Skip to main content
SpringerLink
Log in

Improved outcomes after technical modifications in tubularized incised plate urethroplasty for mid-shaft and proximal hypospadias

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

To investigate and compare the outcomes after tubularized incised plate (TIP) urethroplasty in mid-shaft and proximal hypospadias using a standard and a modified technique.

Methods

We conducted a retrospective study in 104 consecutive children who underwent mid-shaft or proximal TIP repairs from Jan 2007 to Sept 2015. Patients in Cohort One had dorsal dartos (DD) neourethral coverage while patients in Cohort Two had either de-epithelialized split preputial (DESP) or tunica vaginalis (TV) flap coverage. TV flap was used only when DESP flap was not sufficient to cover the neourethra.

Results

There were 52 patients each in Cohort One (DD, n = 52) and Cohort Two (DESP, n = 38; TV, n = 14) with no difference in ratio of mid-shaft/proximal between the two cohorts. At a median follow-up of 28 months, 36 patients (34.6 %) developed 47 complications including fistula (n = 19; 18.3 %) and neourethral dehiscence (n = 4; 3.8 %). Cohort One patients had significantly more fistula (28.8 vs 7.7 %; p = 0.005) and neourethral dehiscence (7.7 vs 0 %; p = 0.04) than Cohort Two. There was no difference between the two cohorts in the complication rates of meatal stenosis, recurrent ventral curvature and neourethral stricture.

Conclusions

Both DESP and TV flap appear to be superior to DD in preventing fistula and neourethral dehiscence in non-distal TIP repairs.

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

References

  1. Snodgrass W (1994) Tubularized, incised plate urethroplasty for distal hypospadias. J Urol 151:464–465

    CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  3. Steven L, Cherian A, Yankovic F, Mathur A, Kulkarni M, Cuckow P (2013) Current practice in paediatric hypospadias surgery; a specialist survey. J Pediatr Urol 9:1126–1130

    Article  PubMed  Google Scholar 

  4. Wilkinson DJ, Farrelly P, Kenny SE (2012) Outcomes in distal hypospadias: a systematic review of the Mathieu and tubularized incised plate repairs. J Pediatr Urol 8:307–312

    Article  PubMed  Google Scholar 

  5. Castagnetti M, El-Ghoneimi A (2010) Surgical management of primary severe hypospadias in children: systematic 20-year review. J Urol 184:1469–1475

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  7. Hafez AT, Helmy T (2012) Tubularized incised plate repair for penoscrotal hypospadias: role of surgeon’s experience. Urology 79:425–427

    Article  PubMed  Google Scholar 

  8. Braga LH, Pippi Salle JL, Lorenzo AJ et al (2007) Comparative analysis of tubularized incised plate versus onlay island flap urethroplasty for penoscrotal hypospadias. J Urol 178:1451–1457

    Article  PubMed  Google Scholar 

  9. Snodgrass W, Bush N (2011) Tubularized incised plate proximal hypospadias repair: continued evolution and extended applications. J Pediatr Urol 7:2–9

    Article  PubMed  Google Scholar 

  10. Eassa W, Jednak R, Capolicchio JP, Brzezinski A, El-Sherbiny M (2011) Risk factors for reoperation following tubularized incised plate urethroplasty: a comprehensive analysis. Urology 77:716–720

    Article  PubMed  Google Scholar 

  11. Deschenes Rompre M, Nadeau G, Moore K, Ajjaouj Y, Braga LH, Bolduc S (2013) Learning curve for TIP urethroplasty: a single-surgeon experience. CUAJ 7:E789–E794

    Article  Google Scholar 

  12. El-Sherbiny MT, Hafez AT, Dawaba MS, Shorrab AA, Bazeed MA (2004) Comprehensive analysis of tubularized incised-plate urethroplasty in primary and re-operative hypospadias. BJU Int 93:1057–1061

    Article  CAS  PubMed  Google Scholar 

  13. Djordjevic ML, Perovic SV, Slavkovic Z, Djakovic N (2006) Longitudinal dorsal dartos flap for prevention of fistula after a Snodgrass hypospadias procedure. Eur Urol 50:53–57

