Improved outcomes after technical modifications in tubularized incised plate urethroplasty for mid-shaft and proximal hypospadias.

Abstract

To investigate and compare the outcomes after tubularized incised plate (TIP) urethroplasty in mid-shaft and proximal hypospadias using a standard and a modified technique. We conducted a retrospective study in 104 consecutive children who underwent mid-shaft or proximal TIP repairs from Jan 2007 to Sept 2015. Patients in Cohort One had dorsal dartos (DD) neourethral coverage while patients in Cohort Two had either de-epithelialized split preputial (DESP) or tunica vaginalis (TV) flap coverage. TV flap was used only when DESP flap was not sufficient to cover the neourethra. There were 52 patients each in Cohort One (DD, n=52) and Cohort Two (DESP, n=38; TV, n=14) with no difference in ratio of mid-shaft/proximal between the two cohorts. At a median follow-up of 28months, 36 patients (34.6%) developed 47 complications including fistula (n=19; 18.3%) and neourethral dehiscence (n=4; 3.8%). Cohort One patients had significantly more fistula (28.8 vs 7.7%; p=0.005) and neourethral dehiscence (7.7 vs 0%; p=0.04) than Cohort Two. There was no difference between the two cohorts in the complication rates of meatal stenosis, recurrent ventral curvature and neourethral stricture. Both DESP and TV flap appear to be superior to DD in preventing fistula and neourethral dehiscence in non-distal TIP repairs.