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

Abstract

Introduction: This study was designed to evaluate the supportive role of spongioplastyduring tubularized incised plate (TIP) urethroplasty repair of hypospadias.Methods: All non–toilet trained children who underwent TIP repair for primaryhypospadias by 1 surgeon over a 30-month period were included inour study. The divergent spongiosa was mobilized off the corpora cavernosaand was rotated toward the midline to wrap the neourethra. A dartos flapwas used to cover the neourethra. The neourethra was calibrated immediatelyafter surgery in all patients. A urethral stent was left in place only when difficultcalibration was encountered. Complications and cosmetic appearance weredocumented 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 andmid-shaft in 26 patients (81.3%) and proximal-shaft in 6 (18.8%). No intraoperativecatheterization difficulties were encountered and all repairs were nonstented.Antibiotics and anticholinergics were not required. Mean follow-up was9 (SD 6) months. Urinary extravasation developed in 1 patient (3.1%) on the secondpostoperative day. A urethral catheter was easily inserted and left indwellingfor 5 days. One patient presented 6 days postoperatively with suspected voidingdifficulty. Urethral calibration was easily performed excluding any mechanicalobstruction. 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 inalmost all cases of penile hypospadias. A nonstented technique for hypospadiasrepair simplifies postoperative care and obviates the need for antibioticsand anticholinergics. We believe that spongioplasty provides good supportto the neourethra and the hypoplastic distal urethra that may facilitate catheterizationin the immediate and early postoperative periods, if required. Futurecontrolled study is warranted to further evaluate the role of spongioplasty.