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Ali MM, Anwar AZ, Mohamed MS, Abdelgawad AH, Rohiem MF, Hussein A, Hasanein MGS. Comparative outcomes among inlay grafted incised plate, onlay preputial flap and tubularized incised plate urethroplasty for the repair of distal penile hypospadias with a narrow urethral plate. World J Urol 2023; 41:3643-3650. [PMID: 37947847 PMCID: PMC10693502 DOI: 10.1007/s00345-023-04690-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE We conducted this study, comparing the outcomes among Transverse Onlay Island Flap, inlay grafted incised plate and our previous records of tubularized incised plate urethroplasty (TIPU) in patients with narrow urethral plates, aiming to determine which method of repair provides a good outcome. METHODS This hybrid study included two datasets. The first from a prospective randomized study evaluating outcomes of two treatment modalities; Inlay graft and only flap for distal hypospadias with shallow urethral plate with 80 patients (40 patients in each group) included, the second based on our previous records of TIPU in 40 patients with distal primary hypospadias with narrow urethral plate. RESULTS The success rate in inlay graft urethroplasty group (n = 40) was 87.5%; glandular dehiscence occurred in one case (2.5%), fistulas occurred in 2 cases (5%), and narrow meatus occurred in two cases (5%). Success rate in onlay flap urethroplasty group (n = 40) was 82.5%; glandular dehiscence occurred in two cases (5%), fistulas occurred in two cases (5%), and narrow meatus occurred in three cases (7.5%). TIPU group (n = 40) had success rate of 62.5%; glandular dehiscence occurred in eight cases (20%), fistulas occurred in five cases (12.5%), and narrow meatus occurred in seven cases (17.5%), with five cases exhibiting both narrow meatus with fistula. CONCLUSION Inlay graft and onlay flap urethroplasty for repair of distal penile hypospadias with narrow urethral plate had higher success rate and fewer complications than traditional TIPU. Moreover, operative time was shorter in TIPU.
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Affiliation(s)
- Mostafa M Ali
- Department of Urology, Urology and Nephrology Hospital, Faculty of Medicine, Minia University, Minia, Egypt.
| | - Ahmed Z Anwar
- Department of Urology, Urology and Nephrology Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mostafa Sh Mohamed
- Department of Urology, Urology and Nephrology Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed H Abdelgawad
- Department of Urology, Urology and Nephrology Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mahmoud F Rohiem
- Department of Urology, Port Said University Hospital, Port Said University, Port Said, Egypt
| | - Alayman Hussein
- Department of Urology, Urology and Nephrology Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mohammed G S Hasanein
- Department of Urology, Urology and Nephrology Hospital, Faculty of Medicine, Minia University, Minia, Egypt
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Woldeselassie HG, Temesgen F, Taddese A, Negussie T, Kiflu W, Dejene B, Derbew M, Workineh ST. Outcomes of Tubularized Incised Plate Urethroplasty (TIPU) for Hypospadias at Tikur Anbesa Specialized and Menelik II referral Hospitals: One-year Prospective study". Urology 2022; 168:189-194. [PMID: 35809699 DOI: 10.1016/j.urology.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 06/05/2022] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the results and related factors of tubularized incised plate (TIP) urethroplasty at two institutions. METHODES This was a prospective cohort analytical study conducted over a period of 12 months. All patients who underwent TIP urethroplasty in the specified period were studied. Quantitative and qualitative data of the intrinsic parameters of the penis were obtained and patients were followed up for an average period of 14.72±3.67 months (range 9-21months) after surgery. RESULTS One hundred twenty-nine patients (N = 129) were included in the study. The mean age at surgery was 50.93 months. The mean glans size and pre-incised urethral plate width were 14.34 mm and 8.38mm respectively. The post-operative results were satisfactory with the meatus in a glanular position in 122(94.6%) patients. Overall, 49 patients (38%) developed complications. Eighteen patients (14%) developed early complications whereas forty-two (32.6%) patients had late complications. UCF and Meatal stenosis occurred in 27 (20.9%) & 14 (10.9%) patients respectively. Seven patients developed recurrent hypospadias and dehiscence of glans occurred in eight patients (6.2%). CONCLUSIONS TIP can be used to repair for all types of hypospadias in the absence of severe penile curvature. It has more complications rate in proximal than distal hypospadias. Distal hypospadias was the most common type of hypospadias corrected with TIP. UCF and meatal stenosis were the most common complication followed by glans dehiscence and recurrent hypospadias. Glans size, age at surgery, plate width, location of meatus and stretched penile length were the most determinant factors for the outcome.
