Pre-incision urethral plate width does not impact short-term tubularized incised plate urethroplasty outcomes
Summary Introduction Two reports have found that urethral plate (UP) widths
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| Veröffentlicht in: | Journal of pediatric urology 2017-12, Vol.13 (6), p.625.e1-625.e6 |
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| description | Summary Introduction Two reports have found that urethral plate (UP) widths |
| doi_str_mv | 10.1016/j.jpurol.2017.05.020 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1964270781</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S1477513117302589</els_id><sourcerecordid>1964270781</sourcerecordid><originalsourceid>FETCH-LOGICAL-c417t-20785d0fc4bdec0f5ae4799163c17c70f3893845079f7857b6c898006a4a68523</originalsourceid><addsrcrecordid>eNqFkUuL1TAUx4sozkO_gUiWblpPHm3ajSCDLxhQUNchNz3lpqZNzWPk-unNtaMLN65OAv8H53eq6hmFhgLtXs7NvOXgXcOAygbaBhg8qC5pL3kt-qF_WN5CyrqlnF5UVzHOAFwCGx5XF2ygnNNOXFbLp4C1XY2N1q8kB0zHoB3ZnE5IftgxHcnoMZLVJ2KXTZtE4tGHVCcMC0n5kJ0O9ieO5HdImbt1T_LlE9OJ-JyMXzA-qR5N2kV8ej-vq69v33y5eV_ffnz34eb1bW0ElalmIPt2hMmIw4gGplajkMNAO26oNBIm3g-8Fy3IYSpKeehMWRig00J3fcv4dfViz92C_54xJrXYaNA5vaLPUdGhE0yWFlqkYpea4GMMOKkt2EWHk6KgzqDVrHbQ6gxaQasK6GJ7ft-QDwuOf01_yBbBq12AZc87i0FFY3E1ONqAJqnR2_81_BtgnF2t0e4bnjDOPoe1MFRURaZAfT4f-3xrKjmwtgD6BR7jp3Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1964270781</pqid></control><display><type>article</type><title>Pre-incision urethral plate width does not impact short-term tubularized incised plate urethroplasty outcomes</title><source>MEDLINE</source><source>ScienceDirect Journals (5 years ago - present)</source><creator>Bush, N.C ; Snodgrass, W</creator><creatorcontrib>Bush, N.C ; Snodgrass, W</creatorcontrib><description>Summary Introduction Two reports have found that urethral plate (UP) widths <8 mm before tubularized incised plate (TIP) incision increased urethroplasty complications. The present study measured pre-incision UP width in consecutive boys undergoing TIP to determine if it affected outcomes. Methods The present study followed the method previously used by Holland and Smith, and Sarhan et al. to measure UP width before creating glans wings or performing midline plate incision in consecutive patients with primary hypospadias and ventral curvature <30°, who all underwent TIP repair ( Summary Fig .). Glans width at its widest point was also measured. Multiple logistic regression assessed urethroplasty complications (fistula, glans dehiscence, meatal stenosis/urethral stricture, diverticulum) based on pre-incision UP width, glans width, patient age, and meatal location. Results The UP widths were determined in 224 consecutive primary TIP repairs during 2012–2015: 200 distal, 11 midshaft, and 13 proximal. The UP width was <8 mm in 192/224 (86%) patients. Mean pre-incision width was 6.1 mm (SD 1.5, range 2–11), without difference in UP widths according to meatal location ( P =0.06). Mean post-incision UP width was 12 mm (SD 2.2, range 10–16). Mean change in width after incision (delta/original UP width) was 116% (SD 63, range 20–250). There was follow-up in 186 patients for a mean of 6 months. Urethroplasty complications (five fistulas, six glans dehiscence) were diagnosed in 11 (6%): 9/165 distal, 1/9 midshaft, and 1/12 proximal repairs. There was no difference in those <8 vs ≥8 mm (11/160 vs 0/26, P =0.17). Similarly, UP width was not different between patients with and without urethroplasty complications. Multiple logistic regression in these 186 patients – including meatal location, UP width, glans width, and age – found only glans width <14 mm was associated with increased odds of urethroplasty complications (OR 19.2, 95% CI 3.5–106, AUC =0.799). Discussion The data show that pre-incision UP width is not an independent risk factor for urethroplasty complications. However, it is possible that technical factors, such as how deeply the dorsal incision is made