Application of modified grafted tubularized incised plate urethroplasty in hypospadias_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Shoufu , HU Yang , WU Yonglong , XU Bo ,  CHEN Haichen

Department of Pediatric Surgery, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen Fujian, 361003, P. R. China;

Corresponding?author：

CHEN Haichen, Email: jrwkwsf@sina.com

Keywords：

Hypospadias; glans grafted tubularized incised plate urethroplasty; child

DOI：

10.7507/1002-1892.202402085

Video：

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Objective To investigate the clinical feasibility and effectiveness of the modified grafted tubularized incised plate urethroplasty (G-TIP), namely “glans G-TIP (GG-TIP) ”, in treatment of hypospadias. Methods A clinical data of 137 children with hypospadias qualified by the selection criteria between January 2021 and June 2023 was retrospectively analyzed. Among them, 75 children were treated with GG-TIP (GG-TIP group) and 62 with G-TIP (G-TIP group). There was no significant difference (P>0.05) between the two groups in terms of age, hypospadias type, penile length, penile head width, penile head height, penile curvature, meatus-apex distance, urethral plate width, and distance from the distal endpoint of navicular groove to the dorsal or ventral midline point of the glans corona, and the difference between the two. The operation time, reconstructed urethral length, distance from meatus to ventral glans corona, postoperative complications, maximum urinary flow rate at 2 weeks after operation, and the hypospadias objective scoring evaluation (HOSE) score at 6 months after operation in the two groups were recorded and analyzed. Results The operation time was significantly shorter in GG-TIP group than in G-TIP group (P<0.05); but there was no significant difference (P>0.05) between the two groups in terms of reconstructed urethral length and distance from meatus to ventral glans corona. All urinary meatus located at the tip of glans with vertical fissure shape. All children in the two groups were followed up 6-35 months (median, 26 months). During follow-up, there were 3 cases of urethral fistula, 2 cases of urethral stricture, and 1 case of glans separation in GG-TIP group, and 3, 3, and 1 cases in the G-TIP group, respectively. There was no significant difference in the incidence of complications between the two groups (P>0.05). The maximum urinary flow rate at 2 weeks and the HOSE score at 6 months after operation were significantly higher in GG-TIP group than in G-TIP group (P<0.05). Conclusion GG-TIP is safe and effective for repairing hypospadias in children. Compared with G-TIP, it has the advantages of relatively simple operation, shortened operation time, significant improvement in urinary flow rate, and better cosmetic results.

Citation： WANG Shoufu, HU Yang, WU Yonglong, XU Bo, CHEN Haichen. Application of modified grafted tubularized incised plate urethroplasty in hypospadias. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(9): 1092-1097. doi: 10.7507/1002-1892.202402085 Copy

