Current Issue UroToday Int J. 2009 Oct;2(5). doi:10.3834/uij.1944-5784.2009.10.08
Reoperative Hypospadias Repair Based on Urethral Plate Status
INTRODUCTION: The purpose of the study was to determine the suitable procedure for redo hypospadias repair based on the status of the urethral plate.
METHODS: Thirty-five patients with failed hypospadias repair were evaluated regarding the status of the urethral plate, the meatus, residual chordee, and the available surrounding tissues. The mean patient age was 5.8 years (range, 2-12 years). At presentation, 25 patients had the meatus at the distal shaft, 8 at the midshaft, and 2 had complete neourethral stricture. The urethral plate appeared healthy and wide in 30 patients and narrow in 3 patients. All patients had a straight penis with single previous repair. The initial procedure was unknown in 15 patients and was the tubularized incised plate (TIP) procedure in 20 patients. Thirty patients underwent reoperation with TIP procedure, 3 had a Mathieu technique, and 2 had onlay island flap. After repair, cosmetic and functional outcomes were evaluated.
RESULTS: Mean follow-up was 23.2 months (range, 12-36 months). Complete wound dehiscence occurred in 3 (8.6%) cases that had the TIP procedure; they are awaiting further repair. No fistulae occurred. Twenty-seven patients had a vertical slit meatus at the tip of the glans and 5 had a rounded meatus. Calibration was satisfactory in all cases using 8-10 Fr plastic catheters. Uroflowmetry was done in 15 (46.9%) patients and found to be within normal limits, with a Q mean of 9.53 mL/s (range, 5-16 mL/s).
CONCLUSIONS: Redo TIP urethroplasty is effective and safe when the urethral plate is healthy. When the urethral plate is narrow or the neourethra is stenosed, other alternatives should be considered for repair.
KEYWORDS: Hypospadias; Reoperation; Urethral plate
CORRESPONDENCE: Mohamed Mostafa Hussein, MD., Urology Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt (mmhussein2007@yahoo.com).
CITATION: UroToday Int J. 2009 Oct;2(5). doi:10.3834/uij.1944-5784.2009.10.08
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