Tubularisation in Hypospadias Repair: Is it Essential or Necessary?

Sir,

Here, we describe the feasibility of buried strip along with tunica vaginalis flap (TVF) in urethroplasty without tubularization in distal penile hypospadias with bad plates.

PROCEDURE

The Institute of Ethical Committee approved to study the files of 72 children [Table 1]. “U-” shaped incision was made encompassing both the hypospadiac meatus, and on both sides of so-called bad plate or tissue intended to be urethra (TITBU). Distal incision was made on the margins of “cleft meatus” to create a rectangular TITBU[1] separated from the rest of the penile skin after degloving. Another midline incision was made on the glandular urethral plate at “cleft meatus” to accommodate the urethral catheter to avert tension of stitches following glanuloplasty as well as for the “hinging”[2] of the glandular urethral plate [Figure 1] as well as to get vertical meatus at follow-up. Following that, the incision was made at the junction of inner pinkish and outer prepuce[3] to deglove the penis. Outer preputial skin was then rotated toward ventrum. The catheter was fixed over the island of TITBU with few tie-over stitches with 4-0 catgut. Glans wings were created by dissecting the tissue cleavage of Buck's fascia and glans. Following that, TVF harvested from testis[4] was wrapped over the catheterized urethral plate. Glans wings were stitched subcutaneously with 5-0 polyglycolic to cover TITBU, catheter, and TVF.

Table 1

Patients’ profile and outcome

Total number of patients	72
Age of patient	8 months-12 years
Local application of testosterone gel	64
Good response with testosterone gel	46
Follow-up period (months)	5-120
Uroflowmetry within normal range	29
Uroflowmetry within single SD range	43
Meatal stenosis	2 (all cured on regular calibration)
Vertical meatus	In 66 patients
Suture track fistula	6
Medium size fistula	5
Glans dehiscence	1
Re-operation	6

SD: Standard deviation

Figure 1

Tunica vaginalis flap over tissue intended to be urethra and catheter

Urethral catheters were removed after 7 days or earlier if there was any pericatheter leakage of urine with or without uncomfortable bladder spasm.

RESULTS

Two suture tract fistulas out of six were cured by regular dilation and four by “needling.”[5] Six patients (8%) needed further operations for repair of medium size fistula and glans dehiscence [Table 1].

CONCLUSION

Tubularization is good for the urethroplasty in hypospadias with good plate. Nevertheless, the concept of buried strip urethroplasty seems to be viable and effective by the amalgamation of TVF as vascular layers.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.