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Outcome of tubularized incised plate urethroplasty with spongioplasty alone as additional tissue cover: A prospective study.
Indian J Urol 2014; 30(4):392-7IJ

Abstract

INTRODUCTION

Additional cover after neourethra formation to decrease the fistula rate, has been described using the dartos, tunica, denuded skin and corpus spongiosum. The use of corpus spongiosum alone to cover the neourethra is infrequent. The objective of this study was to evaluate the efficacy of spongioplasty alone as an intervening layer in the prevention of urethral fistula following tubularized incised plate urethroplasty (TIPU).

MATERIALS AND METHODS

A prospective study was performed including 113 primary hypospadias cases undergoing TIPU with spongioplasty from June 2010 to March 2012. Correction of chordee was carried out by penile degloving alone in 5, mobilization of urethral plate with spongiosum in 22 and combination of both in 45 cases. Intra-operatively, spongiosum was taken to be poorly developed if it was thin and fibrous, moderate if good spongiosal tissue with good vascularization and well-developed if healthy robust spongiosum, which became bulkier than native spongiosum after tubularisation. Spongioplasty was done in a single layer after mobilization of spongiosum, starting just proximal to the native meatus and into the glans distally.

RESULTS

The mean age of the patients was 11.53 years. The type of hypospadias was distal, mid and proximal in 81, 12 and 20 cases respectively. Spongiosum was poorly developed in 13, moderate in 53 and well-developed in 47 cases. The mean hospital stay was 8-10 days and follow-up ranged from 6 months to 2 years. Urethral fistula was seen in six patients (11.3%) with moderate spongiosum (distal 1, mid 1 and proximal 4), and three (23.03%) with poorly developed spongiosum (one each in distal, mid and proximal) with an overall 7.96% fistula rate. None of the patients with well-developed spongiosum developed a fistula. Poorer spongiosum correlated with a greater number of complications (P = 0.011). Five out of thirteen cases with poor spongiosum (38.46%) had proximal hypospadias, i.e. more proximal was the hypospadias, poorer was the development of the spongiosum (P = 0.05). Meatal stenosis was seen in two patients (1.76%) with proximal hypospadias, one with moderate and the other with poorly developed spongiosum. More proximal was the hypospadias, greater were the number of complications (P = 0.0019).

CONCLUSION

TIPU with spongioplasty reconstructs a near normal urethra with low complications. Better developed and thicker spongiosum results in lower incidence of fistula and meatal stenosis. More proximal hypospadias is associated with poorer spongiosum. We recommend spongioplasty to be incorporated as an essential step in all patients undergoing tubularized incised-plate repair for hypospadias.

Authors+Show Affiliations

Department of Urology, S.P. Medical College, Bikaner, Rajasthan, India.Department of Urology, S.P. Medical College, Bikaner, Rajasthan, India.Department of Preventive and Social Medicine, S.P. Medical College, Bikaner, Rajasthan, India.Department of Urology, S.P. Medical College, Bikaner, Rajasthan, India.Department of Urology, S.P. Medical College, Bikaner, Rajasthan, India.Department of Urology, S.P. Medical College, Bikaner, Rajasthan, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25378820

