Risk Factors for Re-operation Following Tubularized Incised Plate Urethroplasty: A Comprehensive Analysis

Abstract

To review our 10-year experience with tubularized incised-plate (TIP) urethroplasty and determine the risk factors for reoperation. The hospital records of 391 patients underwent the TIP procedure from April 1997 to September 2007 were reviewed retrospectively. Data were collected with respect to patient demographics, characteristics of the hypospadias malformation, intraoperative factors and postoperative outcome. Complications requiring reoperation were identified. Univariate and multivariate analyses were used to identify risk factors for reoperation. Median age at surgery was 2 years (range, 0.5-16). Median follow-up was 11 months (range, 3-96). Neourethral complications requiring re-operation developed in 48 patients. A total of 52 reoperations were required because of fistulae (25/6%), neourethral disruption (13/3%), meatal stenosis (13/3%), and stricture (1/0.3%). The re-operation rate was significantly higher in the presence of interrupted sutures, chordee requiring dorsal plication, penoscrotal or proximal shaft defects, a lack of neourethral vascular tissue coverage, and in children over 4 years of age. Multivariate analysis identified the last 3 of these variables as independent risk factors for reoperation. In addition to position of the urethral meatus and the absence of vascular covering flaps, we found that an age over 4 years at the time of surgery is an additional independent risk factor for neourethral complications requiring reoperation.