title: Is combined inner preputial inlay graft with tubularized incised plate in hypospadias repair worth doing?
abstract: BACKGROUND
  It has been noted that after tubularized incised plate urethroplasty (TIP) repair, the final meatal position is glanular but not at the optimum position. Inner preputial inlay graft combined with tubularized incised plate (G-TIP) has been proposed for redo urethroplasty. We extended this indication to be the standard technique for primary hypospadias repair. We conduct this prospective study to obtain a wide, slit-like appearance neomeatus at the optimum position in the glans proper and to judge if hypospadias repair complications differ from TIP repair in the published data in the literature.
  
  
  METHODS
  This prospective study included 230 consecutive patients who underwent this technique. The study was conducted from November 2011 to August 2014 for all hypospadias cases to be repaired in a single stage regardless of the width and depth of urethral plate or the glans size and shape. Localization of the meatus was glanular in 13 patients, coronal in 75, distal penile in 112, mid penile in 25 and proximal in five. The urethral plate was incised deeply and extended distally beyond the end of the plate by 3 mm in glans proper. The mucosal graft was harvested from the inner prepuce, inlayed and quilted in the incised urethral plate. The neourethra was created over a urethral catheter in two layers. The vascular dartos flap was mobilized dorsally and moved ventrally to cover the neourethral suture line as a barrier.
  
  
  RESULTS
  The follow-up period ranged from 5 to 36 months. Excellent cosmetic and functional results were achieved in 221 of 230 patients (96.09%). Neither meatal stenosis nor urethral diverticulum were encountered. An excellent glanular position of a wide slit-like neomeatus was achieved using this technique. Nine patients (3.91%) developed urethrocutaneous fistula. Excellent urinary stream was reported by parents.
  
  
  CONCLUSIONS
  Combined inner preputial graft with TIP urethroplasty secures the optimal glanular position of a wide slit-like neomeatus because of extension of the incision beyond the end of the plate, thus optimizing functional and cosmetic outcome with no meatal stenosis.
authors.affiliation: Pediatric Urology Unit, Ibn Sina Hospital, Kuwait. Electronic address: mamdsalam63@hotmail.com.
authors.forename: Mamdouh
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Pediatric Urology Unit, Ibn Sina Hospital, Kuwait.
authors.forename: Abdulnaser
authors.initials: A
authors.lastname: Alsaid
mesh_terms: D002675:Child, Preschool; D005500:Follow-Up Studies; D052816:Foreskin / Q000637:transplantation*; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*
keywords: Hypospadias; Preputial inlay graft; Tubularized incised plate