One-stage “tip+inlay graft” method of urethroplasty for patiens with distal and mid shaft hypospadias

Rudin Yu.E., Maruhnenko D.V., Bachiev S.V., Makeev R.N., Garmanova T.N.

Purpose. The little size of penile glans is one of the problem hypospadias corrections. We reviewed our experience in one-stage distal hypospadias repair. Between January 2006 and October 2009, 185 boys, (age range 0,5- 17 years) underwent urethroplasty. The patients had different forms (coronal – 105, distal penile -57 and mid shaft penile – 23) of hypospadias. All patients were divided into two groups. The first group included 89 boys with one-stage onlay island flap (16), TIP tubularized incised plate (73) hypospadias repair. The second group included 96 patients with one-stage TIP+INLAY method hypospadias correction. We performed the standard TIP procedure with vertical relaxing incision widens the urethral plate. The surface of being incised plate was covered with the prepucial skin graft. The preputial graft was connected with the glans by 5-6 absorbable sutures. Urethral plate is tubularized with a two-layer running subepithelial absorbable sutures. The entire neourethra was covered with two lays of deepithelized prepucial skin flaps Follow up is 6 months to 3 years. Cosmetic and functional results were satisfactory in the majority of patients. Complications included in the first group – 15 fistulae (16,8%) combined with 8 meatal or urethral stenosies (8,9%). The patients of the second group (one stage inlay procedure) had fistulas only in 5 cases (5,2%) without stenosis, with normal peak flow. The fistulae were closed 6 month after the first operation. Urethral stenosis was successfully treated with the help of short urethral stents. Conclusions. The procedure with vertical relaxing incision widens the urethral plate added with “inlay graft” method (covered incised plate with the prepucial skin graft) help to perform the urethroplastic to patients with hypospadias and little size of glans penis. The patients of the second group had a nice cosmetic results, the incidence of postoperative fistulas was particularly low.

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