or size of the urethral stent, might contribute to this finding by other authors. After watching the TIP repair, Smith stated that the plate incision was deeper than he made. Sarhan et al. reported a mean change of 57% in UP width after incision, whereas the present one was double at 116% (i.e. from 6 mm pre-incision to 12 mm post incision), and they used an 8-Fr catheter. While they stated that they incised the plate deeply, the lower percentage increase in width suggests that it was not as deep as was recommended. Conclusions The UP width before incision did not increase urethroplasty complications. Surgeons do not need to measure or categorize the UP to determine suitability for TIP repair, as long as the plate incision is made deeply to the corpora.</description><identifier>ISSN: 1477-5131</identifier><identifier>EISSN: 1873-4898</identifier><identifier>DOI: 10.1016/j.jpurol.2017.05.020</identifier><identifier>PMID: 29133164</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Child ; Child, Preschool ; Humans ; Hypospadias - pathology ; Hypospadias - surgery ; Infant ; Male ; Pediatrics ; Time Factors ; Treatment Outcome ; Tubularized incised plate (TIP) hypospadias repair ; Urethra - pathology ; Urethra - surgery ; Urethral plate ; Urethroplasty complication risk factors ; Urologic Surgical Procedures, Male - methods ; Urology</subject><ispartof>Journal of pediatric urology, 2017-12, Vol.13 (6), p.625.e1-625.e6</ispartof><rights>Journal of Pediatric Urology Company</rights><rights>2017 Journal of Pediatric Urology Company</rights><rights>Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c417t-20785d0fc4bdec0f5ae4799163c17c70f3893845079f7857b6c898006a4a68523</citedby><cites>FETCH-LOGICAL-c417t-20785d0fc4bdec0f5ae4799163c17c70f3893845079f7857b6c898006a4a68523</cites><orcidid>0000-0002-9887-3680</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jpurol.2017.05.020$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29133164$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bush, N.C</creatorcontrib><creatorcontrib>Snodgrass, W</creatorcontrib><title>Pre-incision urethral plate width does not impact short-term tubularized incised plate urethroplasty outcomes</title><title>Journal of pediatric urology</title><addtitle>J Pediatr Urol</addtitle><description>Summary Introduction Two reports have found that urethral plate (UP) widths <8 mm before tubularized incised plate (TIP) incision increased urethroplasty complications. The present study measured pre-incision UP width in consecutive boys undergoing TIP to determine if it affected outcomes. Methods The present study followed the method previously used by Holland and Smith, and Sarhan et al. to measure UP width before creating glans wings or performing midline plate incision in consecutive patients with primary hypospadias and ventral curvature <30°, who all underwent TIP repair ( Summary Fig .). Glans width at its widest point was also measured. Multiple logistic regression assessed urethroplasty complications (fistula, glans dehiscence, meatal stenosis/urethral stricture, diverticulum) based on pre-incision UP width, glans width, patient age, and meatal location. Results The UP widths were determined in 224 consecutive primary TIP repairs during 2012–2015: 200 distal, 11 midshaft, and 13 proximal. The UP width was <8 mm in 192/224 (86%) patients. Mean pre-incision width was 6.1 mm (SD 1.5, range 2–11), without difference in UP widths according to meatal location ( P =0.06). Mean post-incision UP width was 12 mm (SD 2.2, range 10–16). Mean change in width after incision (delta/original UP width) was 116% (SD 63, range 20–250). There was follow-up in 186 patients for a mean of 6 months. Urethroplasty complications (five fistulas, six glans dehiscence) were diagnosed in 11 (6%): 9/165 distal, 1/9 midshaft, and 1/12 proximal repairs. There was no difference in those <8 vs ≥8 mm (11/160 vs 0/26, P =0.17). Similarly, UP width was not different