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Hypospadias
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Duckett, Asopa, and Standoli described preputial onlay urethroplasties nearly simultaneously, although the Duckett variant became the popular choice (Figure 74.14a–f). With the advent of the TIP repair and increased use of staged repairs, this procedure is used very selectively in those with a more proximal hypospadiac meatus, narrow urethral plate, and minimal chordee. The penis is prepared by means of degloving, and orthoplasty is performed as described above, preserving the urethral plate similar to the TIP repair. The hood of foreskin is laid out and a rectangular portion is marked on the inner surface with a marking pen to outline the graft for the intended neourethra. A rectangular flap is developed using sharp knife and iris scissor dissections, leaving it attached to a broad dartos vascular pedicle. This island pedicle flap must be mobilized adequately down to the penile base in order to swing it away from the remainder of the foreskin and bring it around the penile shaft ventrally without twisting the shaft. The native urethral meatus is prepared to assure that it is vascular, ample, and spatulated. The island flap is then sutured onto the urethral plate using fine absorbable sutures (onlay technique). The glanuloplasty is performed as previously described by creating lateral glanular wings. A critical next step is to provide a supporting vascular tissue to cover the neourethra before skin closure using either the remaining penile dartos or tunica vaginalis. Lastly, ventral skin approximation is accomplished using the dorsal remnants of prepuce.
Developmental abnormalities of the genitalia: intersex, hypospadias, and cryptorchidism
Published in J Kellogg Parsons, E James Wright, The Brady Urology Manual, 2019
Urethroplasty: Options include meatoplasty/glanuloplasty, meatal advancement and glanuloplasty (MAGPI), urethral plate incision and tubularization (Snodgrass), tissue flaps (including Onlay), and grafts.
Extended TIP vs. Standard TIP for primary distal hypospadias repair: randomized study for comparing functional and cosmetic outcomes
Published in Scandinavian Journal of Urology, 2021
Yasser A. Noureldin, Tarek Mohamed Gharib, Kareem Ali El Attar, Tarek Mohammed El Karamany, Ahmed Mahmoud Al Adl
In the present study, the validated and reliable photograph-based HOPE score [6] was significantly higher in e-TIP group compared to s-TIP group (p < 0.001). This significant difference was attributed to the shape and position of the neomeatus, which was the objective of the modified technique. In e-TIP, normal vertical slit-like meatus at position 1 (distal glans) was achieved in 38/46 (82.6%), while in eight patients the meatus was at position 2 (proximal glandular) due to the need to start tubularization slightly lower down in a conical glans. Regarding glans shape, slightly abnormal glans is suggested to be due to excessive glandular wing dissection which happened during glanuloplasty aiming to avoid postoperative glandular dehiscence. In s-TIP technique, normal-like meatus was achieved in 25/48 patients (52.1%); only 11 patients (22.9%) had meatus at position 1 while the rest of the patients had meatus at position 2.