الفهرس 
Anatomy and Embryology of The MaleOnly 14 pages are availabe for public view
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Abstract
Proximal Hypospadias repair remains challenging that’s why there is no perfect technique to generalize for all patients.
A single stage urethroplasty using TIP or TIOF is the most famous technique used by many surgeons all over the world when plate preservation is possible, while a two stage technique is applicable when plate transaction is necessary.
The aim of our study was to evaluate the results of transverse island onlay repair (TIOF) in correction of proximal hypospadias as regard operative time, cosmetic appearance, post-repair urinary stream, complications e.g. Fistula rate, disruption and urethral stricture and comparing all these results with an old historical group underwent TIP repair.
In our hands, the cosmetic and functional outcome and rate of complications of TIOF technique was satisfactory and comparable to that of TIP procedure. There is only statistical difference between both techniques as regard the meatal shape which was in the favor of TIP technique because it form a slit shape meatus unlike the rounded shape occurred with TIOF technique.
However, there is no report that rounded meatus has a significant functional problem on the patients.
Although that TIOF technique is time consuming and techniqually difficult than TIP technique, carry a potential higher risk of complications because of the 2 line of anastomosis, and requires a good lengthy foreskin to give the flap and to cover the penis, it is considered a good alternative to patients with narrow plate width with lower risk of meatal stenosis. However, a randomized controlled trial is recommended on larger number of patients to prove these results.
There is no ideal technique for hypospadias repair. Pediatric surgeon should be oriented with several operative procedures for repair to select the appropriate one for each patient.
According to our result, and to have better outcome from TIOF procedure we recommend the following:
1- Careful technique selection for each patient
2- TIOF technique is a good alternative to patients with proximal Hypospadias having a plate width less than 4 mm with no chordee.
3- More proximal dissection of the flap pedicle to help rotating the flap without rotating the penis with it.
4- Avoid rotating a very wide flap to avoid urethral diverticulum.
5- Avoid rotating ischemic or non-viable dorsal skin to avoid complete dehiscence.