Comparison of the use of graft augmented tubularized split (GATS) and tubularized incised plate urethroplasty (TIPU) techniques for hypospadias repair in patients with narrow plate and small glans

Yıl 2022, , 377 - 381, 01.03.2022

Ahsen Karagözlü Akgül , Sadık Abidoğu Gürsu Kıyan , Embiye Adalı Halil Tuğtepe

https://doi.org/10.28982/josam.980401

Öz

Background/Aim: Hundreds of repair techniques were described for hypospadias repair. It is still a problem to choose the right technique in hypospadias repair for patients with narrow plate and small glans, because the patients with narrow urethral plate and small glans usually suffer from complications. GATS (Glans Augmented Tubularized Split) is an alternative technique with different details from grafted TIPU (Tubularized Incised Plate Urethroplasty). The aim of this study is to compare the outcomes of TIPU and GATS procedures on these difficult cases.
Methods: This retrospective cohort study consists of the analysis of patients who underwent GATS and TIPU procedures in our department between January 2017 and January 2020. Patients with distal and midpenile hypospadias and with shallow groove, glans smaller than 17 mm, and plate narrower than 8mm were included the study. Patient with follow-up shorter than 1 year or incomplete data and secondary cases were excluded. Patients were divided into two groups according to the technique performed, as 25 patients in TIPU group and 20 patients in GATS group.
Results: The mean diameter of glans were 15.3 mm and 14.5 mm, mean width of plate were 5.2 mm and 4.1 mm in TIPU and GATS groups respectively. Complications were observed in 7 (28%) patients of TIPU group and in 2 (10%) patients of GATS group (P>0.05). Urethral stenosis in one patient, urethral fistula in two patients, urethral dehiscence in two and urethral stenosis and diverticula in one patient, urethral stenosis and fistula in one patient were detected in TIPU group. Urethral fistula in one patient and urethral dehiscence in one patient were observed in GATS group.
Conclusion: GATS procedure is an alternative method for difficult cases with narrow urethral plate and small glans with less complications than TIPU technique.

Anahtar Kelimeler

Hypospadias, Narrow urethral plate, Small glans, Shallow groove, Grafting, Complication

