Incised plate urethroplasty in perineal and perineo-scrotal hypospadias

Abstract

Objective: The ideal replacement of the urethra is the urethra itself. However, when the urethra is not available, flaps or tubes are used as substitutes in  hypospadias repair. The urethral plate, when  preserved, is an excellent tool for tubularization and urethral reconstruction. Tubularized incise plate (TIP) repair has become increasingly popular for the treatment of proximal hypospadias, with encouraging results. The objective of this study was to assess the feasibility and results of TIP in perineal and perineo-scrotal hypospadias.

Subjects and methods: Out of a total of 262 hypospadias cases treated at our clinic between January 2006 and June 2010, 35 patients had perineal and perineo-scrotal hypospadias. Of these, 21 cases with a narrow and/or poorly developed urethral plate and residual curvature after penile degloving and urethral mobilization underwent hypospadias repair using proximal TIP combined with a distal Duckett tube made from the inner prepuce after transection of the urethral plate at the  corona. The present study was conducted on the remaining 14 cases treated with TIP alone. We retrospectively reviewed their case sheets, operative photographs and videos. Chordee was corrected by penile degloving and mobilization of the urethral plate with the corpus spongiosum, followed by proximal  urethral  mobilization with or without single-stitch dorsal plication. After incision of the urethral plate and tubularization, the neourethra was covered with a dorsal dartos/tunica flap. Two glanular wings were raised for glanuloplasty. Scrotoplasty was performed to cover the proximal urethra.

Results: The patients’ age ranged from 1 to 23 (mean 13) years. Of the 14 cases studied, 4 had perineoscrotal and 10 perineal hypospadias. Correction of the curvature was possible by penile degloving and urethral plate mobilization in 12 patients, while two required single-stitch dorsal plication. The length of the urethral plate varied from 5 to 16 (average 9) cm. The neourethra was covered with a dorsal dartos flap in nine and with a tunica vaginalis flap in six cases. None of the patients had residual curvature or stricture. Two patients developed a fistula which required re-do surgery.

Conclusions: Tubularized incised plate urethroplasty is an effective method for the repair of perineal and
perineo-scrotal hypospadias with an acceptable complication rate.