title: Grafted tubularised incised-plate urethroplasty: An objective assessment of outcome with lessons learnt from surgical experience with 263 cases.
abstract: OBJECTIVE
  Snodgrass urethroplasty remains the preferred technique in primary distal hypospadias but development of meatal stenosis often limits distal extension of the midline incision of the urethral plate (MIUP), which remains a limiting factor in reconstructing an apical neomeatus (NM). We here-in assess the cosmetic and functional outcome with distal extension of the MIUP in grafted tubularised incised-plate urethroplasty (G-TIP) repair.
  
  
  METHODS
  This prospective study included the surgical experience of 263 cases of primary hypospadias operated upon between 2012 and 2015. The G-TIP technique included standard steps of Snodgrass urethroplasty, including degloving and harvesting of glans wings, followed by MIUP that was extended distally beyond the margins of the urethral plate (UP) into the glans. The incised bed was grafted with a free preputial skin graft and fixed to the bed with polydioxanone 7-0 suture. The UP was tubularised and the suture line reinforced with a Dartos flap. The urethral catheter was removed at 7-10 days after the repair and the outcome was assessed at follow-up using the Hypospadias Objective Scoring Evaluation (HOSE) system.
  
  
  RESULTS
  An apical NM was achieved in 96% of the patients with a 3.7% incidence of urethrocutaneous fistula. The presence of suture tracks and graft at the margins of the NM were seen in the initial 4% and 5% of cases, respectively. Acceptable cosmetic results, with objective HOSE scores of >14, were achieved in 96% of cases.
  
  
  CONCLUSIONS
  The G-TIP repair is a straightforward and feasible technique facilitating reconstruction of an apical NM, with an optimum outcome based on HOSE scoring. However, multicentre data are needed for undertaking comparative analysis and to assess the universal applicability of this technique in primary hypospadias.
authors.affiliation: Department of Pediatric Surgery and Urology, Ibn Sina Hospital, Kuwait City, Kuwait.
authors.forename: Vipul
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Department of Pediatric Surgery and Urology, Ibn Sina Hospital, Kuwait City, Kuwait.
authors.forename: Sunil Kumar
authors.initials: SK
authors.lastname: Yadav
authors.affiliation: Department of Pediatric Surgery and Urology, Ibn Sina Hospital, Kuwait City, Kuwait.
authors.forename: Talal
authors.initials: T
authors.lastname: Alanzi
authors.affiliation: Department of Pediatric Surgery and Urology, Ibn Sina Hospital, Kuwait City, Kuwait.
authors.forename: Islam
authors.initials: I
authors.lastname: Amer
authors.affiliation: Department of Pediatric Surgery and Urology, Ibn Sina Hospital, Kuwait City, Kuwait.
authors.forename: Mohmmad
authors.initials: M
authors.lastname: Salah
authors.affiliation: Department of Pediatric Surgery and Urology, Ibn Sina Hospital, Kuwait City, Kuwait.
authors.forename: Mamdouh
authors.initials: M
authors.lastname: Ahmed
keywords: (G-)TIP, (grafted) tubularised incised-plate urethroplasty; HOSE, Hypospadias Objective Scoring Evaluation; Inlay graft; MIUP, midline incision of the urethral plate; NM, neomeatus; Primary hypospadias; UCF, urethrocutaneous fistula; UP, urethral plate; Urethroplasty