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Tubularized incised plate urethroplasty: modification and outcome
Adel A Al-Hunayan1, Elijah O Kehinde, Mamdouh A Elsalam
1Department of Pediatric Surgery, Bin Sina Hospital, Faculty of Medicine, Kuwait University, Safat, Kuwait. alhunayan@hsc.kuniv.edu.kw
Background/Purpose:
To review the outcome of tubularized incised plate (TIP) urethroplasty in the primary treatment of penile hypospadias with minimal chordee and to describe our experience with the lateral flap used to cover the urethroplasty.
Methods:
The charts of all patients with penile hypospadias who underwent primary TIP repair in our hospital between 1996 and 2001 were examined and pre as well as postoperative biodata were recorded. We used the lateral flap to cover the repair rather than a flap harvested from preputual skin as in the original description.
Results:
94 patients were identified but only 83 were suitable for analysis. The mean age of the evaluable patients was 2.67 years (range 1-10). The mean of follow-up was 17.49 months (range 1-54). The preoperative meatal position was coronal in 50 (60.2%), distal shaft in 28 (33.7%) and mid shaft in 5 (6.1%) patients. The mean length of the urethral plate was 8 mm (range 5-15) while the mean width of the plate was 6 mm (range 4-8). In 30 patients (36.14%) chordee was present preoperatively. All patients were admitted to the hospital following the TIP urethroplasty with a urethral stent in place. The lateral flap was used to cover the repair in 70 patients. The stent was left for an average of 7.83 days (7-10). The average hospital stay was 8.83 days (7-11). A cosmetically normal vertically oriented slit-like meatus was seen in 78 (94%) patients. The TIP repair revealed an apical meatus in 82 (98.8%) and a conical glanular configuration in 79 (95.20%) patients. The parents observed that the urinary stream and the penile shaft were straight in 75 (90.4%) and 82 (98.8%) patients respectively. Seven patients (8.4%) developed meatal stenosis requiring repeated dilatations; four patients (4.8%) developed urethrocutaneous fistula and one (1.2%) had postoperative bleeding requiring transfusion. Of the 70 patients who had the lateral flap, 3 (4.28%) developed urethrocutaneous fistula.
Conclusion:
Our experience indicates that the TIP repair gives a good cosmetic and functional outcome with minimal complications. Urethroplasty coverage using the lateral flap is associated with a low incidence of urethrocutaneous fistulae.