between patients with and without urethroplasty complications. Multiple logistic regression in these 186 patients – including meatal location, UP width, glans width, and age – found only glans width <14 mm was associated with increased odds of urethroplasty complications (OR 19.2, 95% CI 3.5–106, AUC =0.799). Discussion The data show that pre-incision UP width is not an independent risk factor for urethroplasty complications. However, it is possible that technical factors, such as how deeply the dorsal incision is made or size of the urethral stent, might contribute to this finding by other authors. After watching the TIP repair, Smith stated that the plate incision was deeper than he made. Sarhan et al. reported a mean change of 57% in UP width after incision, whereas the present one was double at 116% (i.e. from 6 mm pre-incision to 12 mm post incision), and they used an 8-Fr catheter. While they stated that they incised the plate deeply, the lower percentage increase in width suggests that it was not as deep as was recommended. Conclusions The UP width before incision did not increase urethroplasty complications. Surgeons do not need to measure or categorize the UP to determine suitability for TIP repair, as long as the plate incision is made deeply to the corpora.</description><subject>Child</subject><subject>Child, Preschool</subject><subject>Humans</subject><subject>Hypospadias - pathology</subject><subject>Hypospadias - surgery</subject><subject>Infant</subject><subject>Male</subject><subject>Pediatrics</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Tubularized incised plate (TIP) hypospadias repair</subject><subject>Urethra - pathology</subject><subject>Urethra - surgery</subject><subject>Urethral plate</subject><subject>Urethroplasty complication risk factors</subject><subject>Urologic Surgical Procedures, Male - methods</subject><subject>Urology</subject><issn>1477-5131</issn><issn>1873-4898</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUuL1TAUx4sozkO_gUiWblpPHm3ajSCDLxhQUNchNz3lpqZNzWPk-unNtaMLN65OAv8H53eq6hmFhgLtXs7NvOXgXcOAygbaBhg8qC5pL3kt-qF_WN5CyrqlnF5UVzHOAFwCGx5XF2ygnNNOXFbLp4C1XY2N1q8kB0zHoB3ZnE5IftgxHcnoMZLVJ2KXTZtE4tGHVCcMC0n5kJ0O9ieO5HdImbt1T_LlE9OJ-JyMXzA-qR5N2kV8ej-vq69v33y5eV_ffnz34eb1bW0ElalmIPt2hMmIw4gGplajkMNAO26oNBIm3g-8Fy3IYSpKeehMWRig00J3fcv4dfViz92C_54xJrXYaNA5vaLPUdGhE0yWFlqkYpea4GMMOKkt2EWHk6KgzqDVrHbQ6gxaQasK6GJ7ft-QDwuOf01_yBbBq12AZc87i0FFY3E1ONqAJqnR2_81_BtgnF2t0e4bnjDOPoe1MFRURaZAfT4f-3xrKjmwtgD6BR7jp3Q</recordid><startdate>20171201</startdate><enddate>20171201</enddate><creator>Bush, N.C</creator><creator>Snodgrass, W</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9887-3680</orcidid></search><sort><creationdate>20171201</creationdate><title>Pre-incision urethral plate width does not impact short-term tubularized incised plate urethroplasty outcomes</title><author>Bush, N.C ; Snodgrass, W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-20785d0fc4bdec0f5ae4799163c17c70f3893845079f7857b6c898006a4a68523</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Child</topic><topic>Child, Preschool</topic><topic>Humans</topic><topic>Hypospadias - pathology</topic><topic>Hypospadias - surgery</topic><topic>Infant</topic><topic>Male</topic><topic>Pediatrics</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Tubularized incised plate (TIP) hypospadias repair</topic><topic>Urethra - pathology</topic><topic>Urethra - surgery</topic><topic>Urethral plate</topic><topic>Urethroplasty complication risk factors</topic><topic>Urologic Surgical Procedures, Male - methods</topic><topic>Urology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bush, N.C</creatorcontrib><creatorcontrib>Snodgrass, W</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bush, N.C</au><au>Snodgrass, W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pre-incision urethral plate width does not impact short-term tubularized incised plate urethroplasty outcomes</atitle><jtitle>Journal