Kaynakça

• 1. Snodgrass W. Tubularized, incised plate urethroplasty for distal hypospadias. J Urol. 1994;151(2):464-5. doi: 10.1016/S0022-5347(17)34991-1.
• 2. Braga LHP, Lorenzo AJ, Salle JLP. Tubularized incised plate urethroplasty for distal hypospadias: A literature review. Indian J Urol. 2008;24(2):219-25. doi: 10.4103/0970-1591.40619.
• 3. Braga LHP, Pippi Salle JL, Lorenzo AJ, et al. Comparative Analysis of Tubularized Incised Plate Versus Onlay Island Flap Urethroplasty for Penoscrotal Hypospadias. J Urol. 2007;178(4):1451-1457. doi: 10.1016/j.juro.2007.05.170.
• 4. Holland AJA, Smith GHH. Effect of the depth and width of the urethral plate on tubularized incised plate urethroplasty. J Urol. 2000;164(2):489-91. doi: 10.1016/S0022-5347(05)67408-3
• 5. Perera M, Jones B, O’Brien M, Hutson JM. Long-term urethral function measured by uroflowmetry after hypospadias surgery: Comparison with an age matched control. J Urol. 2012;188(4 SUPPL.):1457-62. doi: 10.1016/j.juro.2012.04.105.
• 6. Shuzhu C, Min W, Yidong L, Weijing Y. Selecting the right method for hypospadias repair to achieve optimal results for the primary situation. Springer plus. 2016;5:1624. doi: 10.1186/s40064-016-3314-y.
• 7. Kolon TF, Gonzales ET. The dorsal inlay graft for hypospadias repair. J Urol. 2000;163(6):1941-3. doi: 10.1016/S0022-5347(05)67603-3.
• 8. Gundeti M, Queteishat A, Desai D, Cuckow P. Use of an inner preputial free graft to extend the indications of Snodgrass hypospadias repair (Snodgraft). J Pediatr Urol. 2005;1(6):395-6. doi: 10.1016/j.jpurol.2005.03.010.
• 9. Silay MS, Sirin H, Tepeler A, et al. “Snodgraft” technique for the treatment of primary distal hypospadias: Pushing the envelope. J Urol. 2012;188(3):938-42. doi: 10.1016/j.juro.2012.04.126
• 10. Eldeeb M, Nagla S, Abou-Farha M, Hassan A. Snodgrass vs Snodgraft operation to repair the distal hypospadias in the narrow urethral plate. J Pediatr Urol. 2020;16(2):165.e1-165.e8. doi: 10.1016/j.jpurol.2020.01.006.
• 11. Helmy TE, Ghanem W, Orban H, et al. Does grafted tubularized incided plate improve the outcome after repair of primary distal hypospadias: A prospective randomized study? J Pediatr Surg. 2018;53(8):1461-3. doi: 10.1016/j.jpedsurg.2018.03.019.
• 12. Cherian A, Smeulders N. Graft Augmented Tubularised Split (GATS ). In: 27th Congress of European Society of Paediatric Urology, Harrogate, UK. 2016.
• 13. Tugtepe H, Thomas DT, Calikli Z, et al. A new objective scoring system for the prediction of complications after hypospadias surgery. In: 29th Congress of ESPU, 2018, Abstract Book. 96. doi: 10.29052/2413-4252.v4.i1.2018.23-55.
• 14. Sarhan O, Saad M, Helmy T, Hafez A. Effect of Suturing Technique and Urethral Plate Characteristics on Complication Rate Following Hypospadias Repair: A Prospective Randomized Study. J Urol. 2009;182(2):682-6. doi: 10.1016/j.juro.2009.04.034
• 15. Thomas, David Terence Calikli Z, Canmemis A, Ergun R, Valiyev N, et al. Prediction of TIPU complications using an objective scoring system. In: 29th Congress of the ESPU. Vol Abstract b. ; 2018:97.
• 16. Bush NC, Snodgrass W. Pre-incision urethral plate width does not impact short-term Tubularized Incised Plate urethroplasty outcomes. J Pediatr Urol. 2017;13(6):625.e1-625.e6. doi: 10.1016/j.jpurol.2017.05.020.
• 17. Leslie B, Jesus LE, El-Hout Y, et al. Comparative histological and functional controlled analysis of tubularized incised plate urethroplasty with and without dorsal inlay graft: A preliminary experimental study in rabbits. J Urol. 2011;186(4 SUPPL.):1631-7. doi: 10.1016/j.juro.2011.04.008.
• 18. Mouravas V, Filippopoulos A, Sfoungaris D. Urethral plate grafting improves the results of tubularized incised plate urethroplasty in primary hypospadias. J Pediatr Urol. 2014;10(3):463-468. doi: 10.1016/j.jpurol.2013.11.012
• 19. Ahmed M, Alsaid A. Is combined inner preputial inlay graft with tubularized incised plate in hypospadias repair worth doing? J Pediatr Urol. 2015;11(4):229.e1-229.e4. doi: 10.1016/j.jpurol.2015.05.015
• 20. Asanuma H, Satoh H, Shishido S. Dorsal inlay graft urethroplasty for primary hypospadiac repair. Int J Urol. 2007;14(1):43-7. doi: 10.1111/j.1442-2042.2006.01662.x
• 21. Nerli RB, Guntaka AK, Patil RA, Patne PB. Dorsal inlay inner preputial graft for primary hypospadias repair. African J Paediatr Surg. 2014;11(2):105-8. doi: 10.4103/0189-6725.132789
• 22. Abbas TO, Braga LH, Spinoit AF, Salle JLP. Urethral plate quality assessment and its impact on hypospadias repair outcomes: A systematic review and quality assessment. J Pediatr Urol. 2021 Jun;17(3):316-25. doi: 10.1016/j.jpurol.2021.02.017.