Faizan Ahmed, Muhammad Sarwar Alvi, Shahid Mehmood Rana.
Tubularized incised plate Urethroplasty for various types of Hypospadias.
Pak Armed Forces Med J Jan ;57(1):56-60.

Objective: To report out short term results of hypospadias repair using Tubularised Incised Plate (TIP) Urethroplasty as described by Snodgrass for various types of hypospadias. Patients and Methods: A cohort of 62 patients comprising various types of hypospadias (62% distal penile, 30% mid penile and 8% proximal penile) underwent Snodgrass repair by one surgeon (FA.) from June 2001 to November 2005. Age of the patients ranged from 1 to 20 years, the modal age being 3.2 years. There was no chordee in 90% of the cases whereas mild to moderate chordee was present in the remaining 10%. Urethroplasty was done by tubularization of the incised urethral plate as described by Snodgrass with coverage of the suture line by vasclarized dartos layer for water proofing. Chordee, if persisted after degloving of the penis, was corrected by dorsal placation. Patients were followed postoperatively on day 5, one month and subsequently on three monthly basis for a year. Result: On the mean follow up of six months 46 patients (74%) achieved good functional and cosmetic results, with normal looking penis and ability to void urine with good forwardly directed stream. Complications were observed in 16 patients (26%). The most common complication was urethrocutaneous fistula in 14 (22%). Out of these 8 patients had minor leak which closed without requiring any further surgical intervention by regular urethral dilatation. The remaining 6 patients required re-operation for closure of the fistula. 2 patients had glans dehiscence which required re-operation 6 months later. Another 2 patients developed meatal stenosis which settled with regular post-op dilatation. So, the complications requiring surgical intervention was seen in 8 patients only. Conclusion: TIP Urethroplasty is a simple single stage procedure applicable for the majority of the hypospadias including mid and proximal hypospadias and redo cases where urethral plate is intact. It provides excellent functional neo-urethra, cosmetically normal looking glans and vertically oriented slit like meatus with lesser complication as compared to other single stage procedures.

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