1.	European Association of Urology. EAU guidelines on pediatric urology [R/OL]. [2024-08-05]. https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Paediatric-Urology-2023.pdf.
2.	Bush NC, Villanueva C, Snodgrass W. Glans size is an independent risk factor for urethroplasty complications after hypospadias repair. J Pediatr Urol, 2015, 11(6): 355.e1-355.e5.
3.	Kolon TF, Gonzales ET Jr. The dorsal inlay graft for hypospadias repair. J Urol, 2000, 163(6): 1941-1943.
4.	Ali MM, Anwar AZ, Mohamed MS, et al. Comparative outcomes among inlay grafted incised plate, onlay preputial flap and tubularized incised plate urethroplasty for the repair of distal penile hypospadias with a narrow urethral plate. World J Urol, 2023, 41(12): 3643-3650.
5.	Silay MS, ’t Hoen L, Bhatt N, et al. Are there any benefits of using an inlay graft in the treatment of primary hypospadias in children? A systematic review and metanalysis. J Pediatr Urol, 2021, 17(3): 303-315.
6.	王學軍, 陳海琛, 潮敏, 等. 青春期前尿道下裂解剖數據測量: 多中心病例系列研究. 中國修復重建外科雜志, 2023, 37(2): 189-195.
7.	Holland AJ, Smith GH, Ross FI, et al. HOSE: an objective scoring system for evaluating the results of hypospadias surgery. BJU Int, 2001, 88(3): 255-258.
8.	Gupta V, Yadav SK, Alanzi T, et al. Grafted tubularised incised-plate urethroplasty: An objective assessment of outcome with lessons learnt from surgical experience with 263 cases. Arab J Urol, 2016, 14(4): 299-304.
9.	王壽福, 陳海琛, 胡楊, 等. 游離包皮內板尿道板頭段鑲嵌-尿道板縱切卷管尿道成形術在尿道下裂中的應用. 臨床泌尿外科雜志, 2023, 38(3): 184-187.
10.	Abbas TO, Pippi Salle JL. When to graft the incised plate during tip repair? A suggested algorithm that may help in the decision-making process. Front Pediatr, 2018, 6: 326. doi: 10.3389/fped.2018.00326.
11.	Abbas TO, Braga LH, Spinoit AF, et al. Urethral plate quality assessment and its impact on hypospadias repair outcomes: A systematic review and quality assessment. J Pediatr Urol, 2021, 17(3): 316-325.
12.	Seleim HM, ElSheemy MS, Abdalazeem Y, et al. Comprehensive evaluation of grafting the preservable narrow plates with consideration of native plate width at primary hypospadias surgery. J Pediatr Urol, 2019, 15(4): 345.e1-345.e7.
13.	Zhang B, Ruan S, Bi Y. Urethral plate in tubularized incised plate urethroplasty: how wide is enough? Transl Androl Urol, 2021, 10(2): 703-709.
14.	Bush NC, Snodgrass W. Pre-incision urethral plate width does not impact short-term Tubularized Incised Plate urethroplasty outcomes. J Pediatr Urol, 2017, 13(6): 625.e1-625.e6.
15.	Snodgrass W, Bush N. TIP hypospadias repair: A pediatric urology indicator operation. J Pediatr Urol, 2016, 12(1): 11-18.
16.	Nguyen MT, Snodgrass WT. Effect of urethral plate characteristics on tubularized incised plate urethroplasty. J Urol, 2004, 171(3): 1260-1262.
17.	Asanuma H, Satoh H, Shishido S. Dorsal inlay graft urethroplasty for primary hypospadiac repair. Int J Urol, 2007, 14(1): 43-47.
18.	Bleustein CB, Esposito MP, Soslow RA, et al. Mechanism of healing following the Snodgrass repair. J Urol, 2001, 165(1): 277-279.
19.	Perera M, Jones B, O’Brien M, et al. Long-term urethral function measured by uroflowmetry after hypospadias surgery: comparison with an age matched control. J Urol, 2012, 188(4 Suppl): 1457-1462.
20.	Elbakry A, Hegazy M, Matar A, et al. Tubularised incised-plate versus tubularisation of an intact and laterally augmented plate for hypospadias repair: A prospective randomised study. Arab J Urol, 2016, 14(2): 163-170.
21.	Xu Y, He Y, Wang H, et al. Widening of narrow urethral plates with lateral skin in TIP hypospadias repair: single center series. BMC Surg, 2024, 24(1): 104. doi: 10.1186/s12893-024-02400-8.
22.	Zhang T, Cao X, Yan X, et al. Spongioplasty with Buck's fascia covering dorsal inlay graft urethroplasty for primary hypospadias repair. J Pediatr Urol, 2023, 19(3): 291.e1-291.e6.

