TUBULARISED, INCISED PLATE URETHROPLASTY FOR DISTAL HYPOSPADIAS

Abstract

Background: Over the yearsour resultsof urethroplasty for hypospadias were dissatisfactory.
We have used different surgical methods for repair of hypospadias and we had had about
76% f ~ t u l a formation, urethroplasty break-down. For this reason, we are looking for
surgical procedures which can improve our results such as less complications and good
cosmetic appearance of the glans. The tubularised, incised plate urethroplasty for distal
hypospadias described in the literature is a very attractive procedure with few reported
complications and good cosmetic results.
Objective: To describe the distal urethroplasty and glanuloplasty procedure, a modification
of the Thiersh-Dupley method to determine indications, outcome and complications.
Design: Prospective clinical study.
Setting: Paediatric Surgical Unit, Kenyatta National Hospital, Nairobi, Kenya.
Subjects: Twenty patients aged one and a half to seven years with coronal, subcoronal and
midshaft penile hypospadias variant underwent Thiersh-Duplay procedure with Snodgrass
modification.
Results: Meatal stenosis occurred in two boys. In one patient, meatal stenosis responded to
one dilatation. In the second patient a meatotomy was performed. Fistulae developed in four
patients. In one patient the f ~ t u l a closed spontaneously after one month on its own.
Conclusion: The advantages of distal hypospadias repair using a tubularised, incised
urethral plate are: it gives an excellent cosmetic and functional result and a decreased risk
of urethroplasty breakdown, fistula formation and meatal stenosis.