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Category: Volume 06 Issue 05 May 2018
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Title: Snodgrass (Tubularized Incised Plate) Urethroplasty better then Mathieu’s Flip Flap and Onlay Flap for Hypospadias with Intact Urethral Plate?

Authors: Dr Deepti B Sharma, Dr Ravikant Mahant*, Dr Fanindra S. Solanki, Dr V.K.Raina, Dr Dhananjay Sharma

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i5.157

Abstract

Introduction: Hypospadias is a congenital anomaly, for which number of procedures had been described. We compared Mathieu’s flip flap, Onlay transverse preputial flap urethroplasties with Tubularized incised plate urethroplasty (TIP) as described by Snodgrass. This had been reported with the better results of meatal cosmesis and lesser complication rates.

Methods: These three procedures were done in patients, who had coronal, subcoronal, distal penile hypospadias, mid penile and proximal penile hypospadias in which urethral plate was not removed for the chordee correction. Following points were assessed. Meatal stenosis, Urethrocutaneous Fistula, Penile edema, Glanuar dehiscence ,Wound dehiscence

Results: Total 74 boys with mean age 6.22 years ± 4.26 were included in this study  Mathieu’s urethroplasty (n=14), Onlay (n= 23) and Snodgrass TIP urethroplasty (n=37) . Meatal stenosis occur in one patient each in Mathieu’s and Onlay procedure as compared to Snodgrass TIP (n= 7) out of which 6 patients improved later on, with meatal dilatation. 15 patients developed fistula in TIP repair as compare to total 12 patients in Mathieu’s and Onlay procedure. Five patients had dehiscence of glans in Mathieu, and Onlay procedure as compared to Snodgrass procedure in which none of the patients had glans dehiscence and it is statistically significant (P < 0.05).

Overall complication rate came out to be 24.3 % in TIP procedure as compare to 32.4% in Mathieu’s and Onlay procedure in combined. It was found that chances of improvement in TIP were higher by 48.33%.

Conclusion: It is concluded that TIP is as good as Mathieu’s and Onlay procedure with slight advantage of its use in reoperative surgery and cosmetic look and high chances of improvement in TIP.

Keywords: Mathieu’s flip flap; Onlay transverse preputial flap urethroplasty; Tubularized incised plate urethroplasty (TIP).

References

  1. Mathieu P : Traitment en un temps de l’hypospadias balanigue ou juxtabalanique, Journal de Chirurgie. 1932;39:481-86. (Cross reference ).
  2. Smith DR : Repair of hypospadias in the preschool children a report of 150 cases, J Urol 1967;97:723-29.
  3. Duckett JW: The current hype in hypo-spadiology. Br.Jr.Urology,1995;76:1-7.
  4. Rich M.A., M.A. Keating, H.McC. Synder, J.W. Duckett. : Hinging the urethral plate in hypospadias meatoplasty. Jr. of Urol. 1989;142:1551-53.
  5. Snodgrass W.: Tubalarized incised plate urethralplasty for distal hypospadias. Jr. Urol. 1994;151:464-65.
  6. Ghali AMA, Hypospadias repair by skin flaps, a comparison of Onlay preputial island flaps with either Mathieu’s meatal based or Ducketttubularized preputial flaps. BJU Int. 1999;83:1032-38.
  7. Snodgrass W. : Tubularized incised plate [TIP] hypospadias repair, UrolClin. N. Am. 2002;29:285-290.
  8. Guo Y, Ma G, Ge Z : Comparison of the Mathieu and the Snodgrass urethroplasty in distal hypospadias repair. Zhonghua Nan KeXue, 2004;10(2):916-8
  9. Robert E Steckler, MR Zaontz : Stent Free thiersch –Duplay hypospadias repair with Snodgrass modification, Jr. Urol. 1997;158:1178–80.
  10. Jonathan H. Ross, Robert Kay : Use of de-epithelialized local skin flap in hypospadias repair accomplished by Tubularization of the incised urethral plate. Urol. 1997;50(1):110-112.
  11. Tonvichein L, NiramisR : TIP in Hypospadias repair, experience of Queen Sinkit National J. Med. Asso. Thai. 86 Suppl. 2003;5522-30.
  12. Lorenzo AJ, W.T. Snodgrass : Regular dilatation is unnecessary after tubularized incised plate hypospadias repair. BJU Int. 2002;89:94-97.
  13. Snodgrass W.T., A. Lorenzo :Tubularized incised plate urethroplasty for proximal hypospadias. BJU Int. 2002;89:90-91.
  14. Oswald J., I. Kornen, M. Riccabona : Comparison of perimeatal based flap (Mathieu) and the tubularized incised plate urethroplasty (Snodgrass) in primary distal hypospadias. BJU Int.. 2000;85:725-27.
  15. Snodgrass W., M. Koyle, G. Monzoni et al :Tubularized incised plate hypospadias repair : results of a multicenter experience. Jr. of Urol, 1996;156:836-41.
  16. Sugarman I.D., J. Trevett, P.S. Malone: Tubularization of the incised urethral plate [Snodgrass procedure] for primary hypospadias surgery. BJU Int. 1999;83:88-90.
  17. Soliman SM: A naturally appearing glanular meatus after Mathieu’s repair combined with Snodgrass incision hinge of plate. Saudi Med J. 2003;24(5 Suppl):5.50.
  18. Kiss A, Nyirady P, Pirot L, Merksz M : Combined use of Mathieu’s with midline incision of urethral plate in Hypospadias repair. Eur J. Paed. Surg. 2003;13(6):383-5.

Corresponding Author

Dr Ravikant Mahant

Department of Surgery, NSCB Medical College, Jabalpur, MP India