Tubularized Incised Plate Urethroplasty Research Articles

Comparison between tubularisation of an intact and laterally augmented urethral plate urethroplasty and tubularised incised plate (TIP) urethroplasty for hypospadias repair

Objectives: The aim of this study was to compare the outcome of hypospadias repair by tubularisation of an intact and laterally augmented urethral plate urethroplasty and TIP urethroplasty. Methods: This prospective comparative study was conducted from July 2018 to January 2020 and included 35 patients with primary distal and mid penile hypospadias. All had urethral plate widths of 8–10 mm. Exclusion criteria were mega meatus intact prepuce, previous repair, circumcision, urethral plate of >10 mm or <8 mm in diameter, chordee >30°. In Group A underwent tubularisation of an intact and laterally augmented urethral plate urethroplasty and in Group B underwent tubularised incised-plate (TIP) urethroplasty. The follow up period was 06 months. Results: The success rate without any complication was 88.89% and 76.48% in Group A and B respectively. Meatal stenosis occurred 0% and 11.76% in Group A and B respectively. Wound dehiscence rate was 5.55% and 5.88% in Group A and B respectively. Urethrocutaneous fistula occurred 5.55% and 5.88% in Group A versus Group B. Overall complication occurred 11.11 in Group A and 23.52% in Group B. Conclusion: The outcome of tubularisation of intact and laterally augmented urethral plate urethroplasty was better than TIP urethroplasty. Journal of Paediatric Surgeons of Bangladesh (2019) Vol. 10 (1 & 2): 32-36

Widening of narrow urethral plates with lateral skin in TIP hypospadias repair: single center series

BackgroundTo compare the outcomes of hypospadias repair using tubularized incised plate (TIP) urethroplasty and modified TIP with lateral skin to widen the urethral plate (WTIP).Materials and methodsData were obtained from pre-pubertal boys who underwent primary hypospadias repair between May 2018 and July 2023. The cases were divided into two groups; one group underwent TIP with urethral plate ≥ 6 mm width and the other group with urethral plate width < 6 mm underwent WTIP. WTIP urethroplasty was performed by widening incisions on the outer margins of the urethral plate to incorporate penile and glandular skin lateral to the urethral plate to facilitate tubularization. Complication rates and urinary functions were compared.ResultsA total of 157 patients were enrolled in this study. Eighty-eight cases with narrow urethral plate were subjected to WTIP urethroplasty, and the rest were subjected to TIP urethroplasty. The preoperative glans width in WTIP group was less than that in TIP group (P < 0.001), and 44.3% had midshaft meatus in WTIP group compared to 17.4% in TIP group (P < 0.001). However, the incidences of postoperative complications (17.6% vs. 21.6%, P = 0.550) were not statistically different between the TIP and WTIP groups. In addition, both groups did not differ significantly in postoperative uroflowmetry assessment.ConclusionsThe described technique helps to create an adequately caliber aesthetic neomeatus and facilitates tubularization, especially in hypospadias with a narrow urethral plate. Our data suggest that augmentation of a narrow urethral plate with WTIP has a similar surgical outcome to that of the TIP procedure in patients with a wide urethral plate.

Use of Validated Questionnaires to Predict Cosmetic Outcomes of Hypospadias Repair.