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Affiliation(s)
| | - Fisseha Temesgen
- Department of Surgery, Pediatrics Surgery unit, AAUCMH, Addis, Ababa, Ethiopia
| | - Amezene Taddese
- Department of Surgery, Pediatrics Surgery unit, AAUCMH, Addis, Ababa, Ethiopia
| | - Tihitena Negussie
- Department of Surgery, Pediatrics Surgery unit, AAUCMH, Addis, Ababa, Ethiopia
| | - Woubedel Kiflu
- Department of Surgery, Pediatrics Surgery unit, AAUCMH, Addis, Ababa, Ethiopia
| | - Belachew Dejene
- Department of Surgery, Pediatrics Surgery unit, AAUCMH, Addis, Ababa, Ethiopia
| | - Miliard Derbew
- Department of Surgery, Pediatrics Surgery unit, AAUCMH, Addis, Ababa, Ethiopia
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Roshandel MR, Aghaei Badr T, Kazemi Rashed F, Salomon S, Ghahestani SM, Ferrer FA. Hypospadias in toddlers: a multivariable study of prognostic factors in distal to mid-shaft hypospadias and review of literature. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000225. [DOI: 10.1136/wjps-2020-000225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 11/15/2021] [Indexed: 11/04/2022] Open
Abstract
BackgroundTubularized incised plate urethroplasty is the most common hypospadias repair technique. However, there are unanswered questions and debates about the anatomical prognostic factors affecting the repair outcomes. This study tried to address some of the problems in the studies compromising the results of the current body of literature.MethodsA prospective cohort of 101 males aged 1–3 years undergoing primary distal to mid-shaft hypospadias repair were enrolled in the study. Complications including edema, erection, inadvertent removal of the urethral stent, surgical wound infection, bladder spasm, hematoma, and hemorrhage were evaluated. Studies in the current literature were reviewed to achieve a better perspective for future investigations.ResultsPersistent complications were found in 16 cases (15.8%) including fistula formation, the persistence of chordee, meatal stenosis, glans, and urethral dehiscence. The mean follow-up time was 6.6±3.4 months. In the single-variable analysis, the meatal location, the length and width of the urethral plate, and the reversible acute postoperative events were significantly associated with the complications. Furthermore, fistula formation was associated with acute surgical site infection (p<0.001). However, the multivariable regression study revealed the presurgical meatal location to be the only statistically significant factor (p=0.03). Notably, the glans diameter or glanular groove shape, urethral plate dimensions, or presence of mild chordee were not independently associated with the outcomes (p>0.05).ConclusionsOur study on the toddlers with hypospadias surgery revealed that the location of urethral meatal was the main predicting factor in the development of major complications. Furthermore, the fistula formation at the infected surgical site emphasizes the importance of postsurgical care.
