Abstract
Purpose:
We report our retrospective, nonrandomized, single center experience with modified tubularized incised urethral plate repair, consisting of grafting the incised urethral plate before tubularization, as first introduced 10 years ago. Indications, technical points and results are described.
Materials and Methods:
From 1997 to 2007 at our unit 1,095 cases of hypospadias were treated, including 75% primary and 25% repeat cases. Of primary cases 18 (8%) of those suitable for tubularized incised urethral plate were instead selected for a grafted tubularized incised urethral plate. All 18 patients were characterized anatomically by a small glans, a flat urethral groove and a long spongiosum defect. Of repeat cases 83 were suitable for a tubularized incised urethral plate, of which 44 (53%) were selected for the modified procedure. Grafted tubularized incised urethral plate surgery consisted of an extended longitudinal incision of the urethral plate distal beyond the neomeatal line associated with scar excision in repeat cases. The resulting urethral plate defect was then lined with a graft.
Results:
Mean followup was 36 months (range 4 to 122). Complications were noted in 8 repeat cases (13% overall), representing 18% of this subgroup.
Conclusions:
Case selection is a crucial factor that influences the quality of tubularized incised urethral plate results. However, in most repeat cases scarring may lead to an increased complication rate after tubularized incised urethral plate surgery. The grafted modification has the advantage of extending indications for the tubularized incised urethral plate to cases in which another surgical procedure would be necessary. To our knowledge we present the first series of primary and repeat cases.
References
- 1 : Tubularized, incised plate urethroplasty for distal hypospadias. J Urol1994; 151: 464. Link, Google Scholar
- 2 : Hypospadias surgery: when, what and by whom?. BJU Int2004; 94: 1188. Google Scholar
- 3 : Current technique of tubularized incised plate hypospadias repair. Urology2002; 60: 157. Google Scholar
- 4 Spagnoli A, Zaccara A and Ferro F: Snodgrass urethroplasty: grafting the incised plate. Presented at annual meeting of American Academy of Pediatrics, Section on Urology, San Francisco, California, 1998, p 141. Google Scholar
- 5 : The use of a dorsal buccal mucosal graft with urethral plate incision (Snodgrass) for hypospadias salvage. BJU Int1999; 83: 508. Google Scholar
- 6 : The dorsal inlay graft for hypospadias repair. J Urol2000; 163: 1941. Link, Google Scholar
- 7 : Dorsal inlay graft urethroplasty for primary hypospadiac repair. Int J Urol2006; 14: 43. Google Scholar
- 8 : Interim outcome of the single stage dorsal inlay skin graft for complex hypospadias reoperations. J Urol2006; 175: 1872. Link, Google Scholar
- 9 : Fetal phallic growth and penile standards for newborn male infants. J Pediatr1975; 86: 395. Google Scholar
- 10 : Study of the dimensions of the penis from birth to adult age and as a function of testicular volume. Pediatrie1990; 45: 519. Google Scholar
- 11 : The modified Snodgrass hypospadias repair: reducing the risk of fistula and meatal stenosis. J Urol2003; 170: 1603. Link, Google Scholar
- 12 : Tubularized incised-plate urethroplasty for hypospadias reoperation. BJU Int2002; 89: 98. Google Scholar
- 13 : Tubularized incised plate hypospadias reoperation. J Urol2004; 171: 2404. Link, Google Scholar
- 14 : Tubularized incised-plate urethroplasty for secondary hypospadias surgery. Int J Urol2001; 8: 444. Google Scholar
- 15 : The midterm success rates of tubularized incised plate urethroplasty in reoperative patients with distal or midpenile hypospadias. Pediatr Surg Int2005; 21: 973. Google Scholar
- 16 : Redo hypospadias repair: experience at a tertiary care children's hospital. Can Urol Assoc J2007; 1: 47. Google Scholar
- 17 : Reoperative Snodgrass procedure. J Urol2001; 166: 2342. Link, Google Scholar
- 18 : Re-operative hypospadias repair using the Snodgrass incised plate urethroplasty. BJU Int2001; 87: 544. Google Scholar
- 19 : Tubularized incised plate urethroplasty for hypospadias reoperations in 100 patients. Int Urol Nephrol2007; 39: 823. Google Scholar
- 20 : Initial experience with staged buccal graft (Bracka) hypospadias reoperations. J Urol2004; 172: 1720. Link, Google Scholar
- 21 : Skin graft for 2-stage treatment of severe hypospadias: back to the future?. J Urol2002; 168: 1730. Link, Google Scholar
Andrological and Gynecological Surgery Unit and Anesthesiology Service (LM), Bambino Gesù Childrens Hospital, Rome, Italy
