Comparative Study of Urethral Plate and Glans Characteristics in Experimentally Created Hypospadias and Clinical Cases Undergoing Snodgrass Repair.

Abstract

Aim: The aim of this study was to study the urethral plate and glans configuration in experimentally created hypospadias in male human cadavers and its comparison with hypospadias patients planned for tubularized incised plate (TIP) urethroplasty.

Materials and methods: In five fresh human cadavers, hypospadias was created by placing one blade of scissors in the urethra and the other onto the ventral median raphe and cutting through the skin, penile dartos, and urethra and laying open urethral edges were sutured to edges of penile skin to create hypospadias. Urethral plate characteristics were recorded using Likert scale and the glans groove using the Plate Objective Scoring Tool (POST). The characters were compared with fifty hypospadias planned for TIP.

Results: In experimentally created hypospadias, all urethral plates were very favorable with POST ratio being >1.5. In 50 hypospadias, cleft urethral plate with POST ratio >1.2 was recorded in 5 (10%). Flat urethral plate was recorded in 20 with 12 showing POST ratio >1.2 and 8 had <1.2. Narrow urethral plate was recorded in 25 with 15 showing POST ratio of >1.2 while 10 had <1.2. In all patients of POST ratio <1.2, ventral migration of dorsal end of glans meatus was present.

Conclusions: Only 10% of hypospadias match the configuration of experimentally created hypospadias and are suitable for classic TIP. Patients with narrow urethral plates are suitable for TIP with the inclusion of paraurethral plate penile skin strip. All categories with POST score <1.2 are suitable for TIP with inner prepucial graft in incised glans bed and incised urethral plate.