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Silay MS, 't Hoen L, Bhatt N, Quaedackers J, Bogaert G, Dogan HS, Nijman RJM, Rawashdeh Y, Stein R, Tekgul S, Radmayr C. Are there any benefits of using an inlay graft in the treatment of primary hypospadias in children? A systematic review and metanalysis. J Pediatr Urol 2021; 17:303-315. [PMID: 33691984 DOI: 10.1016/j.jpurol.2021.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/16/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Dorsal inlay graft urethroplasty (DIGU) has been described as an effective method for hypospadias repair with the proposed advantage of reducing the risk of complications. We aimed to systematically assess whether DIGU has any additional advantages over standard tubularized incised plate urethroplasty (TIPU) repair in children with primary hypospadias. MATERIALS AND METHODS This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The a priori protocol is available at the PROSPERO database (CRD42020168305). A literature search was conducted for relevant publications from 1946 until January 10, 2020 in seven different databases. Randomized controlled trials (RCTs), comparative studies (TIPU vs DIGU) and single arm case series (>20 cases) of DIGU were eligible for inclusion. Secondary hypospadias, two-stage repairs, disorders of sex development, significant curvature of >30°, and a mean or median follow-up of less than 12 months were excluded. DISCUSSION A total of 499 articles were screened and 14 studies (3 RCTs, 5 non-randomized studies (NRSs), and 6 case series) with a total of 1753 children (distal: 1334 (76%) and proximal: 419 (24%)) were found eligible. Mean follow-up of the studies was between 16 and 77 months. DIGU was found superior to TIPU in decreasing meatal/neourethral stenosis (p = 0.02, 95% CI 0.02-0.78). All other parameters were found comparable including overall complications, fistula and glans dehiscence rates. Success rates were similar among the groups ranging between 48% and 96% for DIGU and 43-96% in the TIPU group. The lack of standardization in the definition of complications and success was the major limitation of this study. CONCLUSIONS Using an inlay graft during primary hypospadias repair decreases the risk of meatal/neourethral stenosis. However, current evidence does not demonstrate superiority of DIGU over TIPU in terms of treatment success and overall complication rates.
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Affiliation(s)
- Mesrur Selcuk Silay
- Division of Pediatric Urology, Deparment of Urology, Biruni University, Istanbul, Turkey.
| | - Lisette 't Hoen
- Erasmus MC, Department of Urology, Rotterdam, the Netherlands
| | - Nikita Bhatt
- Urology Registrar, East of England Deanery, Cambridge, United Kingdom
| | - Josine Quaedackers
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, University of Groningen, the Netherlands
| | - Guy Bogaert
- Department of Urology, University of Leuven, Belgium
| | - Hasan Serkan Dogan
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Rien J M Nijman
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, University of Groningen, the Netherlands
| | | | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, University of Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
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Abbas TO, Braga LH, Spinoit AF, Salle JP. Urethral plate quality assessment and its impact on hypospadias repair outcomes: A systematic review and quality assessment. J Pediatr Urol 2021; 17:316-325. [PMID: 33846072 DOI: 10.1016/j.jpurol.2021.02.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/02/2021] [Accepted: 02/16/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND The variability of the urethral plate (UP) characteristics is one of the factors that influence technical choices for hypospadias correction. However, it is difficult to objectively evaluate the UP, leading to controversies in this subject, and vague terms utilized in the literature to describe its characteristics. OBJECTIVE We aim to analyze the previously described methods used to characterize and evaluate UP quality, emphasizing the pros and cons of each system, and highlighting its possible influence on different postoperative outcomes. METHODS We searched the databases PubMed, Embase, and Cochrane Library CENTRAL from January 1, 2000 to August 20, 2020. The following concepts were searched: urethra reconstruction/urethra replacement/urethroplasty AND hypospadias/hypospadias, AND children AND "plate" with the gray literature search. Subgroup analyses were also carried out. The quality of the involved studies was reviewed operating a modified version of the Newcastle-Ottawa Scale (NOS). RESULTS 996 citations perceived as relevant to screening were retrieved. Thirteen studies were included comprising a total of 1552 cases. The number of patients in each study varied between 42 and 442, and the average post-surgical follow-up duration ranged between 6 months and twenty-six months. All studies used postoperative urethral stents of variable sizes and types. The impact of UP was most frequently assessed for cases treated with the tubularized incised plate (TIP) repair. CONCLUSION The UP quality seems to play a role as an independent factor influencing postoperative outcomes of hypospadias repair. Currently used strategies for the appraisal of UP quality are highly subjective with a low index of generalizability. Various attempts to overcome these limitations exist but none was consistently accepted, leaving a wide space for creative investigation in order to obtain an objective, reproducible, precise, and well-validated tool.
