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Published on: January 7, 2019
A comprehensive analysis of a tubularized incised plate hypospadias repair
1East Tennessee Children's Hospital and Division of Urology, Departments of Pediatrics and Surgery, University of Tennessee Medical Center at Knoxville, Knoxville, Tennessee, USA.
Insights
This study shows that a modified tubularized incised plate (TIP) hypospadias repair, without fully incising the urethral plate or using stents, yields excellent outcomes for distal and midshaft hypospadias, with high parental satisfaction.
Area of Science:
- Pediatric Urology
- Surgical Techniques
- Hypospadias Repair
Background:
- Hypospadias repair is a common pediatric urology procedure.
- The tubularized incised plate (TIP) urethroplasty is a widely used technique.
- Modifications to the standard TIP technique are continually explored to improve outcomes.
Purpose of the Study:
- To evaluate the efficacy and patient satisfaction of a modified TIP hypospadias repair.
- To assess outcomes without complete urethral plate incision or routine stenting.
- To analyze results for both distal and midshaft hypospadias defects.
Main Methods:
- Retrospective review of 64 boys (7 months–11 years) undergoing modified TIP urethroplasty.
- Urethral plate incision was deep and proximal, but not full-length in 39% of cases.
- Postoperative stents were omitted in 81.3% of patients; follow-up included clinical evaluation and parental phone surveys.
Main Results:
- All 54 clinically evaluated patients achieved a conical glans, slit meatus, and straight phallus.
- No fistulas, strictures, or dehiscence were reported.
- 40 parents reported universal satisfaction with urinary stream, chordee correction, and appearance at mean 21-month follow-up.
Conclusions:
- Modified TIP urethroplasty, without full urethral plate incision and stenting, is effective for distal and midshaft hypospadias.
- Excellent functional and cosmetic results can be achieved.
- High parental satisfaction supports the long-term success of this modified approach.
Objectives:
To critically evaluate my experience using a modified tubularized incised plate (TIP) hypospadias repair.
Methods:
Sixty-four boys, 7 months to 11 years old (mean age 22.9 months), underwent a TIP urethroplasty by a single pediatric urologist for primary hypospadias. The hypospadias defects included 53 distal and 11 midshaft. The incision of the urethral plate was always deep and proximal but never extended the entire length of the plate. In 25 cases (39%), the incision was less than one half the length of the urethral plate. A two-layer urethroplasty was always obtained. A vascularized subcutaneous pedicle was always placed onto the urethroplasty. This pedicle was ventrally based in 56 of the repairs (87.5%). Postoperative urethral stents were not used in 52 boys (81.3%), including 7 with midshaft repairs. All children were scheduled for a postoperative evaluation at 1 month. A confidential phone survey was later conducted by someone other than the surgeon. The parents were asked if they were satisfied or dissatisfied with the direction and caliber of the urinary stream, chordee correction, and overall general appearance.
Results:
The clinical evaluation was performed in 54 boys (84.7%) not earlier than 1 month after the repair. The examination revealed a conical glans, slit meatus, circumferential mucosal collar, and a straight phallus in all cases. No cases of fistula, stricture, or dehiscence occurred. A follow-up phone survey 3 to 43 months (mean 21 months) postoperatively was obtained from the parents of 40 patients. Without exception, the parents were satisfied with the urinary stream, chordee correction, and overall appearance.
Conclusions:
Without incising the entire urethral plate and stenting the repair, a TIP urethroplasty can still be expected to provide excellent results when correcting distal and midshaft hypospadias. Parents were satisfied with the long-term cosmetic and functional results obtained with a TIP urethroplasty.
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