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      Use of tubularized incised plate urethroplasty for secondary hypospadias repair or repair in circumcised patients

      research-article
      1
      International braz j urol
      Sociedade Brasileira de Urologia
      urethroplasty, hypospadias, urethral plate, circumcision

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          Abstract

          PURPOSE: To retrospectively review our experience of the tubularized incised plate (TIP) urethroplasty in a series of re-operative hypospadias repairs or circumcised children. MATERIALS AND METHODS: Between September 2001 and September 2007, 17 children (mean 4.6 years, range 7 months to 15 years), were referred for hypospadias re-operation. Some of these patients had previously undergone circumcision and missed hypospadias. In all cases, the TIP urethroplasty was covered with an additional layer of subcutaneous tissue or dartos flap. The original location, associated complications and results were recorded. RESULTS: There were 4 (30.7%), incidences of complications of TIP re-operation, 2 meatal stenosis, one stenosis with small fistula and one dehiscence. Re-operation was necessary in only one patient of our series (7.6%) and the others were cured by dilatation. No complications occurred in the circumcised patents. CONCLUSION: Using TIP urethroplasty as described by Snodgrass, is a suitable method for treating primary and re-operative cases. It can also be used successfully in patients, who do not have a healthy skin flap and in circumcised patients when there is a lack of foreskin.

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          Most cited references22

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          Hypospadias repair in adults: adventures and misadventures.

          To evaluate long-term results and complications we reviewed the records of 42 consecutive men 18 to 47 years old (mean age 22.5) who underwent hypospadias repair between 1979 and 1999. The study population was divided into groups 1 consisting of 8 patients without previous hypospadias surgery, 2 consisting of 12 who underwent 1 or more procedures in childhood but in whom local tissue was relatively intact and 3 consisting of 22 who underwent multiple unsuccessful hypospadias repairs with various degrees of penile deformity and loss of local tissue. Complications were noted in 3 of 8 (37.5%), 5 of 12 (41.67%) and 14 of 22 (63.6%) patients in groups 1 to 3, including 3 (100%), 4 (80%) and 10 (71.4%), respectively, in whom secondary surgery was successful in the long term. A patient in group 2 and 2 in group 3 await further surgery, while 2 in group 3 were lost to followup. Overall primary complications developed in 22 of the 42 men (52.3%) and 5 of the 22 (22.7%) had secondary complications. There was long-term success in 37 of 42 cases (88.1%). The results of hypospadias repair in adulthood differ from the results of similar procedures in childhood. Although the various techniques are similar, there is clearly a difference in terms of wound healing, infection, complication rates and overall success. Adults undergoing hypospadias repair must be counseled on all of these variables to avoid unreasonable expectations.
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            Prior circumcision does not complicate repair of hypospadias with an intact prepuce.

            Hypospadias concealed by an intact prepuce is a concern to practitioners performing newborn circumcision, especially given reports that foreskin removal may complicate urethroplasty. However, distal hypospadias repair today less often relies on skin flaps, and some patients may have circumcision interrupted for suspected urethral anomalies when none is present. We evaluated outcomes in consecutive males with hypospadias and an intact prepuce to compare results of urethroplasty in those with vs without prior circumcision. A retrospective review of consecutive patients with hypospadias and an intact prepuce was performed. Patients circumcised before the urethral defect was recognized comprised group 1, while those presenting without circumcision comprised group 2. In all cases urethroplasty was accomplished by urethral plate tubularization without skin flaps, with coverage of the neourethra by a dartos flap. A total of 63 patients with hypospadias and an intact prepuce were operated on by one of us (WTS). Followup was at least 6 weeks for 36 of these patients, who comprised the study. There were no differences in age or followup among the 26 patients in group 1 compared to the 10 patients in group 2. The only complication was a fistula detected 4 years after surgery in a patient in group 1. Prior circumcision did not complicate subsequent hypospadias repair in males whose urethral anomaly was concealed by an intact prepuce. While circumcision should not be performed in newborns with obvious penile defects, it can be done in those with a normal foreskin without concern for the occasional discovery of hypospadias with an intact prepuce.
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              Buccal mucosa grafts for hypospadias surgery: long-term results.

              We review the long-term results of buccal mucosa grafts used as part of secondary hypospadias repair. We evaluated 47 patients for 10 years and analyzed long-term results of buccal mucosa grafts for hypospadias repair. Of the 47 patients 40 have been followed for more than 3 years. The overall complication rate was 32% (13 of 47 cases). All complications occurred in the first 6 months following surgery, and the complication rate was significantly lower in the last 7 years of the series (19%) compared to the first 3 years (60%) (p = 0.01). All 3 patients in this series with a preoperative diagnosis of balanitis xerotica obliterans had a significant postoperative complication. Buccal mucosa appears to be a durable source of nongenital tissue for urethral replacement. Attention to detail in terms of graft harvest, graft preparation and graft fixation helps to avoid major postoperative complications. Onlay grafts appear to be preferable to tube grafts, and patients with the diagnosis of balanitis xerotica obliterans would appear not to be candidates for 1-stage urethral reconstruction using buccal mucosa.
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                Author and article information

                Contributors
                Role: ND
                Journal
                ibju
                International braz j urol
                Int. braz j urol.
                Sociedade Brasileira de Urologia (Rio de Janeiro )
                1677-6119
                October 2008
                : 34
                : 5
                : 609-616
                Affiliations
                [1 ] Mazandaran University of Medical Sciences Iran
                Article
                S1677-55382008000500010
                10.1590/S1677-55382008000500010
                38f80ba2-7a18-4846-ad46-d9ff3dec4df1

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1677-5538&lng=en
                Categories
                UROLOGY & NEPHROLOGY

                Urology
                urethroplasty,hypospadias,urethral plate,circumcision
                Urology
                urethroplasty, hypospadias, urethral plate, circumcision

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