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LETTERS TO THE EDITOR
Year : 2022  |  Volume : 27  |  Issue : 4  |  Page : 508-509
 

Tubularisation in hypospadias repair: Is it essential or necessary?


Pediatric Surgery, Park Medical Research and Welfare Society, Kolkata, West Bengal, India

Date of Submission17-May-2021
Date of Decision06-Oct-2021
Date of Acceptance22-Nov-2021
Date of Web Publication26-Jul-2022

Correspondence Address:
Uday Sankar Chatterjee
Park Medical Research and Welfare Society, 4, Gorky Terrace, Kolkata - 700 017, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.jiaps_91_21

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How to cite this article:
Chatterjee US, Basu AK, Bhaumik K K, Mitra D. Tubularisation in hypospadias repair: Is it essential or necessary?. J Indian Assoc Pediatr Surg 2022;27:508-9

How to cite this URL:
Chatterjee US, Basu AK, Bhaumik K K, Mitra D. Tubularisation in hypospadias repair: Is it essential or necessary?. J Indian Assoc Pediatr Surg [serial online] 2022 [cited 2022 Aug 9];27:508-9. Available from: https://www.jiaps.com/text.asp?2022/27/4/506/352293




Sir,

Here, we describe the feasibility of buried strip along with tunica vaginalis flap (TVF) in urethroplasty without tubularization in distal penile hypospadias with bad plates.


   Procedure Top


The Institute of Ethical Committee approved to study the files of 72 children [Table 1]. “U-” shaped incision was made encompassing both the hypospadiac meatus, and on both sides of so-called bad plate or tissue intended to be urethra (TITBU). Distal incision was made on the margins of “cleft meatus” to create a rectangular TITBU[1] separated from the rest of the penile skin after degloving. Another midline incision was made on the glandular urethral plate at “cleft meatus” to accommodate the urethral catheter to avert tension of stitches following glanuloplasty as well as for the “hinging”[2] of the glandular urethral plate [Figure 1] as well as to get vertical meatus at follow-up. Following that, the incision was made at the junction of inner pinkish and outer prepuce[3] to deglove the penis. Outer preputial skin was then rotated toward ventrum. The catheter was fixed over the island of TITBU with few tie-over stitches with 4-0 catgut. Glans wings were created by dissecting the tissue cleavage of Buck's fascia and glans. Following that, TVF harvested from testis[4] was wrapped over the catheterized urethral plate. Glans wings were stitched subcutaneously with 5-0 polyglycolic to cover TITBU, catheter, and TVF.
Table 1: Patients' profile and outcome

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Figure 1: Tunica vaginalis flap over tissue intended to be urethra and catheter

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Urethral catheters were removed after 7 days or earlier if there was any pericatheter leakage of urine with or without uncomfortable bladder spasm.


   Results Top


Two suture tract fistulas out of six were cured by regular dilation and four by “needling.”[5] Six patients (8%) needed further operations for repair of medium size fistula and glans dehiscence [Table 1].


   Conclusion Top


Tubularization is good for the urethroplasty in hypospadias with good plate. Nevertheless, the concept of buried strip urethroplasty seems to be viable and effective by the amalgamation of TVF as vascular layers.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Chatterjee US, Chatterjee SK. Regenerative urethroplasty in reoperative hypospadias: Buried strip principle revisited. J Indian Assoc Pediatr Surg 2012;17:63-7.  Back to cited text no. 1
  [Full text]  
2.
Rich MA, Keating MA, Snyder HM, Duckett JW. Hinging the urethral plate in hypospadias meatoplasty. J Urol 1989;142:1551-3.  Back to cited text no. 2
    
3.
Kureel SN, Gupta A, Singh CS, Rawat J. A novel skin management scheme in surgery of epispadias undergoing cantwell-ransley repair: A technique to improve the aesthetics and minimize complications. Urology 2013;82:1400-4.  Back to cited text no. 3
    
4.
Chatterjee US, Mandal MK, Basu S, Das R, Majhi T. Comparative study of dartos fascia and tunica vaginalis pedicle wrap for the tubularized incised plate in primary hypospadias repair. BJU Int 2004;94:1102-4.  Back to cited text no. 4
    
5.
Chatterjee US, Basu AK, Bhaumik K. Needling for suture track fistula. J Indian Assoc Pediatr Surg 2021;26:203-5.  Back to cited text no. 5
  [Full text]  


    Figures

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    Tables

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