Hypospadias is a syndrome of penile maldevelopment. The primary goal of hypospadias surgery is to create a penis with normal appearance and function. Historically, the outcome of hypospadias repair has been assessed based on the need for reoperation due to urethroplasty complications (UC), including fistula formation, dehiscence, meatal stenosis, or development of a urethral stricture. The Glans-Urethral Meatus-Shaft (GMS) score is a standardized tool to predict UC. Analysis of the cosmetic outcomes of hypospadias repair based on the appearance of the reconstructed penis has been validated, and standardized scores have been published. The Hypospadias Objective Penile Evaluation (HOPE) score is a validated questionnaire used to assess postoperative cosmetic outcomes. Although predictors of surgical outcomes and UC have been well documented, predictors of optimal cosmetic outcomes are lacking in the literature. Furthermore, reoperation due to cosmetic considerations has been poorly reported. To identify predictors of cosmetic outcomes after hypospadias repair and to assess the reoperation rate according to cosmetic considerations. This prospective cohort study included 126 boys who underwent primary hypospadias repair. The severity of hypospadias, degree of penile curvature, glans width, preoperative HOPE, and GMS scores were documented. The standard technique for single-stage repairs, the tubularized incised plate urethroplasty, was performed. The primary endpoint was cosmetic outcomes evaluated by the HOPE score questionnaire six months postoperatively. Optimal cosmetic results were defined by HOPE scores ≥ 57. The study population consisted of the following cases: 87 (69%) subcoronal, 32 (25%) shaft, and 7 (6%) proximal hypospadias. Among the study participants, 102 boys (81%) had optimal cosmetic results (HOPE ≥ 57), and 24 boys (19%) had surgeries with suboptimal cosmetic outcomes (HOPE < 57). Ancillary procedures were performed in 21 boys (16%), of which 14 (11%) were solely for cosmetic considerations, and 7 were secondary to UC. Using the Receiver Operating Characteristic analysis of potential predictors of optimal cosmetic outcomes, the preoperative HOPE score had the highest area under the curve (AUC = 0.79; 95% CI 0.69-0.89, p < 0.001). After multivariable analysis, the degree of penile chordee (p = 0.013), glans width (p = 0.003), GMS score (p = 0.007), and preoperative HOPE score (p = 0.002) were significant predictors of cosmetic outcomes. Although meatal location predicted suboptimal cosmetic results in univariate analysis, it was not a factor in multivariable analysis. Over 80% of boys undergoing hypospadias repair achieved optimal cosmetic outcomes. More than 10% of cases underwent ancillary procedures, secondary solely to cosmetic considerations. Predictors of optimal cosmetic outcomes after hypospadias surgery included degree of chordee, glans width, and preoperative HOPE and GMS scores, which were the best predictors of satisfactory cosmetic results. Although meatal location is the main predictor of UC, it was not a predictor for cosmetic outcomes. Factors affecting cosmetic outcomes should be clearly explained to parents during the preoperative consultation.

The application of the modified Snodgrass technique in hypospadias surgery.

We aimed to explore the effectiveness of the modified tubularized incised plate urethroplasty (Snodgrass Technique) in hypospadias surgery. A study was conducted on 50 pediatric patients with hypospadias treated in our hospital from May 2020 to May 2023. The patients were divided into two groups based on the condition of their urethral plate; 22 patients were included in the study group and 28 patients were included in the control group. The control group underwent the traditional Snodgrass technique, while the study group received the modified Snodgrass technique. The two groups were compared in terms of treatment efficacy, preoperative and postoperative 6-month Hypospadias Objective Scoring Evaluation (HOSE) scores, surgical data, and postoperative complications. The operation time for the study group was longer than that of the control group, and the intraoperative blood loss was less, but the differences were not statistically significant (p > 0.05). The success rate of surgery in the study group was 95.45% (21/22), compared to 71.43% (20/28) in the control group, showing a statistically significant difference (p < 0.05). The maximum urinary flow rate at 3 and 6 months postoperatively was significantly higher in the study group than in the control group (p < 0.05). The time to maximum flow (TQmax) and post-void residual (PVR) at 3 and 6 months postoperatively were significantly lower in the study group (p < 0.05). A total of 3 patients in the cohort developed urethral fistulas, all between 0.10 cm x 0.10 cm and 0.15 cm x 0.15 cm in size. By instructing the patients to apply pressure to the fistula during urination, all fistulas closed between 3 and 6 months postoperatively. The incidence of postoperative complications was 4.55% in the study group and 28.57% in the control group, a difference that was statistically significant (p < 0.05). The modified Snodgrass technique shows significant therapeutic effectiveness in hypospadias surgery, substantially increasing the success rate and reducing postoperative complications in pediatric patients, making it suitable for widespread application.

Evaluation of Tubularized Incised Plate Urethroplasty with Spongioplasty-Dartosoraphy Reinforcement in Pediatric Hypospadias: A Randomized Controlled Study.

