Nonstented tubularized incised plate urethroplasty with Y-to-I spongioplasty in non–toilet trained children

Authors

  • Fayez Almodhen Montreal Children’s Hospital, McGill University, Montréal, QC
  • Ahmed Alzahrani Montreal Children’s Hospital, McGill University, Montréal, QC
  • Roman Jednak Montreal Children’s Hospital, McGill University, Montréal, QC
  • Jean Paul Capolicchio Montreal Children’s Hospital, McGill University, Montréal, QC
  • Mohamed T. El Sherbiny Montreal Children’s Hospital, McGill University, Montréal, QC

DOI:

https://doi.org/10.5489/cuaj.484

Abstract

Introduction: This study was designed to evaluate the supportive role of spongioplasty
during tubularized incised plate (TIP) urethroplasty repair of hypospadias.

Methods: All non–toilet trained children who underwent TIP repair for primary
hypospadias by 1 surgeon over a 30-month period were included in
our study. The divergent spongiosa was mobilized off the corpora cavernosa
and was rotated toward the midline to wrap the neourethra. A dartos flap
was used to cover the neourethra. The neourethra was calibrated immediately
after surgery in all patients. A urethral stent was left in place only when difficult
calibration was encountered. Complications and cosmetic appearance were
documented at last follow-up.

Results: Thirty-two consecutive patients with a mean age of 18 (standard deviation
[SD] 6) months were included in the study. The defects were distal and
mid-shaft in 26 patients (81.3%) and proximal-shaft in 6 (18.8%). No intraoperative
catheterization difficulties were encountered and all repairs were nonstented.
Antibiotics and anticholinergics were not required. Mean follow-up was
9 (SD 6) months. Urinary extravasation developed in 1 patient (3.1%) on the second
postoperative day. A urethral catheter was easily inserted and left indwelling
for 5 days. One patient presented 6 days postoperatively with suspected voiding
difficulty. Urethral calibration was easily performed excluding any mechanical
obstruction. There were no urinary fistulae and reoperation was not required.
An excellent cosmetic appearance was achieved in all patients.

Conclusion: TIP urethroplasty is a versatile operation that can be performed in
almost all cases of penile hypospadias. A nonstented technique for hypospadias
repair simplifies postoperative care and obviates the need for antibiotics
and anticholinergics. We believe that spongioplasty provides good support
to the neourethra and the hypoplastic distal urethra that may facilitate catheterization
in the immediate and early postoperative periods, if required. Future
controlled study is warranted to further evaluate the role of spongioplasty.

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Author Biographies

Fayez Almodhen, Montreal Children’s Hospital, McGill University, Montréal, QC

Ahmed Alzahrani, Montreal Children’s Hospital, McGill University, Montréal, QC

Roman Jednak, Montreal Children’s Hospital, McGill University, Montréal, QC

Jean Paul Capolicchio, Montreal Children’s Hospital, McGill University, Montréal, QC

Mohamed T. El Sherbiny, Montreal Children’s Hospital, McGill University, Montréal, QC

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How to Cite

Almodhen, F., Alzahrani, A., Jednak, R., Capolicchio, J. P., & El Sherbiny, M. T. (2013). Nonstented tubularized incised plate urethroplasty with Y-to-I spongioplasty in non–toilet trained children. Canadian Urological Association Journal, 2(2), 110–14. https://doi.org/10.5489/cuaj.484

Issue

Vol. 2 No. 2 (2008): CUAJ April

Section

Original Research

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