Narrow urethral plate augmentation in anterior and middle hypospadias repair: Onlay flap VS. Inlay graft. A prospective randomized comparative study

Faculty Medicine Year: 2020
Type of Publication: ZU Hosted Pages:
Authors:
Journal: Journal of Pediatric Urology Elsevier Volume:
Keywords : Narrow urethral plate augmentation , anterior , middle    
Abstract:
Abstract Introduction: The measurement of the urethral plate width (as an objective parameter) and its effect of this width on the results of tubularized incised plate urethroplasty (TIPU) have been reported in two series and both authors reported that a urethral plate width < 8 mm is associated with higher complication rates. The augmentation of the urethral plate either by dorsal inlay graft urethroplasty (DIGU) or Onlay flap has been compared with the original TIPU in different degrees of hypospadias with better surgical results in augmented cases. Objective: To evaluate the surgical results of longitudinal Onlay preputial flap (LOF) vs (DIGU) techniques in augmentation of the narrow urethral plate. Study design: Primary anterior and middle hypospadias cases with narrow urethral plates were randomly allocated into two groups; group one operated by DIGU and group two operated by (LOF). The Success rate, individual complication rate, and operative times were compared. Results: 39 cases completed the study. No significant differences in patients' characteristics were detected. In the DIGU group, one case (5.3%) complicated with fistula and glandular dehiscence wherein in the LOF group, 7 cases (35%) Complicated with 5 fistulae, 2 glanular dehiscences, one flap loss, one diverticulum (p= .02). No significant differences in the rates of individual complications. Discussion: Variables affecting the success of hypospadias repairs are many. Urethral plate quality is an important variable among these variables. The definition of urethral plate quality is usually subjective. In the DIGU group, only 1/19 (5.3%) case had two complications, fistula and glandular dehiscence. Mouravas et al., in their comparative study between TIPU and G-TIP without mention of urethral plate width reported a significant reduction of the overall complications and urethral stenosis without significant reduction in fistula rate. In their G-TIP group, only 2 cases out of 24 (8.3%) were complicated with one fistula and one glandular dehiscence where in the TIPU group, 7 cases (30.4%) were complicated with one glandular dehiscence and 6 cases with urethral stenosis. In the LOF group, fistula in 5/20 cases (25%) was the commonest complication followed by glandular dehiscence in 2 cases (10%). Diverticulum and flap loss occurred in one case for each (5%). In the multivariate analysis of 474 patients' cohort by Spinoit et al., there were no significant differences between the risk of re-intervention after TIP and Onlay flap in anterior and middle hypospadias (25.8% vs. 18.8%), and (22.2% vs. 20%) respectively. Conclusion: Our data suggest that augmentation of the narrow urethral plate with DIGU has a better surgical outcome than with LOF. No significant difference in cosmetic outcomes detected.
   
     
 
       

Author Related Publications

  • Mohamed Mahmoud Hassan Abdullah, "Risk factors of penile resurfacing in re-operative hypospadias repair: A retrospective analytical study", Elsevier, 2022 More
  • Mohamed Mahmoud Hassan Abdullah, "Mathieu vs urethral plate tubularization in circumcised Megameatus intact prepuce repair: A prospective randomized comparative study", .turkish journal of urology, 2022 More
  • Mohamed Mahmoud Hassan Abdullah, "Urethral complex thickness and thickness index are the independent risk factors for urethroplasty complications after tubularized incised plate hypospadias repair", Elsevier, 2022 More
  • Mohamed Mahmoud Hassan Abdullah, "Evaluation of distally folded onlay flap in repair of distal penile hypospadias", Journal of Pediatric Urology, 2010 More
  • Mohamed Mahmoud Hassan Abdullah, "One-stage lingual augmented urethroplasty in repair of distal penile hypospadias", African Journal of Urology, 2014 More

Department Related Publications

  • Eslam Mohyeldeen, "The roleofneuralprecursorcell-expresseddevelopmentally down-regulated protein9inpredictingbacillusCalmette-Guerin response innonmuscleinvasivebladdercancer", Elsevier, 2018 More
  • Khaled Mohamed Abdelwahab, "apparantdiffiusion coeffecint value can predect poor BCG responders in T1 HG NMIBC : COHORT STUDY", WILLY, 2021 More
  • Mustafa Kamel Ahmed Youssef, "Efficacy of laparoscopically assisted high ligation of patent processus vaginalis in children", Journal of Pediatric Urology (2016) 12, 50.e1e50.e5, 2016 More
  • Khaled Mohamed Abdelwahab, "Single versus multiple instillation of povidone iodine and urographin in the treatment of chyluria: A prospective randomised study", Arab Journal of Urology, 2015 More
  • Majid Mohamed Ali Mahmoud Aawad, "Prognostic implication of MYb-like, swirm and Mpn domain-containing protein-1 and Twist-1 in renal cell carcinoma", Journal of Interdisciplinary Histopathology, 2017 More
Tweet