Skip to main content
SpringerLink
Log in

Modified tubularized incised plate urethroplasty reduces the risk of fistula and meatal stenosis for proximal hypospadias: a report of 63 cases

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

To report the feasibility of modified tubularized incised plate (TIP) urethroplasty technique for proximal hypospadias in 63 cases.

Methods

From January 2004 to March 2010, 63 patients underwent one-stage TIP urethroplasty (modified Snodgrass technique repair) using 2–3 of three covering layers (corpus spongiosum, dartos, and tunica vaginalis). The primary meatus was proximal penile, penoscrotal, scrotal, and perineal in 38, 13, 10, and 2 patients, respectively. All patients had chordee that was corrected with dorsal plication. Glanuloplasty was performed in all cases. Complications and cosmetic results were documented after 6–72 months of follow-up.

Results

A total of 63 boys with proximal hypospadias underwent Snodgrass hypospadias repair at a mean age of 8.5 months (range 6–54). Mean operative time was 210 ± 35 min. Patients were followed up with 6-month intervals for up to 6 years postoperatively. After 6 years of follow-up, nine urethrocutaneous fistulae, four bleeding, four meatal stenoses, and one urethral stricture were reported. Cosmetic result was satisfactory according to parent’s opinion and another surgeon. No residual chordee was observed in any cases (without artificial correction).

Conclusion

In conclusion, this preliminary report can be estimated as an alternative technique with acceptable complication and cosmetic results for proximal hypospadias correction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

TIP:

Modified tubularized incised plate

References

  1. Aulagne M, Harper L, de Napoli-Cocci S, Bondonny J, Dobremez E (2010) Long-term outcome of severe hypospadias. J Pediatr Urol. 6(5):469–472

    Article  CAS  PubMed  Google Scholar 

  2. Snodgrass WT (2011) Hypospadias. Pediatr Urol 177–190

  3. Snodgrass W, Elmore J (2004) Initial experience with staged buccal graft (Bracka) hypospadias reoperations. J Urol 172(4):1720–1724

    Article  PubMed  Google Scholar 

  4. Ghanem MA, Nijman RJM (2010) Outcome analysis of tubularized incised urethral plate using dorsal dartos flap for proximal penile hypospadias repair. J Pediatr Urol 6(5):477–480

    Article  PubMed  Google Scholar 

  5. Snodgrass WT (1999) Tubularized incised plate hypospadias repair: indications, technique, and complications. Urology 54(1):6–11

    Article  CAS  PubMed  Google Scholar 

  6. Zheng D-C, Yao H-J, Cai Z-K et al (2015) Two-stage urethroplasty is a better choice for proximal hypospadias with severe chordee after urethral plate transection: a single-center experience. Asian J Androl 17(1):94

    Article  PubMed  Google Scholar 

  7. Cheng EY, Vemulapalli SN, Kropp BP et al (2002) Snodgrass hypospadias repair with vascularized dartos flap: the perfect repair for virgin cases of hypospadias? J Urol 168(4):1723–1726

    Article  PubMed  Google Scholar 

  8. Springer A, Krois W, Horcher E (2011) Trends in hypospadias surgery: results of a worldwide survey. Eur Urol 60(6):1184–1189

    Article  PubMed  Google Scholar 

  9. Manzoni G, Bracka A, Palminteri E, Marrocco G (2004) Hypospadias surgery: when, what and by whom? BJU Int 94(8):1188–1195

    Article  PubMed  Google Scholar 

  10. Shanberg A, Sanderson K, Duel B (2001) Re-operative hypospadias repair using the Snodgrass incised plate urethroplasty. BJU Int 87(6):544–547

    Article  CAS  PubMed  Google Scholar 

  11. Braga LHP, Lorenzo AJ, Skeldon S et al (2007) Failed pyeloplasty in children: comparative analysis of retrograde endopyelotomy versus redo pyeloplasty. J Urol 178(6):2571–2575

    Article  PubMed  Google Scholar 

  12. Mureau MAM, Slijper FME, Slob AK, Verhulst FC, Nijman RJM (1996) Satisfaction with penile appearance after hypospadias surgery: the patient and surgeon view. J Urol 155(2):703–706

    Article  CAS  PubMed  Google Scholar 

  13. Marrocco G, Vallasciani S, Fiocca G, Calisti A (2004) Hypospadias surgery: a 10-year review. Pediatr Surg Int 20(3):200–203

    Article  CAS  PubMed  Google Scholar 

  14. Snodgrass W, Villanueva C, Bush NC (2014) Duration of follow-up to diagnose hypospadias urethroplasty complications. J Pediatr Urol. 10(2):208–211

    Article  PubMed  Google Scholar 

  15. Jayanthi VR (2003) The modified Snodgrass hypospadias repair: reducing the risk of fistula and meatal stenosis. J Urol 170(4):1603–1605

    Article  PubMed  Google Scholar 

  16. Sozubir S, Snodgrass W (2003) A new algorithm for primary hypospadias repair based on tip urethroplasty. J Pediatr Surg 38(8):1157–1161

