Summary
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
Graphical Abstract
Keywords
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Article info
Publication history
Published online: November 24, 2020
Accepted:
November 18,
2020
Received in revised form:
November 3,
2020
Received:
August 13,
2020
Identification
Copyright
© 2020 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
ScienceDirect
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- Commentary to: Narrow urethral plate augmentation in anterior and middle hypospadias repair: Onlay flap VS. Inlay graft. A prospective randomized comparative study [ ]Journal of Pediatric UrologyVol. 17Issue 2
- PreviewThank you for the opportunity to write a commentary on this article. In their paper, the authors compare two surgical techniques to augment a narrow urethral plate. They choose a prospective, randomized study design and found that dorsal inlay grafts have a better outcome than longitudinal onlay flaps.
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