Tubularized incised plate (TIP) in previously operated (redo) hypospadias
Ali M Ziada1, Hany Morsi, Ahmad Aref
1Department of Urology, Kasr El-Aini Faculty of Medicine, Cairo University, 47, 79th Street #503, Maadi, Cairo 11431, Egypt. ziada@tedata.net.eg
Insights
The tubularized incised plate (TIP) technique offers a viable solution for hypospadias repair after previous failed attempts. This method demonstrates satisfactory cosmetic and functional outcomes in pediatric patients.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Genitourinary Surgery
Background:
- Hypospadias repair can be complex, with a significant failure rate necessitating revision surgeries.
- Redo hypospadias surgery presents unique challenges due to altered tissue planes and potential scarring from prior interventions.
Purpose of the Study:
- To evaluate the efficacy of the tubularized incised plate (TIP) technique in pediatric patients undergoing revision hypospadias surgery.
- To assess the cosmetic and functional outcomes, as well as complication rates, associated with the TIP technique in previously operated hypospadias cases.
Main Methods:
- Retrospective analysis of 30 children (ages 2-10) with a history of one or more failed hypospadias repairs.
- Utilized the Snodgrass TIP technique for neourethral reconstruction in all patients.
- Follow-up included urethral calibration and clinical re-evaluation up to 1 year post-surgery.
Main Results:
- Overall complication rate of 23% (7/30 patients), including fistulae (6) and meatal stenosis (3).
- Cosmetic and functional results were deemed satisfactory by parents in the majority of cases.
- Successful secondary repair of fistulae with meatoplasty in 5 patients; one patient required revised repair, and another required meatotomy.
Conclusions:
- The tubularized incised plate (TIP) procedure is a feasible and effective surgical option for correcting hypospadias after prior failed repairs.
- The TIP technique provides satisfactory functional and cosmetic outcomes, making it a viable choice for complex pediatric hypospadias cases.
Objective:
We report our experience of using the tubularized incised plate (TIP) technique for repair of hypospadias in patients who had undergone one or more failed attempts at repair.
Methods:
A total of 30 children (age range 2-10 years; mean 4.3 years) with hypospadias presented to our unit for redo hypospadias. The number of prior repairs was as follows: one in 17 patients, two in eight patients and three in five patients. The meatus was at the distal shaft in 19 cases, mid shaft in eight cases, and proximal shaft in three cases. Preoperatively 13 patients had fistulae, and none had residual chordee. The urethral plates were judged to be surgically altered in 11 patients and unaltered in 19 patients. The neourethra was then reconstructed using the Snodgrass TIP technique. Follow-up urethral calibration was performed to assess the results. All patients were discharged same day postoperatively. All patients were followed up at 1 week, 3 weeks, 6 weeks, 3 months, 6 months and 1 year. Patients were contacted in June/July 2005 and brought back for re-evaluation of the results.
Results:
The cosmetic and functional results were satisfactory as judged by the parents. Overall complications were encountered in 7 patients (23%). Complications included six fistulae, five were associated with meatal stenosis and one with infection. Stand alone meatal stenosis occurred in three other cases of which only one required intervention. Fistula repair was successfully performed 6 months later in five patients with associated meatoplasty. One case had a revised repair. One case required meatotomy.
Conclusion:
The TIP procedure is a viable option with satisfactory cosmetic and functional results for the correction of a previously failed hypospadias repair.