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Affiliation(s)
- Tariq O Abbas
- Regenerative Medicine Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Pediatric Urology Division, Surgery Department, Sidra Medicine, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; Weill Cornell Medicine - Qatar, Doha, Qatar.
| | - Luis H Braga
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - A F Spinoit
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Jl Pippi Salle
- Pediatric Urology Division, Surgery Department, Sidra Medicine, Doha, Qatar
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Seleim HM. Topographic Labeling of Glans Penis and Corpus Spongiosum When Planning Surgery for Distal Hypospadias. Res Rep Urol 2021; 13:167-173. [PMID: 33884258 PMCID: PMC8054822 DOI: 10.2147/rru.s308451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background Outcomes of hypospadias surgery continually lagged behind anticipations among practitioners, prompting continuing refinement of approaches. Refinements typically involved modified surgical techniques. Objective Herein, the author aimed for reporting the comparative anatomical topography of distal hypospadias anomaly vs normal controls, to boost its reparative approach. Patients and Methods This is a prospective clinical study of distal hypospadias cases presented to the author’s facility between June 2018 and June 2020. Anatomical topography of the hypospadias penis was studied concerning the corresponding marks in another control cohort with normal penile development. Meatal marks, glans wings alignment, frenulum, and corpus spongiosum were the anatomical landmarks looked into. Operative correction of the anomaly was carried out considering these landmarks, aiming for pinpoint reassembly. The control group served to identify the normal topography. Results The author studied 49 cases of distal hypospadias and 10 uncircumcised boys with an otherwise normal penile anatomy. In distal hypospadias, the corpus spongiosum splayed out – at about mid-penile level – ending at a consequently splayed glans penis, rather than involving a primary glans defect. After the corpus spongiosum had been closed/zippered up, no further glans wings’ surgical dissection was deemed necessary to attain the anatomical topography identified by the control group. By the end of a median follow-up period of 14 months, no urethrocutaneous fistulae or meatal stenoses were reported, with a typical apical re-assembled meatus, glans ventrum, and frenulum. Conclusion Topographic mapping against control subjects revealed that the glans penis is fully developed in boys with distal hypospadias. After the spongiosal plate has been adequately zippered up, no glans wings’ surgical dissection was deemed necessary to attain the typical glanular topography identified by the control group.
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Affiliation(s)
- Hamed M Seleim
- Pediatric Surgery and Urology, Tanta University Hospitals, Tanta, Egypt
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Omran M, Sakr A, Elgalaly H, Fawzy A, Abdalla M. Narrow urethral plate augmentation in anterior and middle hypospadias repair: Onlay flap VS. Inlay graft. A prospective randomized comparative study. J Pediatr Urol 2021; 17:216.e1-216.e8. [PMID: 33308949 DOI: 10.1016/j.jpurol.2020.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/03/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The measurement of the urethral plate width (as an objective parameter) and its effect of this width on the results of tubularized incised plate urethroplasty (TIPU) have been reported in two series and both authors reported that a urethral plate width < 8 mm is associated with higher complication rates. The augmentation of the urethral plate either by dorsal inlay graft urethroplasty (DIGU) or Onlay flap has been compared with the original TIPU in different degrees of hypospadias with better surgical results in augmented cases. OBJECTIVE To evaluate the surgical results of longitudinal Onlay preputial flap (LOF) vs (DIGU) techniques in augmentation of the narrow urethral plate. STUDY DESIGN Primary anterior and middle hypospadias cases with narrow urethral plates were randomly allocated into two groups; group one operated by DIGU and group two operated by (LOF). The Success rate, individual complication rate, and operative times were compared. RESULTS 39 cases completed the study. No significant differences in patients' characteristics were detected. In the