The original description of tubularized incised plate urethroplasty (TIPU) was provided by Snodgrass in 1994. The results were significantly improved by several modifications. To decrease the incidence of complications, interposing a vascularized flap after tubularization of the neourethra is recommended. The extent to which the type of interposed tissue has a direct effect on the rate of complications and cosmetic outcomes after TIPU repair is considered the answer to the main hypothesis of this study. This prospective controlled randomized trial was conducted in the Department of Pediatric Surgery, Al-Azhar University, Cairo, Egypt, between May 2019 and May 2023. A total of 220 patients were included in this study. Patients were randomly assigned to either group A or group B. Group A included 110 patients who underwent TIPU with spongioplasty-dartosoraphy reinforcement. The other 110 patients (group B) underwent TIPU with dorsal dartos flap interposition, without spongioplasty. Complications developed in 34 of 220 patients (15.4%). In group A, complications developed in 11 of 110 patients (10.0%). In group B, complications occurred in 23 of 110 patients (20.9%). Although the fistula rate, glanular dehiscence, disruption, and meatal stenosis were not significantly different between the study groups, the skin necrosis rate was significantly lower in group A than in group B. The overall complication rate was significantly lower in group A than in group B. Also, the difference in the mean Hypospadias Objective Scoring Evaluation between the two groups was statistically significant. TIPU with spongioplasty-dartosoraphy reinforcement is an effective modification of conventional TIPU. This modification appears to reduce the rate of complications and yield better cosmetic outcomes.

The long-term consequences of the hypospadias salvage repair issue

PurposeTo present the long-term results of redo-hypospadias at our tertiary referral center following a failed prior repair.MethodsOne hundred sixty-four individuals with a history of unsuccessful repairs qualified for our retrospective cohort study. Our inclusion criteria were as follows: pre-operative data that was accessible, redo-hypospadias that was successfully repaired, and at least three years of follow-up at the last hospital visit.ResultsThe mean patient age was 91.3 ± 21.1 months. The mean follow-up after successful repair was 41.3 ± 3.1 months. Ninety-two (group A) had one prior repair, and 72 (group B) had 2 or 3 repairs. Group A underwent six primary techniques: 32 underwent Onlay Island Flap (OIF), 10 underwent Mathieu, 12 underwent Tubularized Incised Plate Urethroplasty (TIPU), 8 underwent Urethral Mobilization (UM), and 34 underwent Buccal Mucosal Graft (BMG) { dorsal inlay Graft Urethroplasty (DIGU) in 4 and staged BMG in 30 patients}. In group B, four procedures were used: TIPU in 4, UM in 6, and BMG in 62 (staged BMG in 50 cases and DIGU in 12).ConclusionsThe selected type of repair will depend on many factors, like residual healthy local skin and expertise. Safe techniques for repair of redo hypospadias after its 1st failure include TIPU, Mathieu, UM, OIF, and DIGU for distal varieties. After 2nd or 3rd repair DIGU, UM, and TIPU can be performed in distal types, while staged BMG can be applied for proximal ones.

Tubularized incised plate urethroplasty and grafted tubularized incised plate urethroplasty: systematic review, meta-analysis and trial sequential analysis

BackgroundHypospadias is one of the most common genital birth defects. There are around 300 various techniques available for the repair of hypospadias. This study aims to compare the reported outcomes...

Hypospadias with Intact Prepuce: A Spectrum of Anomalies and their Reconstruction.

The aim of the study was to perform a detailed analysis of the clinical characteristics of megameatus with intact prepuce (MIP) and to audit our results of reconstructive surgeries on MIP. Design: Retrospective analysis. Setting: Pediatric surgery department of tertiary level. Subjects, methods: Hospital records and pictures of MIP operated over a 9-year period. Age, size of penis, circumcised or not, shape of glans, external urethral meatus (EUM), urethral plate (UP), chordee, distal urethra, reconstructive surgery, and complications were analyzed. Postoperative result was objectively assessed by Hypospadias Objective Scoring Evaluation (HOSE). Twelve of 254 hypospadias were MIP (incidence = 4.72%). The mean age at operation was 38.25 months (12-87 m). Patients sought circumcision or surgical correction of anomaly. Two patients were precircumcised. MIP was coronal 7, subcoronal 3, and glanular 2. Meatus was wide in 10 and normal in 2. Glans penis was wide in 9 and conical in 3. UP was wide (9), moderately wide (2), or narrow and shallow (1). In two cases of wide deep UP, distal septum was present. Distal urethra was nondilated in all but 1, which had megalourethra. Reconstructive surgery was Tubularized Urethral Plate Urethroplasty (7 cases) or classical Snodgrass (Tubularised incised plate urethroplasty (TIPU), with superimposed vascular dartos flap (5 cases). The megalourethra underwent partial excision and TIPU. Distal UP-septum was incised. Urethral injury (2 cases) and UP injury (1 case) were intraoperative complications. One postoperative complication (ventral glans necrosis) resulted. The mean follow-up period was 4.79 months (1-12 m). In the postoperative follow-up, 11 (92%) had HOSE score 14-16, whereas one had HOSE 13. Some hypospadias cases which have intact prepuce have no megameatus; hence, they cannot be termed MIP. All cases of hypospadias having intact prepuce can be covered by the umbrella term "Hypospadias with Intact Prepuce (HIP);" MIP is a large subgroup under HIP. HIP presents with a spectrum of anomalies of glans, EUM, and UP. Repair by tubularization of UP without or with midline incision gives excellent results.