of pediatric urology</jtitle><addtitle>J Pediatr Urol</addtitle><date>2017-12-01</date><risdate>2017</risdate><volume>13</volume><issue>6</issue><spage>625.e1</spage><epage>625.e6</epage><pages>625.e1-625.e6</pages><issn>1477-5131</issn><eissn>1873-4898</eissn><abstract>Summary Introduction Two reports have found that urethral plate (UP) widths <8 mm before tubularized incised plate (TIP) incision increased urethroplasty complications. The present study measured pre-incision UP width in consecutive boys undergoing TIP to determine if it affected outcomes. Methods The present study followed the method previously used by Holland and Smith, and Sarhan et al. to measure UP width before creating glans wings or performing midline plate incision in consecutive patients with primary hypospadias and ventral curvature <30°, who all underwent TIP repair ( Summary Fig .). Glans width at its widest point was also measured. Multiple logistic regression assessed urethroplasty complications (fistula, glans dehiscence, meatal stenosis/urethral stricture, diverticulum) based on pre-incision UP width, glans width, patient age, and meatal location. Results The UP widths were determined in 224 consecutive primary TIP repairs during 2012–2015: 200 distal, 11 midshaft, and 13 proximal. The UP width was <8 mm in 192/224 (86%) patients. Mean pre-incision width was 6.1 mm (SD 1.5, range 2–11), without difference in UP widths according to meatal location ( P =0.06). Mean post-incision UP width was 12 mm (SD 2.2, range 10–16). Mean change in width after incision (delta/original UP width) was 116% (SD 63, range 20–250). There was follow-up in 186 patients for a mean of 6 months. Urethroplasty complications (five fistulas, six glans dehiscence) were diagnosed in 11 (6%): 9/165 distal, 1/9 midshaft, and 1/12 proximal repairs. There was no difference in those <8 vs ≥8 mm (11/160 vs 0/26, P =0.17). Similarly, UP width was not different between patients with and without urethroplasty complications. Multiple logistic regression in these 186 patients – including meatal location, UP width, glans width, and age – found only glans width <14 mm was associated with increased odds of urethroplasty complications (OR 19.2, 95% CI 3.5–106, AUC =0.799). Discussion The data show that pre-incision UP width is not an independent risk factor for urethroplasty complications. However, it is possible that technical factors, such as how deeply the dorsal incision is made or size of the urethral stent, might contribute to this finding by other authors. After watching the TIP repair, Smith stated that the plate incision was deeper than he made. Sarhan et al. reported a mean change of 57% in UP width after incision, whereas the present one was double at 116% (i.e. from 6 mm pre-incision to 12 mm post incision), and they used an 8-Fr catheter. While they stated that they incised the plate deeply, the lower percentage increase in width suggests that it was not as deep as was recommended. Conclusions The UP width before incision did not increase urethroplasty complications. Surgeons do not need to measure or categorize the UP to determine suitability for TIP repair, as long as the plate incision is made deeply to the corpora.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>29133164</pmid><doi>10.1016/j.jpurol.2017.05.020</doi><orcidid>https://orcid.org/0000-0002-9887-3680</orcidid></addata></record> |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Child Child, Preschool Humans Hypospadias - pathology Hypospadias - surgery Infant Male Pediatrics Time Factors Treatment Outcome Tubularized incised plate (TIP) hypospadias repair Urethra - pathology Urethra - surgery Urethral plate Urethroplasty complication risk factors Urologic Surgical Procedures, Male - methods Urology |
| title | Pre-incision urethral plate width does not impact short-term tubularized incised plate urethroplasty outcomes |
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