them only using meatoplasty (15) .…”

“…This study's success rate was 83.3% similar to most of the recent related literature (6,9,18) but it seems that meticulous selection of urethroplasty technique according to urethral plate width (TIP if width ≥ 6 mm and on lay island flap if width less than 6 mm) and the use of a double layer cover between the neo urethra and the skin can combined raise the success rate up to 93.2% (18) . This study's fistula rate was 3.3% which was comparable to fistula rates associated with spongioplasty as a standalone covering layer reported in the recent English literature that we reviewed ranging from 0% (19) to 3.9% (4) and less than the reported 7.5% fistula rate of the standard dartos flap (1,14,18) . The added effect of spongioplasty in conjunction with dartos flap cover resulted in decreased fistula rates even to 0% (1,10,18) .…”

“…Aiming to achieve the best results, this study included only distal hypospadias cases unlike other studies in which about half of the study sample was of distal type and the other half was mid penile (7) or included all types of hypospadiac meatal locations (6) . This study included primary cases only (4,19) , but unlike the single-center experience with 500 cases published in 2009 in which about one eighth of the cases had at least one unsuccessful prior surgery (6) . We Included distal cases only assuming that the spongiosum would mostly be well developed but a recent publication applied a stricter criterion of well-developed robust spongiosum and other suitable glanular, meatal and shaft specifications and used the TIP technique with spongioplasty alone as the second layer (19) .…”

“…This study included primary cases only (4,19) , but unlike the single-center experience with 500 cases published in 2009 in which about one eighth of the cases had at least one unsuccessful prior surgery (6) . We Included distal cases only assuming that the spongiosum would mostly be well developed but a recent publication applied a stricter criterion of well-developed robust spongiosum and other suitable glanular, meatal and shaft specifications and used the TIP technique with spongioplasty alone as the second layer (19) . Most of the related studies tended to limit the urethroplasty technique to just one or merely two techniques.…”

“…A protective barrier between the neourethra and the skin is one of the key elements in minimizing the development of fistulas (15) . In this study we decided to follow the footsteps of some of the recent reports using the mobilized approximated spongiosum as a standalone covering layer after urethroplasty (17,19) but other publications choose to assess the supporting effect of spongioplasty in conjunction with the standard TIP urethroplasty repair, including dorsal preputial dartos flap (7,10) . Many attempts were done trying to select the best second layer cover for repairing different forms of hypospadias that some of them investigated the extra added effect of reconstructing forked corpus spongiosum compared to the standard standalone dartos flap as a second layer (1,9and18) and others divided the study sample into two halves and compared between the dartos flap and the spongioplasty as the second layer (12) .…”