Outcomes of double-breasted spongioplasty as additional tissue coverage in tubularized incised plate urethroplasty

BackgroundModern hypospadiology is constantly developing new ideas to improve functional outcomes. Tubularized incised plate urethroplasty (TIPU) with neourethral covering by vascularized tissue (dartos flap, corpus spongiosum) is presently the most common procedure performed. Aim of this study was to evaluate the effectiveness of double-breasted spongioplasty (DBS) as additional tissue coverage in TIPU by comparing it with TIPU without spongioplasty. MethodsWe conducted a prospective comparative study from September 2022 to October 2023 on 120 midshaft and distal hypospadias cases aged 1 to 12 years. Group A (n = 60) underwent TIPU without spongioplasty; Group B (n = 60) underwent TIPU with DBS. Pre-operative patient parameters were categorized according to Glans-Meatus-Shaft (GMS) Score. Follow-up was 4 months to one year. Complications like urethrocutaneous fistula (UCF) and meatal stenosis (MS) were recorded. Functional outcomes were assessed using Hypospadias objective scoring evaluation (HOSE). ResultsAverage age was 5.68 ± 2.26 in group A and 6.40 ± 2.10 in group B. Group A had mean GMS 5.32 ± 1.09; Group B had 5.45 ± 1.12 (p = 0.49). In group A, 4 (6.66 %) had MS, 5 (8.33 %) had UCF; in group B, 5 (8.33 %) had MS, 2 (3.33 %) had UCF (p > 0.05). Dorsal plication for ventral curvature was avoided in 7 patients after DBS. Surgeon evaluated mean HOSE was 14.73 ± 1.87 in Group A and 15.40 ± 1.26 in B (p = 0.02); in group A, 83.33 % while in group B 95 % cases had acceptable HOSE (≥14) (p = 0.04). ConclusionDouble-breasted spongioplasty in TIPU has better functional outcomes when compared with TIPU without spongioplasty and may correct ventral curvature of mild to moderate severity. Level of evidenceLEVEL II.

Comparative outcomes among inlay grafted incised plate, onlay preputial flap and tubularized incised plate urethroplasty for the repair of distal penile hypospadias with a narrow urethral plate

PurposeWe conducted this study, comparing the outcomes among Transverse Onlay Island Flap, inlay grafted incised plate and our previous records of tubularized incised plate urethroplasty (TIPU) in patients with narrow urethral plates, aiming to determine which method of repair provides a good outcome.MethodsThis hybrid study included two datasets. The first from a prospective randomized study evaluating outcomes of two treatment modalities; Inlay graft and only flap for distal hypospadias with shallow urethral plate with 80 patients (40 patients in each group) included, the second based on our previous records of TIPU in 40 patients with distal primary hypospadias with narrow urethral plate.ResultsThe success rate in inlay graft urethroplasty group (n = 40) was 87.5%; glandular dehiscence occurred in one case (2.5%), fistulas occurred in 2 cases (5%), and narrow meatus occurred in two cases (5%). Success rate in onlay flap urethroplasty group (n = 40) was 82.5%; glandular dehiscence occurred in two cases (5%), fistulas occurred in two cases (5%), and narrow meatus occurred in three cases (7.5%). TIPU group (n = 40) had success rate of 62.5%; glandular dehiscence occurred in eight cases (20%), fistulas occurred in five cases (12.5%), and narrow meatus occurred in seven cases (17.5%), with five cases exhibiting both narrow meatus with fistula.ConclusionInlay graft and onlay flap urethroplasty for repair of distal penile hypospadias with narrow urethral plate had higher success rate and fewer complications than traditional TIPU. Moreover, operative time was shorter in TIPU.

