Re-operative Hypospadias Repair Using Tubularized Incised Plate Urethroplasty

Hypospadias repair remains one of the most common reconstructive procedures in pediatric urology; however, re-operative hypospadias represents a challenging subset due to distorted anatomy, urethral plate scarring, deficient local tissues, and higher complication rates compared with primary repairs.

The tubularized incised plate (TIP) urethroplasty, originally described by Snodgrass, revolutionized primary hypospadias repair and has since been adapted for selected reoperative cases. Contemporary evidence suggests that despite prior surgery and scary, a well-vascularized urethral plate of adequate width can still be successfully tubularized following a midline relaxing incision, offering acceptable functional and cosmetic outcomes.

Inclusion criteria

• Both sexes.
• Children with recurrent or residual hypospadias in whom the urethral plate is deemed suitable for reuse, defined as a plate width of at least 8-9 mm with acceptable vascularity and without severe fibrosis.

Exclusion criteria

• Patients with severely scared or fibrotic urethral plates are not suitable for tubularization.
• Absent or destroyed urethral plates following previous failed hypospadias repairs.
• Patients require staged urethral reconstruction rather than a single-stage procedure.
• Presence of poor urethral plate vascularity or ischemic tissue.
• Extensive penile scarring or fibrosis resulting from multiple previous surgical attempts.
• Severe penile curvature requiring excision of the urethral plate.
• Inability to achieve adequate, well-vascularized tissue coverage over the neourethra.