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Comparative Analysis of Tubularized Incised Plate Versus Onlay Island Flap Urethroplasty for Penoscrotal Hypospadias

2007; Lippincott Williams & Wilkins; Volume: 178; Issue: 4 Linguagem: Inglês

10.1016/j.juro.2007.05.170

1527-3792

Luis H. Braga, João L. Pippi Salle, Armando J. Lorenzo, Sean Skeldon, Sumit Davé, Walid A. Farhat, Antoine E. Khoury, Darius Bägli,

Urinary and Genital Oncology Studies

No AccessJournal of UrologyPediatric urology1 Oct 2007Comparative Analysis of Tubularized Incised Plate Versus Onlay Island Flap Urethroplasty for Penoscrotal Hypospadias Luis H.P. Braga, Joao L. Pippi Salle, Armando J. Lorenzo, Sean Skeldon, Sumit Dave, Walid A. Farhat, Antoine E. Khoury, and Darius J. Bagli Luis H.P. BragaLuis H.P. Braga , Joao L. Pippi SalleJoao L. Pippi Salle , Armando J. LorenzoArmando J. Lorenzo , Sean SkeldonSean Skeldon , Sumit DaveSumit Dave , Walid A. FarhatWalid A. Farhat , Antoine E. KhouryAntoine E. Khoury , and Darius J. BagliDarius J. Bagli View All Author Informationhttps://doi.org/10.1016/j.juro.2007.05.170AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Despite being the dominant technique for repair of distal hypospadias, application of the tubularized incised plate approach for penoscrotal hypospadias remains controversial. We report our experience with severe hypospadias, comparing tubularized incised plate to transverse island flap onlay urethroplasty. Materials and Methods: We retrospectively reviewed consecutive patients with penoscrotal hypospadias presenting between 1998 and 2006. Based on surgeon preference 35 children underwent tubularized incised plate and 40 underwent onlay urethroplasty. Penoscrotal transposition and degree of ventral curvature, type of ventral curvature repair, complication rate, postoperative uroflowmetry pattern in toilet trained patients and number of reoperations were compared between the 2 groups. Results: Mean patient age at surgery was 17 months (range 9 to 91) for tubularized incised plate urethroplasty and 17.8 months (10 to 58) for the onlay procedure. Urethroplasty was performed over an 8Fr catheter in all patients. With mean followups of 30 months (range 6 to 74) and 38.8 months (16 to 80) the overall complication rates were 60% and 45% for the tubularized incised plate and onlay procedures, respectively. Fistula occurred in 15 patients and repair breakdown in 3 patients (total 51.4%) treated with tubularized incised plate repair, compared to 8 and 2 patients, respectively (25%), treated with onlay repair (p = 0.01). Fistula location also differed significantly between the 2 groups, with proximal fistulas occurring in 11 of 15 tubularized incised plate repairs (73.3%) vs 2 of 8 onlay repairs (25%, p = 0.02). Recurrent ventral curvature was more frequent after onlay urethroplasty (5.7% vs 12.5%, not significant). At a mean age of 5.1 years a plateau uroflow curve (vs normal bell curve) was observed in 16 of 24 children (66.7%) who underwent tubularized incised plate repair and in 7 of 21 (33.3%) who underwent onlay repair (p <0.01). Conclusions: In this series the overall complication rate was similar for tubularized incised plate and onlay urethroplasty. Despite similar urethroplasty calibers, the uroflow curves and fistula positions in patients undergoing tubularized incised plate repair suggest that the neourethra distal to the fistula may be relatively narrow, creating flow resistance and leading to proximal fistula. Longer followup and close monitoring are needed before embracing one approach over the other. References 1 : A multicenter evaluation of technical preferences for primary hypospadias repair. J Urol2005; 174: 2354. Link, Google Scholar 2 : Tubularized incised plate hypospadias repair for proximal hypospadias. J Urol1998; 159: 2129. Link, Google Scholar 3 : Further experience with the tubularized-incised urethral plate technique for hypospadias repair. BJU Int2002; 89: 291. 