Surgical efficacy of tubularized incised plate urethroplasty applying for Buck's fascia coverage in the treatment of hypospadias

ObjectiveThe aim of this study was to compare the effectiveness of Buck's fascia and dartos fascia in covering the neourethra during tubularized incised plate urethroplasty (TIPU) for treating hypospadias in children. MethodsWe conducted a retrospective analysis of 100 cases of hypospadias treated with TIPU at the Department of Urology, Beijing Children's Hospital from January 2019 to September 2021. The cases were divided into two groups (A and B) based on the type of intraoperative neourethral covering used during surgery. Group A (n = 53) was covered with Buck's fascia, while group B (n = 47) was covered with dartos fascia. Two experienced surgeons performed the surgeries in their respective groups. We recorded general clinical data, intraoperative measurements, and postoperative follow-up data for both groups and analyzed the results statistically. ResultsThere were no significant differences in clinical data, such as mean age, urethral opening position, penile length, urethral plate width, urethral defect length, preoperative penile curvature and follow-up time (P > 0.05) between the two groups. However, group A had a wider glans and a lower proportion of dorsal tunica albuginea plication to correct penile curvature but a higher proportion of 6F catheters left in place (P < 0.05). c, group A reported 12 cases (22.6 %) of complications including eight cases (15.1 %) of urethral stricture and five cases (9.4 %) of urethral fistula; four cases were related to penile corporal fistula while one related to coronal fistula. On the other hand, group B reported 17 cases (36.2 %) of complications including three cases (6.4 %) of urethral stricture and fourteen cases (29.8 %) of urethral fistula; four cases were related to penile corporal fistula while one related to coronal fistula. A multifactorial analysis incorporating confounding factors revealed a lower incidence rate for urethral fistulas in group A compared to group B(P < 0 0.05). ConclusionThe application of Buck's fascia to cover the new urethra can effectively reduce the incidence of urethral fistula in TIPU, and the quality of Buck's fascia and suture tension should be taken into account to avoid the formation of urethral strictures.

Comparison of the efficacy and safety of dorsal inlay graft urethroplasty (DIGU) method with tubularized incised plate urethroplasty (TIPU) method in primary distal hypospadias repair: a systematic review and meta-analysis

Link of Video Abstract: https://youtu.be/r399GEt3guoIntroduction: Tubularized Incised Plate Urethroplasty (TIPU) is a technique that is widely used in distal hypospadias repair. The advantages possessed by this technique are better cosmetics, the meatus is at the tip of the penis, and the phallus is straight. Some researchers believe that a urethral plate with a size of less than 8 mm is unsuitable for the TIPU technique so augmentation with a graft using the dorsal inlay graft urethroplasty (DIGU) technique is needed. To date, there have been no systematic reviews and meta-analyses that have directly compared the efficacy and complications of DIGU and TIPU. Therefore, this study aimed to compare the effectiveness and complications of these two modalities for repair in primary distal hypospadias patients. Methods: This study is a systematic review study and meta-analysis. The protocol for conducting and compiling this study was based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search was performed on six databases: PubMed, Scopus, Web of Science, ProQuest, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov. The risk of bias in the study will be analyzed using the Cochrane Risk of Bias Tools for Randomized Trials version 2 (RoB 2). Results: Six studies that met the inclusion criteria were included in the meta-analysis with a total of 381 samples. The success rates (OR 1.46, 95% CI 0.74-2.87, p = 0.28) and urine output (OR 2.54, 95% CI 0.63-10.20, p = 0.19) were not significantly different, while the mean operating time (MOT) (SMD 1.96, 95% CI 1.10-2.82, p &lt; 0.0001) was significantly shorter in TIPU (P &lt; 0.05). The incidence of meatal stenosis was significantly more in TIPU than DIGU significantly (OR 5.11, 95% CI 1.46-17.92, p = 0.01), while fistula (OR 2.93, 95% CI 0.92-9.35, p = 0.07) and dehiscence (OR 3.05, 95% CI 0.81-11.45, p = 0.10) was not significantly different between the two techniques. Conclusion: TIPU has the advantage of shorter operating time but a higher incidence of meatal stenosis than DIGU.

Effectiveness of penile ventral curvature correction and the trend of hypospadias repair: a prospective study of the national center in China

BackgroundHypospadias repair is a complex surgical procedure that involves correcting penile ventral curvature (VC) and performing urethroplasty. This study aims to evaluate the effectiveness of different strategies for VC correction...

A meta-analysis: single or double dartos flap layer in tubularized incised plate urethroplasty to prevent urethrocutaneous fistula?

