Clinical Study On Modified Sondgrass Procedure In Hypospadias Repair

Objectives:The tubularized incised-plate (TIP) urethroplasty is gaining an ever increasing popularity in hypospadias repair because of its low complication rates and favorable cosmetic and functional results published in recent years. A retrospective review of 107 patients who had TIP and its modified procedure for the primary repair of hypospadias at the Genernal Hospital of GuangZhou Military Command was performed to objectively assess the clinical outcomes of this technique.Methods:All 107 patients having a TIP urethroplasty and its modified procedure for the primary repair of hypospadias between January 2005 and September 2008 were requested to attend for review in an independent clinic. The median age at the time of surgical repair was 4.8 years old (11 months to 18 years). The position of the meatus was distal in 24 boys (38%), middle in 28 (17%) and posterior in 34 (45%) according to Barcat classification. The severity of chordee was graded according to the etiological classification on chordee without hypospadias.Cases which could not be performed with TIP or finished in one stage would be turned to other procedures or be performed in two stages. Postoperatively temporary urine diversion was carried out with suprapubic and urethral stent tube for about 8-14days.Results:TIP and its modified urethroplasty were carried out in 107 patients. All patients were followed up after surgical repair for 2~26 months (median 14 months). Average opreation time was 165.2±28.0 min ,while the average duration in hospital was 13±3.5days. Of the 107 patients, 86(80.4%) were successful cured, obtaining a neourethra with slit-like meatus at the tip of the glans and satisfactory voiding function. Small urethrocutaneous fistula occurred in fifteen (14.0%) cases, including nine at the coronary sulcus, one at the shaft, five at the penoscrotum. Two patients (1.8%) developed mild meatal stenosisand were successfully managed by simple treatment. Four patients(3.7%)were found with mild and persistent penile curvature postoperatively, reccurent chordee was found inone boy a year after TIP procedure, and corrected by a second surgery. Urethral stricture and dehiscence were not encountered so far.Chordee correction was performed in twenty-nine patients(27.1%)with the dorsal plication suture.Four patients with posterior hypospadias and serious chordee were treated by alternative procedures with transection of the urethral plate in two stages.,while TIP combined with Duckett urethroplasty were used for the treatment of two boys with scrotal hypospadias.Conclusions: The results of TIP and its modified urethroplasty are versatile to most types of hypospadias ,also they are satisfactory with the benefit of a cosmetic final outcome similar to a circumcised penis. The results are irrespective of surgical age, hypospadiac meatal position and the method of urinary diversion.Beacuse the integral urethra plate was kept, urethral stricture is seldom occurred. Fistulas are reduced by using the double-breasted de-epithelialized skin of the modified TIP urethroplasty. Subcuticular suture is a versatile method and it provides satisfactory cosmetic outcome.TIP urethroplasty is contraindicated in posterior hypospadias with severe chordee(chordee more than 40°) caused by urethral tethering.