Two-stage flap repair of severe hypospadias: Usefulness of the tubularized incised plate urethroplasty

Tijani, KH; Idiodi-Thomas, Hestia O; Elebute, OA; Alakaloko, Felix; Ojewola, Rufus Wale; Ademuyiwa, Adesoji O

doi:10.1016/j.jpurol.2017.04.017

Cited by 7 publications

(5 citation statements)

References 21 publications

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“…For patients with severe hypospadias (treated initially) and failed hypospadias, a staged operation may be a wise choice. There are many two-stage operations, such as Byar’s operation [ 8 ], Bracka’s operation [ 9 , 10 ], staging Duckett surgery [ 11 ], and free graft roll tube surgery [ 12 , 13 ]. At present, in the first stage of staged surgery, the penis should be fully extended, and part of the urethra should be reconstructed; this approach is different from previous staging surgeries.…”

Section: Discussionmentioning

confidence: 99%

Staged transverse preputial island flap urethroplasty for some proximal hypospadias with moderate-to-severe chordee

Lin

Wang

et al. 2021

BMC Urol

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Background We aimed to assess the outcome of staged transverse preputial island flap (TPIF) urethroplasty for repairing certain cases of primary proximal hypospadias with moderate-to-severe chordee in children. Methods Nighty-two consecutive boys who underwent either one-stage or staged TPIF urethroplasty for the repair of proximal hypospadias with moderate-to-severe chordee between August 2015 and December 2019 were evaluated retrospectively. Patients were divided into two groups: one-stage TPIF urethroplasty group (n = 44) and staged TPIF urethroplasty group (n = 48). We noted and compared the postoperative complications, including urethrocutaneous fistula, urethral diverticula, residual penile curvature, and urethral stricture in both groups. Results Both groups were followed up for 1–5 years, with an average of 3 years. No cases of residual or recurrence of penile chordee were reported in either group. In Group A, 9 patients (9/44, 20.4%) had postoperative urethrocutaneous fistula, and all patients underwent urinary fistula repair or urethroplasty. In Group B, postoperative urethrocutaneous fistula occurred in 2 cases (2/48, 4.1%), and one patient developed a urethrocutaneous fistula after the first operation, which was successfully repaired during the second operation. A urethrocutaneous fistula occurred in 1 case after completion of the second-stage operation; urethral fistula repair was performed successfully 6 months later. There were 2 cases of urethral stricture in Group A (2/44, 4.5%) and none in Group B. There were 6 cases of urethral diverticulum in Group A (6/44, 13.6%) and no cases of urethral diverticulum in Group B. The operative success rates were 61.3% and 95.8% in Group A and Group B, respectively (P < 0.001). Conclusions Compared with one-stage TPIF urethroplasty, staged TPIF urethroplasty in the treatment of certain cases of primary proximal hypospadias with moderate-to-severe chordee resulted in fewer postoperative fistulas, urethral strictures and urethral diverticula. The staged TPIF urethroplasty procedure was effective in reducing the operation difficulty and complication rate of hypospadias, improving the curative effect of complex hypospadias and having good clinical application value.

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Section: Discussionmentioning

confidence: 99%

Staged transverse preputial island flap urethroplasty for some proximal hypospadias with moderate-to-severe chordee

Lin

Wang

et al. 2021

BMC Urol

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“…TIP urethroplasty formed a centrally and vertically positioned meatus that resembled the normal urethral meatus; in addition, it is thought to allow for better cosmetic results (18). On the other hand, it has been shown that the incision of the urethral plate reported that TIP urethroplasty in a two-stage flap urethroplasty for proximal hypospadias appears to prevent the development of diverticulum (21). Therefore, we applied staged TIP urethroplasty to repair proximal hypospadias with severe chordee.…”

Section: Discussionmentioning

confidence: 99%

“…Also, Andersson et al reported that there is great potential for the normalization of urinary flow at puberty for boys treated for hypospadias with TIP urethroplasty ( 20 ). In addition, Tijani et al reported that TIP urethroplasty in a two-stage flap urethroplasty for proximal hypospadias appears to prevent the development of diverticulum ( 21 ). Therefore, we applied staged TIP urethroplasty to repair proximal hypospadias with severe chordee.…”