Urethrocutaneous fistula is one of the most common complications after urethroplasty. This meta-analysis aims to evaluate the superiority of double dartos flap to single dartos flap in preventing fistula during tubularized incised plate urethroplasty (TIPU), which is one of the most frequently used operations for hypospadias. We extracted clinical trials under the following included criteria: (1) children with TIPU; (2) a comparison of single and double flap layer; and (3) record of complications with the following excluded criteria: (1) non-comparison and (2) lack of data. Finally, 13 studies from PubMed, Cochrane Library, Scopus, and Embase have been investigated, with a total of 1,185 patients from 2005 to 2022. The quality assessment was conducted according to the Cochrane handbook and the Newcastle-Ottawa scale. A mixed-effect model was utilized to weigh the risk of fistula, phallic rotation, meatal stenosis, and wound dehiscence by the Review Manager V.5.4 software. The double dartos flap layer group excels in descending the risk of postoperative fistula [odds ratio (OR) = 9.56; 95% confidence interval (CI) (4.76, 19.22); P < 0.00001] and phallic rotation [OR = 31.26; 95% CI (9.60, 101.84); P < 0.00001], while there are no differences in the rate of meatal stenosis [OR = 1.49; 95% CI (0.73, 2.70); P = 0.31] and wound dehiscence [OR = 2.30; 95% CI (0.80, 6.63); P = 0.12]. The routine utility of a double dartos flap layer is recommended as a potential treatment during the tubularized incised plate urethroplasty. identifier PROSPERO CRD42022366294.

The long term evaluation of the sexual and voiding functions in adolescents with the tubularized incised plate urethroplasty for distal hypospadias at childhood

The long term evaluation of the sexual and voiding functions in adolescents with the tubularized incised plate urethroplasty for distal hypospadias at childhood

Analysis of The Curative Effect of Tubularized Incised Plate Urethroplasty for Distal Hypospadias With The Dysplastic Corpus Spongiosum Covering Technique.

To investigate the use of tubularized incised plate (TIP) urethroplasty for distal second- and third-degree hypospadias to free the dysplastic forked corpus spongiosum and Buck's fascia, which are used as a covering material for the new urethra, thereby reducing the incidence of urinary fistula and other complications in the coronal sulcus. Clinical data of 113 patients with distal hypospadias treated with TIP urethroplasty from January 2017 to December 2020 were retrospectively analyzed. The study group comprised 58 patients (use of dysplastic corpus spongiosum and Buck's fascia to cover the new urethra), and the control group comprised 55 patients (use of dorsal Dartos fascia to cover the new urethra). All children were followed up for more than 12 months. In the study group, 4 patients developed urinary fistulas, 4 developed a urethral stricture, and no case developed glans fissure. In the control group, 11 patients developed urinary fistulas, 2 developed a urethral stricture, 3 developed a glans cracking. Using the dysplastic corpus spongiosum to cover the new urethra increases the amount of tissue in the coronal sulcus and reduces the incidence of urethral fistula, but it may increase the incidence of urethral stricture.

Comparison of urethrocutaneous fistula after tubularized incised plate urethroplasty and urethral advancement and glanuloplasty incorporated in coronal hypospadias.

Objective: To find the incidence of urethrocutaneous fistula after Tubularized Incised Plate Urethroplasty (TIPU) and Urethral Advancement and Glanuloplasty Incorporated (URAGPI) repairs in children presenting with coronal hypospadias. Study Design: Randomized Prospective Study. Setting: Department of Paediatric Surgery, Pak Emirates Military Hospital, Rawalpindi. Period: 10th March 2022 to 10th November 2022. Material &amp; Methods: A total of 40 children were enrolled in the study. Patients were randomly allocated to receive either TIPU (n=20) or URAGPI (n=20) technique after approval of hospital ethical review committee. Data was collected on a specifically designed proforma. Outcome was measured in terms of incidence of urethrocutaneous fistula in the two study groups. Results: Average age of patients was 28.2 ± 9.7 (months) in TIPU and 29.6 ± 9.9 months in URAGPI group. Frequency of fistula was 4 (20.0%) in TIPU repair compared to none 0 (0.0%) in the URAGPI repair. Difference in proportions of urethrocutaneous fistula was found statistically significant between the two groups (p-value = 0.03). Conclusion: Incidence of urethrocutaneous fistula was found greater in TIPU technique when compared with URAGPI technique.

