Urethral plate grafting improves the results of tubularized incised plate urethroplasty in primary hypospadias

Mouravas, V.; Filippopoulos, Antonios; Sfoungaris, Dimitrios

doi:10.1016/j.jpurol.2013.11.012

Cited by 35 publications

(48 citation statements)

References 20 publications

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“…Among the different reconstructive techniques, the TIP repair proposed by Snodgrass in 1994 is most preferred owing to its simplicity and good cosmetic and functional outcomes [1], [2], [3], [4], [5]. Among the reported complications meatal stenosis, UCF, and urethral stricture have been reported in literature with an incidence varying from 2% to 26% as per surgeon expertise, shallow MIUP, small glans volume, and an incision extending beyond the distal limits of the UP that often heals by fibrosis [1], [2], [5], [6], [7], [8]. However, if the incision does not reach far enough the cosmetic result will be suboptimal, contributing to a meatus that is not slit-like [1], [9], [10].…”

Section: Discussionmentioning

confidence: 99%

“…Among the reported complications meatal stenosis, UCF, and urethral stricture have been reported in literature with an incidence varying from 2% to 26% as per surgeon expertise, shallow MIUP, small glans volume, and an incision extending beyond the distal limits of the UP that often heals by fibrosis [1], [2], [5], [6], [7], [8]. However, if the incision does not reach far enough the cosmetic result will be suboptimal, contributing to a meatus that is not slit-like [1], [9], [10]. To optimise the outcome in such cases and among surgeons in the early learning curve many modifications to the original procedure have been proposed.…”

Section: Discussionmentioning

confidence: 99%

“…TIP modification in the form of grafting of the UP was proposed by Kolon and Gonzales [2] in 2000. Grafting allows immediate coverage of the incised UP with epithelium and minimises the effects of a narrow UP and low glans volume, thus facilitating tubularisation and medial rotation of the glans for reconstruction of a slit-like NM with a conical glans [1], [2]. Similarly, Jayanthi [11] proposed extension of the midline incision distally into the tip of glans and found that it facilitates reconstruction of an anatomical apical NM without any increase incidence of meatal stenosis, which is often not recommended in the original TIP repair.…”

Section: Discussionmentioning

confidence: 99%

“…TIP repair has been based on the theory that a deep MIUP facilitates its widening and hence allows a tension-free tubularisation [1], [3], [4], [12]. The incised bed of the UP heals by granulation and subsequent fibrous, which has been proposed to be a contributing factor for the development of urethral strictures in cases reported occasionally in the literature [1], [13], [14].…”

Section: Discussionmentioning

confidence: 99%

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Grafted tubularised incised-plate urethroplasty: An objective assessment of outcome with lessons learnt from surgical experience with 263 cases

Gupta

Yadav

Alanzi

et al. 2016

Arab Journal of Urology

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ObjectiveSnodgrass urethroplasty remains the preferred technique in primary distal hypospadias but development of meatal stenosis often limits distal extension of the midline incision of the urethral plate (MIUP), which remains a limiting factor in reconstructing an apical neomeatus (NM). We here-in assess the cosmetic and functional outcome with distal extension of the MIUP in grafted tubularised incised-plate urethroplasty (G-TIP) repair.Patients and methodsThis prospective study included the surgical experience of 263 cases of primary hypospadias operated upon between 2012 and 2015. The G-TIP technique included standard steps of Snodgrass urethroplasty, including degloving and harvesting of glans wings, followed by MIUP that was extended distally beyond the margins of the urethral plate (UP) into the glans. The incised bed was grafted with a free preputial skin graft and fixed to the bed with polydioxanone 7-0 suture. The UP was tubularised and the suture line reinforced with a Dartos flap. The urethral catheter was removed at 7–10 days after the repair and the outcome was assessed at follow-up using the Hypospadias Objective Scoring Evaluation (HOSE) system.ResultsAn apical NM was achieved in 96% of the patients with a 3.7% incidence of urethrocutaneous fistula. The presence of suture tracks and graft at the margins of the NM were seen in the initial 4% and 5% of cases, respectively. Acceptable cosmetic results, with objective HOSE scores of >14, were achieved in 96% of cases.ConclusionThe G-TIP repair is a straightforward and feasible technique facilitating reconstruction of an apical NM, with an optimum outcome based on HOSE scoring. However, multicentre data are needed for undertaking comparative analysis and to assess the universal applicability of this technique in primary hypospadias.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Grafted tubularised incised-plate urethroplasty: An objective assessment of outcome with lessons learnt from surgical experience with 263 cases

Gupta

Yadav

Alanzi

et al. 2016

Arab Journal of Urology

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show abstract

“…Mouravas et al compared TIP with grafted TIP in 47 patients [13], and observed that G-TIP results in lower fistula rate, and that the rate of neourethral stenosis was significantly less.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

Is combined inner preputial inlay graft with tubularized incised plate in hypospadias repair worth doing?

Ahmed

Alsaid

2015

Journal of Pediatric Urology

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Dorsal Inlay TIP (DTIP)

Abbas

Salle

2022

Hypospadias Surgery

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Urethral plate grafting improves the results of tubularized incised plate urethroplasty in primary hypospadias

Cited by 35 publications

References 20 publications

Grafted tubularised incised-plate urethroplasty: An objective assessment of outcome with lessons learnt from surgical experience with 263 cases

Grafted tubularised incised-plate urethroplasty: An objective assessment of outcome with lessons learnt from surgical experience with 263 cases

Is combined inner preputial inlay graft with tubularized incised plate in hypospadias repair worth doing?

Dorsal Inlay TIP (DTIP)

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