    Article  PubMed  Google Scholar 

  14. Elicevik M, Tireli G, Sander S (2004) Tubularized incised plate urethroplasty: 5 years’ experience. Eur Urol 46:655–659

    Article  PubMed  Google Scholar 

  15. Kamal BA (2005) Double dartos flaps in tubularized incised plate hypospadias repair. Urology 66:1095–1098

    Article  PubMed  Google Scholar 

  16. Bilici S, Sekmenli T, Gunes M, Gecit I, Bakan V, Isik D (2011) Comparison of dartos flap and dartos flap plus spongioplasty to prevent the formation of fistulae in the Snodgrass technique. Int Urol Nephrol 43:943–948

    Article  PubMed  Google Scholar 

  17. Babu R, Hariharasudhan S (2013) Tunica vaginalis flap is superior to inner preputial dartos flap as a waterproofing layer for primary TIP repair in midshaft hypospadias. J Pediatr Urol 9:804–807

    Article  PubMed  Google Scholar 

  18. Ross JH, Kay R (1997) Use of a de-epithelialized local skin flap in hypospadias repairs accomplished by tubularization of the incised urethral plate. Urology 50:110–112

    Article  CAS  PubMed  Google Scholar 

  19. Snodgrass WT (2005) Snodgrass technique for hypospadias repair. BJU Int 95:683–693

    Article  PubMed  Google Scholar 

  20. Chatterjee US, Mandal MK, Basu S, Das R, Majhi T (2004) Comparative study of dartos fascia and tunica vaginalis pedicle wrap for the tubularized incised plate in primary hypospadias repair. BJU Int 94:1102–1104

    Article  PubMed  Google Scholar 

  21. Cimador M, Pensabene M, Sergio M, Catalano P, de Grazia E (2013) Coverage of urethroplasty in pediatric hypospadias: randomized comparison between different flaps. Int J Urol 20:1000–1005

    PubMed  Google Scholar 

  22. Bakal U, Abes M, Sarac M (2015) Necrosis of the ventral penile skin flap: a complication of hypospadias surgery in children. Adv Urol 2015:452870. doi:10.1155/2015/452870 (Epub 2015 Apr 1)

    Article  PubMed  PubMed Central  Google Scholar 

  23. Baskin LS, Ebbers MB (2006) Hypospadias: anatomy, etiology, and technique. J Pediatr Surg 41:463–472

    Article  PubMed  Google Scholar 

  24. Belman AB (1988) De-epithelialized skin flap coverage in hypospadias repair. J Urol 140:1273–1276

    CAS  PubMed  Google Scholar 

  25. Baccala AA Jr, Ross J, Detore N, Kay R (2005) Modified tubularized incised plate urethroplasty (Snodgrass) procedure for hypospadias repair. Urology 66:1305–1306

    Article  PubMed  Google Scholar 

  26. El-Kassaby AW, Al-Kandari AM, Elzayat T, Shokeir AA (2008) Modified tubularized incised plate urethroplasty for hypospadias repair: a long-term results of 764 patients. Urology 71:611–615

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China

    Yuk Him Tam, Kristine Kit Yi Pang, Yuen Shan Wong, Siu Yan Tsui, Hei Yi Wong, Jennifer Wai Cheung Mou, Kin Wai Chan & Kim Hung Lee

Authors
  1. Yuk Him Tam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristine Kit Yi Pang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuen Shan Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Siu Yan Tsui
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hei Yi Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jennifer Wai Cheung Mou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kin Wai Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kim Hung Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yuk Him Tam.

Ethics declarations

Conflict of interest

All the authors declare that they have no competing interests.

Funding source

No external funding related to the work of this manuscript was received.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tam, Y.H., Pang, K.K.Y., Wong, Y.S. et al. Improved outcomes after technical modifications in tubularized incised plate urethroplasty for mid-shaft and proximal hypospadias. Pediatr Surg Int 32, 1087–1092 (2016). https://doi.org/10.1007/s00383-016-3954-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-016-3954-6

Keywords

Search

Navigation