Alwaeli Hayder H, Hasan Al-Timimi Hasanain F, Ismail Mohammed B
Department of Surgery, Al-Kindy Teaching Hospital.
Department of Surgery, College of Medicine, University of Baghdad, Baghdad, Iraq.
Ann Med Surg (Lond). 2023 Aug 7;85(10):4745-4749. doi: 10.1097/MS9.0000000000001136. eCollection 2023 Oct.
Hypospadias is a congenital abnormality of anterior urethral and penile development where the urethral meatus is ectopically located on the ventral aspect of the penis. It is a relatively common condition affecting ~1 in 250 male birth. Extended-Tubularized Incised Plate (E-TIP) is a modification of Snodgrass repair by extending the midline incision to the apical part of the glans resulting in a more normal appearing location of the meatus and straight urinary stream without increasing the risk of complications.
To evaluate functional and cosmetic outcomes of E-TIP repair for mid-shaft and distal hypospadias as a modification of Snodgrass repair.
A prospective cross-sectional study including 53 cases of mid-to-distal hypospadias repaired with the E-TIP technique between November 2019 and February 2022 in Baghdad. The authors start with the standard technique described by Snodgrass, but the midline incision of the urethral plate extended up to the apical part of the glans tip, and tabularization started distally creating a slit-like a neomeatus. Outcome assessment depended on an objective evaluation of the following parameters: maximum flow rate, post-void residual, Hypospadias Objective Score Evaluation (HOSE) score, and direction of the urinary stream.
The mean age was 3.4±2.1 years, ranging from 0.6 to 9 years. The mean duration of follow-up was 14.4±6.9 months, and the location of the meatus was coronal in 16 patients (30%), subcoronal in 25 (47%), and mid-distal shaft in 12 (23%). The glans width was greater than or equal to 14 mm in 46 patients (87%) and less than 14 mm in 7 (13%). Q.max was above the fifth percentile of age-related uroflowmetry nomograms for healthy children 5-15 years old in 29 boys (93.5%) and below the fifth percentile in 2 (6.5%). Post-void residual urine was less than 10% of voided volume in 28 out of 31 boys (90%) and greater than 10% in 3 (10%). Regarding cosmetic outcomes, 50 boys (94%) had good penile appearance and their HOSE score greater than or equal to 14 with a slit-like meatus located at the tip of the glans, while 3 (6%) of them their score was less than 14. The overall mean HOSE score postoperatively for all patients was 15±0.9. Six patients (11%) had a deviated urinary stream and 47 (89%) had a straight stream.
E-TIP repair is a good alternative to standard Snodgrass repair for mid-shaft to distal hypospadias with a good functional and cosmetic outcome, particularly the neomeatus position at the tip of the glans, which is similar to the normal one without increasing the risk of meatal stenosis.
尿道下裂是一种先天性前尿道和阴茎发育异常疾病，尿道口异位位于阴茎腹侧。这是一种相对常见的疾病，约每250例男性出生中就有1例受影响。延长管状切开板（E-TIP）是对Snodgrass修复术的一种改良，通过将中线切口延伸至龟头顶端，使尿道口位置更接近正常，尿流更直，且不增加并发症风险。
评估作为Snodgrass修复术改良方法的E-TIP修复术治疗阴茎中段和远端尿道下裂的功能和外观效果。
一项前瞻性横断面研究，纳入2019年11月至2022年2月在巴格达采用E-TIP技术修复的53例阴茎中段至远端尿道下裂患者。作者首先采用Snodgrass描述的标准技术，但尿道板的中线切口延伸至龟头顶端，从远端开始进行管状化，形成类似新尿道口的狭缝状开口。结果评估取决于对以下参数的客观评价：最大尿流率、排尿后残余尿量、尿道下裂客观评分评估（HOSE）得分以及尿流方向。
平均年龄为3.4±2.1岁，范围为0.6至9岁。平均随访时间为14.4±6.9个月，尿道口位置冠状位16例（30%），冠状沟下25例（47%），阴茎中段至远端12例（23%）。46例患者（87%）龟头宽度大于或等于14毫米，7例（13%）小于14毫米。29例男孩（93.5%）的最大尿流率高于5至15岁健康儿童年龄相关尿流率列线图的第五百分位数，2例（6.5%）低于第五百分位数。31例男孩中有28例（90%）排尿后残余尿量少于排尿量的10%，3例（10%）大于10%。关于外观效果，50例男孩（94%）阴茎外观良好，HOSE得分大于或等于14分，龟头顶端有狭缝状尿道口，而其中3例（6%）得分低于14分。所有患者术后总的平均HOSE得分为15±0.9分。6例患者（11%）尿流方向偏斜，47例（89%）尿流直。
对于阴茎中段至远端尿道下裂，E-TIP修复术是标准Snodgrass修复术的良好替代方法，功能和外观效果良好，特别是龟头顶端新尿道口的位置与正常位置相似，且不增加尿道口狭窄风险。
