Michael T Nguyen1, Warren T Snodgrass. 1. Division of Pediatric Urology, Children's Medical Center and The University of Texas Southwestern Medical Center, Dallas, Texas 75235-9142, USA.
Abstract
PURPOSE: We report our updated experience with tubularized incised plate hypospadias reoperations in a series of patients of whom the majority had undergone prior urethral plate incision. MATERIALS AND METHODS: Records of 31 consecutive patients undergoing tubularized incised plate reoperation were reviewed. The decision for this repair was based on a preserved urethral plate that appeared supple despite prior surgery. RESULTS: Of the 31 patients the mean number of prior operations was 1.1, including 18 (58%) who had undergone primary repairs that involved midline plate incision. Overall, 28 (90%) patients had a successful outcome with a functional neourethra and vertical slit meatus. Complications occurred in 7 (23%) patients, consisting mostly of fistulas. Among 27 cases in which dartos was used as a barrier layer fistulas occurred in 1 (6%) of 18 when a ventral flap was placed over the neourethra versus 3 (33%) of 9 when adjacent tissues alongside the neourethra were approximated in the midline (p = 0.055). The rate of complications was not affected by history of urethral plate incision. In 3 patients partial or complete glans dehiscence or a large fistula occurred, and 2 subsequently required staged buccal graft urethroplasty. CONCLUSIONS: Tubularized incised plate reoperation results in a functional neourethra with a vertical slit meatus when the plate has been preserved and appears supple after prior surgery. Fistulas are less likely when a flap is interposed between the neourethra and skin. Complications are low despite previous urethral plate incision if there is no apparent scarring of the plate. An alternative technique for reoperative urethroplasty should be considered if the urethral plate has been excised or is grossly scarred.
PURPOSE: We report our updated experience with tubularized incised plate hypospadias reoperations in a series of patients of whom the majority had undergone prior urethral plate incision. MATERIALS AND METHODS: Records of 31 consecutive patients undergoing tubularized incised plate reoperation were reviewed. The decision for this repair was based on a preserved urethral plate that appeared supple despite prior surgery. RESULTS: Of the 31 patients the mean number of prior operations was 1.1, including 18 (58%) who had undergone primary repairs that involved midline plate incision. Overall, 28 (90%) patients had a successful outcome with a functional neourethra and vertical slit meatus. Complications occurred in 7 (23%) patients, consisting mostly of fistulas. Among 27 cases in which dartos was used as a barrier layer fistulas occurred in 1 (6%) of 18 when a ventral flap was placed over the neourethra versus 3 (33%) of 9 when adjacent tissues alongside the neourethra were approximated in the midline (p = 0.055). The rate of complications was not affected by history of urethral plate incision. In 3 patients partial or complete glans dehiscence or a large fistula occurred, and 2 subsequently required staged buccal graft urethroplasty. CONCLUSIONS: Tubularized incised plate reoperation results in a functional neourethra with a vertical slit meatus when the plate has been preserved and appears supple after prior surgery. Fistulas are less likely when a flap is interposed between the neourethra and skin. Complications are low despite previous urethral plate incision if there is no apparent scarring of the plate. An alternative technique for reoperative urethroplasty should be considered if the urethral plate has been excised or is grossly scarred.