Tubularized-incised urethral plate urethroplasty: is regular dilatation necessary for success?

Abstract

Objectives: To report the results of the tubularized-incised urethral plate repair of hypospadias.

Patients and methods: Twenty-seven patients (mean age 8 years, range 6-18) had their hypospadias corrected using the tubularized-incised urethral plate technique. Five patients had glanular, 16 had coronal, and two had recurrent hypospadias after a failed Mathieu repair, and four patients required a second-stage repair. The urethral plate was incised in the midline and tubularized over a suitably sized stent. In patients who required second-stage repair a Thiersch-Duplay neourethra was constructed from the hypospadiac orifice to the corona and the glanular urethra was constructed by tubularization of the incised urethral plate.

Results: The functional and cosmetic results were excellent. Of the first seven patients, four had a small fistula associated with meatal stenosis. By regular dilatation of the glanular urethra, all fistulae resolved spontaneously. Dilatation was instituted in all the remaining patients and no fistula or meatal stenosis occurred. Other complications included haematoma formation in one patient, urinary tract infection in another and frequent bladder spasm in two.

Conclusions: The tubularized-incised urethral plate urethroplasty is a simple and versatile technique that provides an excellent cosmetic appearance of the glans. It can be applied not only for the primary repair of distal hypospadias, but also for re-operation of recurrent hypospadias. The technique is ideal for constructing a glanular urethra when the Thiersch-Duplay operation is used to repair posterior hypospadias. Regular urethral dilatation is important in preventing adhesions between both sides of the incised plate, which can result in meatal stenosis and fistula.