Outcome of Snodgrass Tubularized Incised Plate Urethroplasty for Distal Hypospadias in Uyo, South-South Nigeria

Abstract

Background: Hypospadias is the most common penile congenital abnormality. Snodgrass Tubularized incised plate (TIP) urethroplasty preserves the urethral plate and produces a functional and cosmetically acceptable penis with low complication rates. Objective: This is a review of our initial experience with the Snodgrass Tubularized Incised Plate (TIP) Urethroplasty for distal hypospadias repair. Materials and Methods: We retrospectively reviewed the medical records of boys who had Tubularized incised plate urethroplasty (TIP) for distal hypospadias in University of Uyo Teaching Hospital over a 5-year period (January 2016-December2020). The location of the meatus, age at surgery, technique, complications, voiding function and cosmetic results were recorded. The ectopic meatus location was subcoronal in 4 (40%), coronal in 3 (30%), distal penile in 2 (20%) and midshaft in 1(10%). Dorsal incision of the urethral plate was done with double layer tubularization over a stent, with glanuloplasty and dartos barrier layer over the neourethra before skin cover. Results: Ten children with age range from six to thirty months were included in the study. The mean age of repair was 27months (range 18-36months). All had healthy urethral plates and were suitable for Tubularized incised plate (TIP) urethroplasty. The postoperative results of repair showed straight urinary stream and satisfactory cosmetic appearance in four patients (40%), while three patients (30%) developed urethrocutaneous fistula, one patient (10%) had meatal stenosis; one patient (10%) had urethral stricture and one patient (10%) had partial glans dehiscence. Two pinhole fistulae closed spontaneously and one was repaired by rotation of local dartos flaps, while the meatal stenosis and urethral stricture were easily dilated. The urine stream and cosmesis improved in nine patients (90%) after treatment of complications and 3-6 months follow up. The patient with partial dehiscence had a repeat urethroplasty. Conclusion: Snodgrass Tubularized incised plate urethroplasty produced a functional and cosmetically acceptable reconstruction in our patients.