Tubularized incised plate proximal hypospadias repair: Continued evolution and extended applications

Snodgrass, Warren; Bush, Nicol

doi:10.1016/j.jpurol.2010.05.011

Cited by 116 publications

(53 citation statements)

References 28 publications

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“…The incidence of urethrocutaneous fistula has been significantly reduced after spreading the concept of covering the urethroplasty by a second 'water-proofing' layer [21] . With distal hypospadias, covering the urethroplasty by a dorsal dartos flap is most popular, whereas with proximal hypospadias, the tunica vaginalis flap is another attractive alternative having the advantage of sparing intact vascularity of the dorsal skin to be used for coverage of the ventral shaft [22,23] . We have applied some modifications to facilitate covering the urethroplasty in proximal hypospadias by dartos flaps as well [12,13] .…”

Section: Discussionmentioning

confidence: 99%

Tubularized Incised Plate Urethroplasty for Primary Hypospadias Repair: Versatility versus Limitations

AbouZeid

2017

JGS

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Introduction: Several techniques have been described for the repair of hypospadias but without any definitive privilege of one technique over the others. The choice of the repair remains largely dependent on the judgment and personal experience of the operating surgeon. Aim of Study: The aim of this study was to identify the most commonly encountered complications following tubularized incised plate (TIP) urethroplasty and their rate of occurrence in relation to different forms of hypospadias. Patients and Methods: This study was conducted on patients with different degrees of hypospadias (ranging from distal penile to scrotal hypospadias) who underwent primary TIP urethroplasty. All included cases were operated by the same surgeon (the author) at two tertiary centers for pediatric surgery during the period 2007 through 2016. Data analysis was performed in a retrospective manner based on retrieved medical records, in addition to saved digital photography documenting the preoperative phenotypic severity of the hypospadiac phallus, operative steps, appearance at follow-up visits, postoperative investigations, and reoperations. Results: We retrieved data of 193 patients with different degrees of hypospadias who underwent a primary TIP urethroplasty during the 10-year period of the study. All cases in the study completed their early postoperative follow-up (at 1 and 4 weeks). Approximately 40% of cases completed more than 1-year follow-up (mean: 2.3 years, median: 2 years). Rate of reoperation was 21.7% (20 cases for fistula, five recurrences of chordee, one meatal stenosis, and 16 skin refashioning and correction of penoscrotal interposition). All cases who returned for reoperation underwent urethral calibration under anesthesia±cystoscopy. Conclusion: TIP urethroplasty is a versatile technique that can be used for the repair of different degrees of hypospadias with low rate of complications. The main limitation is the presence of considerable chordee (moderate or severe) when urethral plate preservation and dorsal penile plication might be a suboptimal way of management that is liable for recurrence of the ventral curvature.

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Section: Discussionmentioning

confidence: 99%

Tubularized Incised Plate Urethroplasty for Primary Hypospadias Repair: Versatility versus Limitations

AbouZeid

2017

JGS

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“…The complication rates observed in our study are similar to other reports. 8,9 Complication rates get even smaller when considering only the last 50 cases (2% meatal stenosis and 2% fistulas). These results again emphasize the importance of having hypospadias surgery performed by specialized pediatric urologist with a high volume of cases to optimize the success rate.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] More recently, a new important factor is emerging -surgeon experience. Frimberger and colleagues highlighted the complexity of creating a straight phallus with an anatomically positioned meatus and good cosmetic results.…”

Section: Introductionmentioning

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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“…We used ICD-10 code 752.61, which covered the diagnosis of various types of hypospadias, as well as codes 58.45 and 58.46, which covered various techniques of hypospadias repairs. The patients underwent either one-stage tubularised incised plate (TIP) repair 5,8 (Fig 2), or two-stage preputial flap repair 9 (Fig 3), as these two techniques had been our standard practice for primary repair of hypospadias from distal to proximal types during the study period. We excluded reoperative hypospadias repairs and repairs with buccal mucosal graft (BMG).…”

Section: Patientsmentioning

confidence: 99%

Hypospadias surgery in children: improved service model of enhanced recovery pathway and dedicated surgical team

2018

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Tubularized incised plate proximal hypospadias repair: Continued evolution and extended applications

Cited by 116 publications

References 28 publications

Tubularized Incised Plate Urethroplasty for Primary Hypospadias Repair: Versatility versus Limitations

Tubularized Incised Plate Urethroplasty for Primary Hypospadias Repair: Versatility versus Limitations

Learning curve for TIP urethroplasty: A single-surgeon experience

Hypospadias surgery in children: improved service model of enhanced recovery pathway and dedicated surgical team

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