Versatility of tubularized incised plate urethroplasty in the management of different types of hypospadias: 5-year experience

Abstract

Background: The outcomes of urethroplasty in the management of different types of hypospadias have continued to improve since the introduction of the tubularized incised plate (TIP) urethroplasty (Snodgrass method). The aim of this study was to evaluate the feasibility and applicability of TIP urethroplasty in the management of different types of hypospadias. Materials and Methods: This work was carried out at Al-Azhar University Hospital, Cairo, Egypt in the period from January 2002 to December 2002 and King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia; in the period from January 2003 to January 2007 by the same authors. The medical records of 175 boys with different types of hypospadias, who underwent TIP urethroplasty, were critically reviewed. Their age ranged from 9 to 36 months (mean age; 22.72 ± 7.75 months).The period of follow-up was ranged from 7 to 60 months (mean 34.42 ± 15.41). Results: All families were happy with penile aesthetic appearance. The total number of boys with different types of hypospadias was 175 (145 1ry and 30 2ry). Out of 175 cases, the overall urethrocutaneous fistula rate was 11 (6.29%), and the overall rates for glanular dehiscence, urethral stricture, meatal stenosis and meatal regression were 4 (2.29%), 5 (2.86%), 17 (9.71%), and 10 (5.71%), respectively. All cases of urethral stricture and most cases of meatal stenosis 12 (6.86%) responded well to regular urethral dilatation. Meatoplasty was performed in only 5 (2.85%) cases (1 of 1ry and 4 of 2ry cases). Secondary surgery for fistula repair and glans closure was successful in all patients. All children void with a single straight urinary stream in a forward direction, and have a rounded glans with vertical slit- like terminal glanular meatus. The mean hospital stay was 4.6 days. Conclusion: TIP urethroplasty with neourethral coverage using a vascularized pedicle of dartos flap is versatile and simple operation in management of different types of hypospadias. It has a good functional and cosmetic outcome.