REVIEW OF LITERATURE
Hypospadias repair surgery can be
broadly classified into urethral plate
tubularization, urethral plate supplementation or substitution with skin flaps and
urethral plate substitution
with grafts . The choice of procedure for surgery depends upon the
personal taste ,individual case ,
experience and training 20.
Tubularization of urethral plate:Original concepts and its
One of the most commonly used technique for hypospadias repair is Snodgrass or TIPS ( Tubularized
incised-plate urethroplasty) .In this technique tubularization of the urethral plate is done
and in the posterior wall of urethral plate relaxing incision is given.This
‘relaxing incision’ in the posterior wall allows forward movement of it and circumvents
the limitation caused by the width of the urethral plate in Thiersch- Duplay
procedure. This technique is used in
correction of distal hypospadias , proximal hypospadias and in hypospadiac
cripples as well. Hypospadias cripples is the most difficult complication of
hypospadias correction surgery which represents a combination of stricture ,
fistula and scarred penis.
most common complications of TIPS are urethrocutaneous fistula and meatal
stenosis. Braga et al 21 has reported the complication rate of
Tubularised incised plate urethroplasty was 33% after reviewing 4554 children from 62 published
reports ; the mean frequency of meatal stenosis was 2.1% and mean frequency of
urethrocutaneous fistula was 5.9%. In cases of narrow urethral plate (less than 8 Fr) or a
‘flat glans’, Jayanthi et al 22 has adviced for modified Barcat repairs
which includes several modifications
that comprises –
1) urethral plate incision extending from the
meatus to the tip of the glans.
urethral tubularization from the meatus proximally.
meatal calibration such that even before tubularization, it would accept a 10
or 12Fr bougie.