REVIEW cripples as well. Hypospadias cripples is the most

                    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.

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Tubularization of urethral plate:Original concepts and its
modification

 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.

The
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.

2)
urethral tubularization from the meatus proximally.

3)
meatal calibration such that even before tubularization, it would accept a 10
or 12Fr bougie.