Effect of Haematological Parameters in the Development of Urethrocutaneous Fistula After Hypospadias Surgery.

Investigation of the relationship between urethrocutaneous fistula (UCF) development and haematological parameters after hypospadias surgery was aimed for in this study. Patients who underwent tubularized incised plate urethroplasty between January 2015 and June 2021 with the diagnosis of distal hypospadias were included in the study. We divided the participants into two groups based on UCF development. We compared haematological parameters, including neutrophil, lymphocyte, and platelet counts; neutrophil-lymphocyte ratio (NLR); platelet-lymphocyte ratio (PLR); and systemic immune inflammation index (SII) values between the two groups. A total of 78 patients were included in the study. Of the patients, 11 developed UCF. The mean age of the patients was 74.9 ± 42.8 months. Catheter diameter, operation time, neutrophil counts, NLR, and SII values were similar between those with and without UCF (p > 0.05). However, the UCF group had significantly higher lymphocyte and platelet counts than those without UCF (p < 0.05). Moreover, the PLR value was significantly lower in the UCF group (p < 0.05). Patients who developed UCF post hypospadias surgery had a significant association with altered blood cell counts, including increased lymphocytes and decreased PLR rate. The PLRcan be used as a biological marker for UCF development.

Associations between suturing techniques and suture materials with complications of tubularised incised plate urethroplasty: A systematic review and meta-analysis

Tubularised incised plate (TIP) urethroplasty has received widespread acceptability for hypospadias repair. Differences in surgical approach might impact the outcome of TIP urethroplasty. This study was performed to examine the associations between suturing techniques and suture materials with complications of TIP urethroplasty. Following electronic databases: PubMed, ScienceDirect, EMBASE, and Cochrane Library were systematically reviewed for the studies that reported comparisons of interrupted and continuous suturing techniques and comparisons of several suture materials with complication rates during TIP urethroplasty. Risks of bias were evaluated with RoB 2 tool for randomised controlled trials (RCTs) and ROBINS-I tool for comparative non-RCTs. All data were analysed utilising review manager 5.4. Thirteen total studies involving 2,967 patients underwent TIP procedure were included in this study. However only nine studies fulfilled the criteria for quantitative synthesis. In meta-analysis, there was no significant difference of total complications rate among interrupted and continuous suturing techniques (OR 0.86; 95% CI: 0.46–1.59). Subgroup analysis for each complications (urethrocutaneous fistula, infection, dehiscence, meatal stenosis, and urethral stricture) were also not statistically different. The utilisation of absorbable synthetic braided suture compared to monofilament sutures did not increase the complications rate of TIP urethroplasty (OR 1.49; 95% CI: 0.83–2.68). No publication bias was observed in the funnel plot. Our meta-analysis showed that suturing techniques and suture materials had no significance on the complications of TIP urethroplasty. The selection of suturing techniques and suture materials should be based on surgeons or centre's local experience.

Outcome of Classical Tubularized Incised-Plate Urethroplasty (TIP) for Primary Anterior Hypospadias Repair: 5 Years’ Experience

Introduction: Classical Tubularized Incised-plate Urethroplasty (TIP) is a surgical procedure used to repair hypospadias, which is a birth defect in which the opening of the urethra located on the underside of the penis rather than at the tip. Aim of the Study: The aim of this study was to evaluate the surgical outcome of classical tubularized incised plate (TIP) urethroplasty. Methods: This retrospective study was conducted in the Department of Pediatric Surgery, Bangladesh Shishu Hospital &amp; Institute, Dhaka from July 2017 to June 2022. Total 53 patients were included in this study. Result: In the current study, the mean age of participants was 43.08±21.72 months where the minimum age was 12 months and maximum age was 103 months. The mean weight of participants was 19.25±7.78 kg. The mean penile length of participants was 35.9±8.05 mm. The mean operation time was 73.24±4.80 minutes. Mean operation cost was 277.50±40.46 US$. Mean hospital stay was 10.7±0.75 days. In our study, 15.09% had UC fistula, 5.66% had wound infection and 7.54% had meatal stenosis. Follow up period was 7.9±2.1 months. In this study, more than half (50.94%) had distal penile hypospadias, 28.30% had coronal hypospadias and 20.75% had sub-coronal hypospadias. Conclusion: According to the findings of our study, Tubularized Incised-plate (TIP) urethroplasty is found to be a safe and reliable technique for hypospadias repair. The rate of complications was found low in TIP urethroplasty.