    Article  PubMed  Google Scholar 

  17. Filinte GT, Akan M, Temiz G, Aycicek Cardak GN, Gonullu E (2014) Applications of triangular glanular flap in hypospadias repairs for different purposes. J Plast Surg Hand Surg 48(1):34–37

    Article  PubMed  Google Scholar 

  18. Lacy JM, Hendrix LN, Grant C, Ziada AM (2014) Distal hypospadias repair using only glans wing mobilization and approximation. Can J Urol 21(2):7241–7245

    PubMed  Google Scholar 

  19. Amilal B, Arup M (2008) Acute postoperative complications of hypospadias repair. Indian J Urol 24:241

    Article  Google Scholar 

  20. Gargollo PC, Cai AW, Borer JG, Retik AB (2011) Management of recurrent urethral strictures after hypospadias repair: Is there a role for repeat dilation or endoscopic incision? J Pediatr Urol 7(1):34–38

    Article  PubMed  Google Scholar 

  21. Snodgrass WT, Nguyen MT (2002) Current technique of tubularized incised plate hypospadias repair. Urology 60(1):157–162

    Article  PubMed  Google Scholar 

  22. Snodgrass W, Koyle M, Manzoni G, Hurwitz R, Caldamone A, Ehrlich R (1998) Tubularized incised plate hypospadias repair for proximal hypospadias. J Urol 159(6):2129–2131

    Article  CAS  PubMed  Google Scholar 

  23. Snodgrass W, Koyle M, Manzoni G, Hurwitz R, Caldamone A, Ehrlich R (1996) Tubularized incised plate hypospadias repair: results of a multicenter experience. J Urol 156(2):839–841

    Article  CAS  PubMed  Google Scholar 

  24. Snodgrass WT (2001) Re: effect of the depth and width of the urethral plate on tubularized incised plate urethroplasty. J Urol 166(2):633

    Article  CAS  PubMed  Google Scholar 

  25. Snodgrass W, Lorenzo A (2002) Tubularized incised-plate urethroplasty for proximal hypospadias. BJU Int 89(1):90–93

    Article  CAS  PubMed  Google Scholar 

  26. Chen S, Yang S, Hsieh C, Chen Y (2001) Tubularized incised plate urethroplasty for proximal hypospadias. BJU Int 86(9):1050–1053

    Article  Google Scholar 

  27. Snodgrass W, Cost N, Nakonezny PA, Bush N (2011) Analysis of risk factors for glans dehiscence after tubularized incised plate hypospadias repair. J Urol 185(5):1845–1851

    Article  PubMed  Google Scholar 

  28. Kajbafzadeh A-M, Arshadi H, Payabvash S, Salmasi AH, Najjaran-Tousi V, Sahebpor ARA (2007) Proximal hypospadias with severe chordee: single stage repair using corporeal tunica vaginalis free graft. J Urol 178(3):1036–1042

    Article  PubMed  Google Scholar 

  29. Lorenzo A, Snodgrass W (2002) Regular dilatation is unnecessary after tubularized incised-plate hypospadias repair. BJU Int 89(1):94–97

    Article  CAS  PubMed  Google Scholar 

  30. Kajbafzadeh A-M, Sabetkish S, Mahboubi AH, Sabetkish N (2014) Single incisional approach for reconstruction of hypospadias and concomitant inguinal hernia. J Pediatr Urol 10(1):45–51

    Article  PubMed  Google Scholar 

  31. Yamataka A, Kobayashi H, Okada Y, Tsukamoto K, Lane GJ, Miyano T (2003) A novel technique for reinforcing the neourethra in hypospadias associated with bilateral undescended testis: use of the gubernaculum. J Pediatr Surg 38(12):1799–1801

    Article  PubMed  Google Scholar 

  32. Snodgrass W, Yucel S (2007) Tubularized incised plate for mid shaft and proximal hypospadias repair. J Urol 177(2):698–702

    Article  PubMed  Google Scholar 

  33. Cendron M, Ellsworth PI (1999) Treatment of complex hypospadias by the Snodgrass technique. Ann Urol 33(5):364–367

    CAS  Google Scholar 

  34. Xu N, Xue X-Y, Li X-D et al (2014) Comparative outcomes of the tubularized incised plate and transverse island flap onlay techniques for the repair of proximal hypospadias. Int Urol Nephrol 46(3):487–491

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children’s Hospital Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Qarib’s Street, Keshavarz Boulevard, Tehran, 1419433151, Iran

    Hamid Arshadi, Shabnam Sabetkish & Abdol-Mohammad Kajbafzadeh

Authors
  1. Hamid Arshadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shabnam Sabetkish
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abdol-Mohammad Kajbafzadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Abdol-Mohammad Kajbafzadeh.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (MP4 9383 kb)

Supplementary material 2 (MP4 7934 kb)

Supplementary material 3 (MP4 3606 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arshadi, H., Sabetkish, S. & Kajbafzadeh, AM. Modified tubularized incised plate urethroplasty reduces the risk of fistula and meatal stenosis for proximal hypospadias: a report of 63 cases. Int Urol Nephrol 49, 2099–2104 (2017). https://doi.org/10.1007/s11255-017-1725-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-017-1725-5

Keywords

Search

Navigation