DIGU group, one case (5.3%) complicated with fistula and glandular dehiscence wherein in the LOF group, 7 cases (35%) Complicated with 5 fistulae, 2 glanular dehiscences, one flap loss, one diverticulum (p= .02). No significant differences in the rates of individual complications. DISCUSSION Variables affecting the success of hypospadias repairs are many. Urethral plate quality is an important variable among these variables. The definition of urethral plate quality is usually subjective. In the DIGU group, only 1/19 (5.3%) case had two complications, fistula and glandular dehiscence. Mouravas et al., in their comparative study between TIPU and G-TIP without mention of urethral plate width reported a significant reduction of the overall complications and urethral stenosis without significant reduction in fistula rate. In their G-TIP group, only 2 cases out of 24 (8.3%) were complicated with one fistula and one glandular dehiscence where in the TIPU group, 7 cases (30.4%) were complicated with one glandular dehiscence and 6 cases with urethral stenosis. In the LOF group, fistula in 5/20 cases (25%) was the commonest complication followed by glandular dehiscence in 2 cases (10%). Diverticulum and flap loss occurred in one case for each (5%). In the multivariate analysis of 474 patients' cohort by Spinoit et al., there were no significant differences between the risk of re-intervention after TIP and Onlay flap in anterior and middle hypospadias (25.8% vs. 18.8%), and (22.2% vs. 20%) respectively. CONCLUSION Our data suggest that augmentation of the narrow urethral plate with DIGU has a better surgical outcome than with LOF. No significant difference in cosmetic outcomes detected.
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Affiliation(s)
- Mohamed Omran
- Department of Urology, Faculty of Medicine, Zagazig University, Sharkia Governorate, Zagazig City, 44519, Egypt.
| | - Ahmed Sakr
- Department of Urology, Faculty of Medicine, Zagazig University, Sharkia Governorate, Zagazig City, 44519, Egypt
| | - Hazem Elgalaly
- Department of Urology, Faculty of Medicine, Zagazig University, Sharkia Governorate, Zagazig City, 44519, Egypt
| | - Amr Fawzy
- Department of Urology, Faculty of Medicine, Zagazig University, Sharkia Governorate, Zagazig City, 44519, Egypt
| | - Mohamed Abdalla
- Department of Urology, Faculty of Medicine, Zagazig University, Sharkia Governorate, Zagazig City, 44519, Egypt
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Tubularized Reconstructed Plate Urethroplasty: An Alternative Technique for Distal Hypospadias Repair. Urology 2020; 148:243-249. [PMID: 33080256 DOI: 10.1016/j.urology.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To report current results of a new surgical technique, tubularized reconstructed plate urethroplasty (TRPU) in distal hypospadias repair which allows the tubularization of urethral plate without incision or grafting. METHODS This study is a prospective single surgeon series. Between January 2019 and March 2020, total of 158 patients underwent hypospadias repair, and 29 selected patients had TRPU procedure. Demographic data, duration of follow-up, complications were recorded. A vertical incision is made starting from halfway up the glans. This incision creates a diamond like defect which enables wedge removal of a segment of spongiosum tissue from the base of urethral plate extending to the hypospadiac meatus. Vertical incision is closed horizontally. The urethral plate is stretched and loosened from the base and re-secured into its bed using quilting stitches. Reconstructed urethral plate ensures the required width to allow the formation of neourethra of adequate circumference, followed by a formal glansplasty. RESULTS Preoperative glans width was 13.4 ± 0.9 mm, urethral plate width was 6.1 ± 0.9 mm. Mean postoperative follow-up period was 13.6 months. All patients had successful functional outcome and cosmetically satisfying appearance. None of the patients required meatal calibration. The total complication rate was 3.4%. CONCLUSION Native urethral plate itself is used as a natural flap to increase the surface area of the urethral plate in this new perspective of urethroplasty method. We believe that TRPU procedure provides an alternative approach for the formation of neourethra and it is a successful and relatively simple procedure with low complication rates, good cosmetic results and promising successful functional short-term outcome.
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