1. European Association of Urology. EAU guidelines on pediatric urology [R/OL]. [2024-08-05]. https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Paediatric-Urology-2023.pdf.
2. Bush NC, Villanueva C, Snodgrass W. Glans size is an independent risk factor for urethroplasty complications after hypospadias repair. J Pediatr Urol, 2015, 11(6): 355.e1-355.e5.
3. Kolon TF, Gonzales ET Jr. The dorsal inlay graft for hypospadias repair. J Urol, 2000, 163(6): 1941-1943.
4. Ali MM, Anwar AZ, Mohamed MS, et al. Comparative outcomes among inlay grafted incised plate, onlay preputial flap and tubularized incised plate urethroplasty for the repair of distal penile hypospadias with a narrow urethral plate. World J Urol, 2023, 41(12): 3643-3650.
5. Silay MS, ’t Hoen L, Bhatt N, et al. Are there any benefits of using an inlay graft in the treatment of primary hypospadias in children? A systematic review and metanalysis. J Pediatr Urol, 2021, 17(3): 303-315.
6. 王學軍, 陳海琛, 潮敏, 等. 青春期前尿道下裂解剖數據測量: 多中心病例系列研究. 中國修復重建外科雜志, 2023, 37(2): 189-195.
7. Holland AJ, Smith GH, Ross FI, et al. HOSE: an objective scoring system for evaluating the results of hypospadias surgery. BJU Int, 2001, 88(3): 255-258.
8. Gupta V, Yadav SK, Alanzi T, et al. Grafted tubularised incised-plate urethroplasty: An objective assessment of outcome with lessons learnt from surgical experience with 263 cases. Arab J Urol, 2016, 14(4): 299-304.
9. 王壽福, 陳海琛, 胡楊, 等. 游離包皮內板尿道板頭段鑲嵌-尿道板縱切卷管尿道成形術在尿道下裂中的應用. 臨床泌尿外科雜志, 2023, 38(3): 184-187.
10. Abbas TO, Pippi Salle JL. When to graft the incised plate during tip repair? A suggested algorithm that may help in the decision-making process. Front Pediatr, 2018, 6: 326. doi: 10.3389/fped.2018.00326.
11. Abbas TO, Braga LH, Spinoit AF, et al. Urethral plate quality assessment and its impact on hypospadias repair outcomes: A systematic review and quality assessment. J Pediatr Urol, 2021, 17(3): 316-325.
12. Seleim HM, ElSheemy MS, Abdalazeem Y, et al. Comprehensive evaluation of grafting the preservable narrow plates with consideration of native plate width at primary hypospadias surgery. J Pediatr Urol, 2019, 15(4): 345.e1-345.e7.
13. Zhang B, Ruan S, Bi Y. Urethral plate in tubularized incised plate urethroplasty: how wide is enough? Transl Androl Urol, 2021, 10(2): 703-709.
14. Bush NC, Snodgrass W. Pre-incision urethral plate width does not impact short-term Tubularized Incised Plate urethroplasty outcomes. J Pediatr Urol, 2017, 13(6): 625.e1-625.e6.
15. Snodgrass W, Bush N. TIP hypospadias repair: A pediatric urology indicator operation. J Pediatr Urol, 2016, 12(1): 11-18.
16. Nguyen MT, Snodgrass WT. Effect of urethral plate characteristics on tubularized incised plate urethroplasty. J Urol, 2004, 171(3): 1260-1262.
17. Asanuma H, Satoh H, Shishido S. Dorsal inlay graft urethroplasty for primary hypospadiac repair. Int J Urol, 2007, 14(1): 43-47.
18. Bleustein CB, Esposito MP, Soslow RA, et al. Mechanism of healing following the Snodgrass repair. J Urol, 2001, 165(1): 277-279.
19. Perera M, Jones B, O’Brien M, et al. Long-term urethral function measured by uroflowmetry after hypospadias surgery: comparison with an age matched control. J Urol, 2012, 188(4 Suppl): 1457-1462.
20. Elbakry A, Hegazy M, Matar A, et al. Tubularised incised-plate versus tubularisation of an intact and laterally augmented plate for hypospadias repair: A prospective randomised study. Arab J Urol, 2016, 14(2): 163-170.
21. Xu Y, He Y, Wang H, et al. Widening of narrow urethral plates with lateral skin in TIP hypospadias repair: single center series. BMC Surg, 2024, 24(1): 104. doi: 10.1186/s12893-024-02400-8.
22. Zhang T, Cao X, Yan X, et al. Spongioplasty with Buck's fascia covering dorsal inlay graft urethroplasty for primary hypospadias repair. J Pediatr Urol, 2023, 19(3): 291.e1-291.e6.

Chinese Journal of Reparative and Reconstructive Surgery

Application of modified grafted tubularized incised plate urethroplasty in hypospadias

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