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Link, Google Scholar Division of Urology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada© 2007 by American Urological AssociationFiguresReferencesRelatedDetailsCited ByDeMarco R (2021) Hypospadias Surgery: Search for Elusive Perfection—Should We Re-Define Surgical Success to Improve Outcomes and Provide Reasonable Postoperative Expectations?Journal of Urology, VOL. 206, NO. 3, (505-506), Online publication date: 1-Sep-2021.Braga L, Jegatheeswaran K, McGrath M, Easterbrook B, Rickard M, DeMaria J and Lorenzo A (2016) Cause and Effect versus Confounding—Is There a True Association between Caudal Blocks and Tubularized Incised Plate Repair Complications?Journal of Urology, VOL. 197, NO. 3 Part 2, (845-851), Online publication date: 1-Mar-2017.Metzler I, Nguyen H, Hagander L, Jalloh M, Nguyen T, Gueye S, deVries C and Meara J (2014) Surgical Outcomes and Cultural Perceptions in International Hypospadias CareJournal of Urology, VOL. 192, NO. 2, (524-529), Online publication date: 1-Aug-2014.Castagnetti M, Zhapa E and Rigamonti W (2012) Primary Severe Hypospadias: Comparison of Reoperation Rates and Parental Perception of Urinary Symptoms and Cosmetic Outcomes Among 4 RepairsJournal of Urology, VOL. 189, NO. 4, (1508-1513), Online publication date: 1-Apr-2013.Chertin B, Natsheh A, Ben-Zion I, Prat D, Kocherov S, Farkas A and Shenfeld O (2013) Objective and Subjective Sexual Outcomes in Adult Patients after Hypospadias Repair Performed in ChildhoodJournal of Urology, VOL. 190, NO. 4S, (1556-1560), Online publication date: 1-Oct-2013.Wright I, Cole E, Farrokhyar F, Pemberton J, Lorenzo A and Braga L (2013) Effect of Preoperative Hormonal Stimulation on Postoperative Complication Rates After Proximal Hypospadias Repair: A Systematic ReviewJournal of Urology, VOL. 190, NO. 2, (652-660), Online publication date: 1-Aug-2013.Snodgrass W, Cost N, Nakonezny P and Bush N (2011) Analysis of Risk Factors for Glans Dehiscence After Tubularized Incised Plate Hypospadias RepairJournal of Urology, VOL. 185, NO. 5, (1845-1851), Online publication date: 1-May-2011.Leslie B, Jesus L, El-Hout Y, Moore K, Farhat W, Bägli D, Lorenzo A and Pippi Salle J (2011) Comparative Histological and Functional Controlled Analysis of Tubularized Incised Plate Urethroplasty With and Without Dorsal Inlay Graft: A Preliminary Experimental Study in RabbitsJournal of Urology, VOL. 186, NO. 4S, (1631-1637), Online publication date: 1-Oct-2011.Castagnetti M and El-Ghoneimi A (2010) Surgical Management of Primary Severe Hypospadias in Children: Systematic 20-Year ReviewJournal of Urology, VOL. 184, NO. 4, (1469-1475), Online publication date: 1-Oct-2010. Volume 178Issue 4October 2007Page: 1451-1457 Advertisement Copyright & Permissions© 2007 by American Urological AssociationKeywordsurinary fistulaurologic surgical proceduresinfantsmalesurgical flapshypospadiasMetricsAuthor Information Luis H.P. Braga More articles by this author Joao L. Pippi Salle More articles by this author Armando J. Lorenzo More articles by this author Sean Skeldon More articles by this author Sumit Dave More articles by this author Walid A. Farhat More articles by this author Antoine E. Khoury More articles by this author Darius J. Bagli More articles by this author Expand All Advertisement PDF DownloadLoading ...