Outcome of tubularized incised plate (TIP) urethroplasty: A single-center experience with 307 cases

Leili Mohajerzadeh, Javad Ghoroubi, Fathollah Roshanzamir, Hamidreza Alizadeh



Introduction: In order to assess our skill in the tubularized incised plate (TIP) urethroplasty technique in children with hypospadias.

Material andMethods: Of 307 children (mean age 38 month) who received a TIP urethroplasty, all had primary hypospadias. Patients who were referred with complication were eliminated from our study. The hypospadias defects were subcoronal in 25 (8%), distal penile in 236 (76%), midpenile in 25 (8%), proximal in 14(4%) and unknown in 7(2%) cases. Chordee was present in 53 (17.2%) patients. Presence of complications requiring reoperation and overall general appearance was recorded.

Results: The mean follow-up was 36 (19-72) months. Overall success rate was 70 % (215). Re-operation was required in 92 patients (30%): for urethrocutaneous fistula in 79 (26%), complete disruption of the repair in 2(0.6%) cases and meatal stenosis requiring meatoplasty in 12 (3%). Complete glans dehiscence occurred in 3 patients, which was repaired using the MAGPI technique. Partial breakdown of the glans occurred in 10 cases which did not require further surgery. One case had a huge urethral diverticulum.

Conclusions: This technique is relatively common compared to other accessible operations, but attention to details is necessary in order to achieve good results. It appears that complications, such as fistulas and meatal stenosis are more common in this method than other techniques, which require more research in the future.


Hypospadias; Urethral plate; Urethroplasty; Meatal stenosis; Fistula

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- Sarhan OS, El-Hefnawy AS, Hafez AT, et al: Factors affecting outcome of tubularized incised plate (TIP) urethroplasty: Single-center experience with 500 cases. Journal of Pediatric Urology 2009; 5:378-382.

- Sozubir S, Snodgrass W: A New Algorithm for Primary Hypospadias Repair Based On Tip Urethroplasty. Journal of Pediatric Surgery,2003; 38(8): 1157-1161.

- Shimotakahara A, Nakazawa N, Wada A, et al: Tubularized incised plate urethroplasty with dorsal inlay graft prevents meatal/neourethral stenosis: a single surgeon's experience. Journal of Pediatric Surgery 2011; 46: 2370–2372.

- Olsen LH, Grothe I, Rawashdeh YF, et al: Urinary flow patterns in infants with distal hypospadias. J Pediatr Urol 2011; 7:434-8.

- Snodgrass W. Response to Letter to the Editor 10-00238.J Pediatr Urol 2010; 7:174-7.

- Snodgrass W: Tubularized, incised plate urethroplasty for distal hypospadias. J Urol 1994; 151: 464.

- Snodgrass WT, Koyle M, Manzoni G, et al: Tubularized, incised plate hypospadias repair: Results of a multicenter experience. J Urol 1996; 156:839-841.

- Borer JG, Bauer SB, Peters CA, et al: Tubularized incised plate urethroplasty: Expanded use in primary and repeat surgery for hypospadias. J Urol 2001; 165:581.

- Mizuno K, Hayashi Y, Kojima Y, et al: Tubularized incised plate urethroplasty for proximal hypospadias. Int J Urol 9:88-90, 2002

- Snodgrass WT, Lorenzo A: Tubularized incised-plate urethroplasty for proximal hypospadias. Br J UrolInt 2002; 89:90-93.

- Snodgrass W: Does tubularized incised plate hypospadias repair create neourethral strictures. J Urol 1999; 162:1159.

- Waterman BJ, Renschler T, Cartwright PC, Snow BW, Devries CR. Variables in successful repair of urethrocutaneousfistula after hypospadias surgery. Journal of Urology 2002; 168: 726–730.

- Snodgrass WT, Nguyen MT. Current technique of tubularized incised plate hypospadias repair. Urology 2002; 60 (1):157-162.

- Holmdalh G, Karstro¨m L, Abrahamsson K, et al: Hypospadias repair with tubularized incised plate. Is uroflowmetry necessary postoperatively? J Pediatr Urol 2006; 2:304-7.

- Andersson M, Doroszkiewicz M, Arfwidsson C, et al: Hypospadias repair with tubularized incised plate:does the obstructive flow pattern resolve spontaneously? J Pediatr Urol 2010; 7: 441-445.

- Singh RB, Pavithran NM: Lessons learnt from Snodgrass TIP urethroplasty: a study of 75 cases. Pediatr Surg Int 2004; 20:204-6.

- Cooper C S, Noh PH, Snyder Howard M: Preservation of urethral plate spongiosum: technique to reduce hypospadias fistulas. Pediatric Urology 2001; 57 (2):531-4.

- Spencer-Barthold J, Teer TL, Redman JF: Modified Barcatbalanic groove technique for hypospadias repair: experience with 295 cases. J Urol 1996; 155: 1735–1737.

- Djordjevic ML, Perovic SV, Slavkovic Z, et al: Longitudinal Dorsal Dartos Flap for Prevention of Fistula after a Snodgrass Hypospadias Procedure. European Urology 2006; 50: 53–57.

- Manzoni G, Bracka A, Palminteri E, et al: Hypospadias surgery: when, what and by whom? B J U International 2004; 9 4:1188 – 1195.|

- Snodgrass W, Bush N: Tubularized incised plate proximal hypospadias repair: Continued evolution and extended applications. Journal of Pediatric Urology 2011; 7: 2-9.

- Parikh A.M, Park A.M, Sumfest J: Cumulative summation (CUSUM) charts in the monitoring of hypospadias outcomes: A tool for quality improvement initiative. Journal of Pediatric Urology 2014; 10: 306-311.

DOI: https://doi.org/10.22037/irjps.v1i1.9872


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