A modification of the TIP procedure for distal hypospadias: The burrowing technique

Abstract

Introduction: The tubularized incised plate urethroplasty (TIP) hypospadias repair is a commonly performed procedure for hypospadias. Multiple series document excellent cosmetic outcome in conjunction with low complication rates. We describe a modification that we have named the "burrowing technique." We believe that this technique facilitates dissection of the glans, which improves mobility, decreases tension with closure, and potentially improves outcomes. Methods: A retrospective review was performed of 193 coronal or mid-shaft hypospadias repairs by a single surgeon. The first 98 were performed using the TIP procedure, then the burrowing technique was developed and a subsequent 95 were analyzed for outcomes using this modification. Urethral plate characteristics and glandular size did not influence the choice of surgical technique. Cases were selected to allow for a "learning curve," and were consecutively accrued. None of the boys had undergone prior hypospadias surgery. Proximal 2 stage repairs and distal (glanular) repairs were excluded. Results: A total of 193 boys underwent repair, 98 with the traditional TIP procedure and 95 using the burrowing modification. In total, 37 (19.2%) patients required re-operation for either fistulas or dehiscence; 23 (23.5%) in the non-burrowing group and 14 (14.7%) in the burrowing group, odds ratio 0.54 (p = 0.10). Conclusions:The TIP procedure has revolutionized the management of distal hypospadias. The burrowing modification increases glandular mobility simplifying the procedure and demonstrates a non-statistically significant trend in reducing reoperation rates.

Our Experience with a Double-Layer Surgical Technique for Preventing Fistula Development in Children and Young Adults with Hypospadias

“…Most cases are distally located. Although there are over 300 surgical methods described for Hp surgery, there is no consensus on the optimal surgical technique [5]. The main purpose of this research was to generally deal with the complications of Hp surgery, such as urethrocutaneous fistula, fissure, dehiscence or urethral stricture, as well as infection and hematoma.…”

Fatores determinantes para reoperação em hipospádia distal: uma revisão integrativa da literatura

“…Com o avanço das técnicas cirúrgicas na tentativa de adaptar uma melhor abordagem terapêutica, existem relatos de mais de Determinants of reoperation in distal hypospadia: an integrative review of the literature Monte RRL, et al trezentas técnicas cirúrgicas para a correção de hipospádia, variando do tipo e classificação da mesma e da experiência do cirurgião. O reparo da hipospádia distal está associado a taxa de complicação de 5% a 15% 6 , dentre elas: fístula uretrocutânea, estenose da uretra, estenose do meato, divertículo e curvatura ventral peniana 1,5,6 . Isto é um dos fatores determinantes para a necessidade de reoperação.…”