Citation

Bhat, Amilal, et al. "Outcome of Tubularized Incised Plate Urethroplasty With Spongioplasty Alone as Additional Tissue Cover: a Prospective Study." Indian Journal of Urology : IJU : Journal of the Urological Society of India, vol. 30, no. 4, 2014, pp. 392-7.
Bhat A, Sabharwal K, Bhat M, et al. Outcome of tubularized incised plate urethroplasty with spongioplasty alone as additional tissue cover: A prospective study. Indian J Urol. 2014;30(4):392-7.
Bhat, A., Sabharwal, K., Bhat, M., Saran, R., Singla, M., & Kumar, V. (2014). Outcome of tubularized incised plate urethroplasty with spongioplasty alone as additional tissue cover: A prospective study. Indian Journal of Urology : IJU : Journal of the Urological Society of India, 30(4), pp. 392-7. doi:10.4103/0970-1591.134234.
Bhat A, et al. Outcome of Tubularized Incised Plate Urethroplasty With Spongioplasty Alone as Additional Tissue Cover: a Prospective Study. Indian J Urol. 2014;30(4):392-7. PubMed PMID: 25378820.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcome of tubularized incised plate urethroplasty with spongioplasty alone as additional tissue cover: A prospective study. AU - Bhat,Amilal, AU - Sabharwal,Karamveer, AU - Bhat,Mahakshit, AU - Saran,Ramakishan, AU - Singla,Manish, AU - Kumar,Vinay, PY - 2014/11/8/entrez PY - 2014/11/8/pubmed PY - 2014/11/8/medline KW - Additional tissue cover KW - complications KW - fistula KW - hypospadias KW - spongioplasty KW - urethroplasty SP - 392 EP - 7 JF - Indian journal of urology : IJU : journal of the Urological Society of India JO - Indian J Urol VL - 30 IS - 4 N2 - INTRODUCTION: Additional cover after neourethra formation to decrease the fistula rate, has been described using the dartos, tunica, denuded skin and corpus spongiosum. The use of corpus spongiosum alone to cover the neourethra is infrequent. The objective of this study was to evaluate the efficacy of spongioplasty alone as an intervening layer in the prevention of urethral fistula following tubularized incised plate urethroplasty (TIPU). MATERIALS AND METHODS: A prospective study was performed including 113 primary hypospadias cases undergoing TIPU with spongioplasty from June 2010 to March 2012. Correction of chordee was carried out by penile degloving alone in 5, mobilization of urethral plate with spongiosum in 22 and combination of both in 45 cases. Intra-operatively, spongiosum was taken to be poorly developed if it was thin and fibrous, moderate if good spongiosal tissue with good vascularization and well-developed if healthy robust spongiosum, which became bulkier than native spongiosum after tubularisation. Spongioplasty was done in a single layer after mobilization of spongiosum, starting just proximal to the native meatus and into the glans distally. RESULTS: The mean age of the patients was 11.53 years. The type of hypospadias was distal, mid and proximal in 81, 12 and 20 cases respectively. Spongiosum was poorly developed in 13, moderate in 53 and well-developed in 47 cases. The mean hospital stay was 8-10 days and follow-up ranged from 6 months to 2 years. Urethral fistula was seen in six patients (11.3%) with moderate spongiosum (distal 1, mid 1 and proximal 4), and three (23.03%) with poorly developed spongiosum (one each in distal, mid and proximal) with an overall 7.96% fistula rate. None of the patients with well-developed spongiosum developed a fistula. Poorer spongiosum correlated with a greater number of complications (P = 0.011). Five out of thirteen cases with poor spongiosum (38.46%) had proximal hypospadias, i.e. more proximal was the hypospadias, poorer was the development of the spongiosum (P = 0.05). Meatal stenosis was seen in two patients (1.76%) with proximal hypospadias, one with moderate and the other with poorly developed spongiosum. More proximal was the hypospadias, greater were the number of complications (P = 0.0019). CONCLUSION: TIPU with spongioplasty reconstructs a near normal urethra with low complications. Better developed and thicker spongiosum results in lower incidence of fistula and meatal stenosis. More proximal hypospadias is associated with poorer spongiosum. We recommend spongioplasty to be incorporated as an essential step in all patients undergoing tubularized incised-plate repair for hypospadias. SN - 0970-1591 UR - https://www.unboundmedicine.com/medline/citation/25378820/Outcome_of_tubularized_incised_plate_urethroplasty_with_spongioplasty_alone_as_additional_tissue_cover:_A_prospective_study_ L2 - http://www.indianjurol.com/article.asp?issn=0970-1591;year=2014;volume=30;issue=4;spage=392;epage=397;aulast=Bhat DB - PRIME DP - Unbound Medicine ER -