Section: Discussionmentioning

confidence: 99%

The effect of staged TIP urethroplasty on proximal hypospadias with severe chordee

et al. 2022

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BackgroundProximal hypospadias with severe chordee is still a formidable challenge for most pediatric urologists, and the treatment approach remains controversial. Here, we describe a modified two-stage technique to repair proximal hypospadias with severe chordee.MethodsWe retrospectively identified 53 children referred for proximal hypospadias with severe chordee from July 2016 to July 2019, who underwent a two-stage urethroplasty. In group 1, the children were repaired with staged tubularized incised plate (TIP) urethroplasty, while Byars’ two-stage urethroplasty was attempted in group 2. We corrected chordee by releasing all remaining attachments to the corpora after degloving the penis, transceting the urethral plate, and dorsal plication. The mean age of patients in the first stage of surgery was 26.6 months in group 1 and 24.8 months in group 2. Postoperative complications in the two groups included: fistula, urethral stricture, urethral diverticulum, and glanular dehiscence.ResultsA total of 20 cases were repaired with staged TIP urethroplasty (group 1), and 33 cases were repaired with Byars’ two-stage urethroplasty (group 2). The length of follow-up in group 1 was 39.8 ± 10.1 months, and in group 2, it was 38.1 ± 8.7 months (P > 0.05). After the second stage of surgery, 1 case (5%) in group 1 and 11 cases (33.3%) in group 2 developed a urinary fistula (P < 0.05). One case (5%) in group 1 and three cases (9.1%) in group 2 had urethral stricture (P > 0.05). All strictures were cured by repeated dilation, and no patient required reoperation. No cases in group 1 and one case (3%) in group 2 had urethral diverticulum (P > 0.05). There was no residual chordee in both groups. Two cases (10%) in group 1 and 13 cases (39.3%) in group 2 required reoperation (P < 0.05).ConclusionsStaged urethroplasty is appropriate to repair proximal hypospadias with severe chordee. Particularly, staged TIP urethroplasty is a good choice for patients with proximal hypospadias and severe chordee, especially those with better penile development, wider urethral plate, larger glans, and deeper navicular fossa of the urethra.

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“…In the initial use of this new procedure (with mean follow-up to 2.1 years), all four patients voided well and needed no further intervention. Similarly, Erickson et al [35] described a single-stage procedure in 14 men with anterior urethral strictures using this combination of dorsal onlay OMG with a ventral fasciocutaneous flap.…”

Section: Dorsal Graft With Ventral Penile Skin Flapmentioning

confidence: 99%

“…In some cases, there is not enough foreskin or penile skin tissue for surgery, so the choice of the technique will depend on the surgeon's preference. Staged repairs aim at the initial rectification of ventral chordee with the fashioning of a new urethral plate using preputial/penile skin flap or OMG and followed by urethral reconstruction in the next stage [34][35][36] . A recently described technique by Djordjevic et al [32] used the combination of a longitudinal dorsal island skin flap and OMG [Figure 7].…”

Section: Dorsal Graft With Ventral Penile Skin Flap In Proximal Hypos...mentioning

confidence: 99%

Combined grafts and flaps in urethral stricture repair

Dávila¹,

Rosito²,

Stojanovic³

et al. 2022

Plast Aesthet Res

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Although urethral strictures have been known since antiquity, the surgical management of urethral strictures has undergone a great (re)evolution over the last six decades, both in the perception of the disease and in the surgical repair techniques, always presenting itself as a challenge for the surgeon and patient. Reconstruction of urethral stricture disease involving a combination of grafts and flaps consists of a group of complex procedures with specific clinical indications. The knowledge of these procedures by reconstructive urologists is both necessary and relevant. A thorough understanding of the anatomy, including blood supply, is a crucial proviso for the correct evaluation and successful management of urethral stricture disease. We discuss the main techniques and indications in combined graft and flap urethroplasties.

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Two-stage flap repair of severe hypospadias: Usefulness of the tubularized incised plate urethroplasty

Cited by 7 publications

References 21 publications

Staged transverse preputial island flap urethroplasty for some proximal hypospadias with moderate-to-severe chordee

Staged transverse preputial island flap urethroplasty for some proximal hypospadias with moderate-to-severe chordee

The effect of staged TIP urethroplasty on proximal hypospadias with severe chordee

Combined grafts and flaps in urethral stricture repair

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