A Prospective Study to Evaluate the Role of Different Variables in Results of TIPU for Hypospadias

Abstract

The objective of this article is to evaluate the role of different variables affecting the results of tubularised incised plate repair for hypospadias.We prospectively evaluated 125 patients of TIPU repair from April 2009 to October 2011. Study parameters were age, severity of hypospadias, degree of curvature and torsion, size of penis and glans, width of urethral plate, development of spongiosum and complication rate. Patients were classified into five groups by age; Group I-6 months to 2 years, Group II-2 to5 years, Group III-5 to10 years, Group IV-10 to 15 years and Group V-older than 15 years. Results were analyzed with reference to different variables.Age ranged from 6 months to 26 years (mean 8.8 years). Complication rate when comparing group V and youngest patients (groups I & II) was 20% Vs 3.6% (p=0.08), and when comparing older children (G-III and IV) with youngest patients (group I & II) was 15% Vs 3.6% (p=0.135). More severe hypospadias had higher complications (30% in proximal, 5.7% in distal (p = 0.001). The complication rate was 3.6%, 38.8% and 35.7% respectively in cases with mild, moderate and severe curvature (p = 0.001). Complications were higher in patients with poor spongiosum and higher age (p = 0.001) and in patients with narrow urethral plate (p = 0.0001). Follow up period was from about 10 months to 2 years (mean = 20 months).Urethral fistula and stricture were the most commonly reported complications. Important factors in outcome of TIPU repair were the degree of curvature, width of urethral plate development of spongiosum, age of child and severity of hypospadias. The development of urethral plate and spongiosum is directly proportional to the complication rate. Complications increase significantly with the increasing age of the patient.

TIPU outcomes for hypospadias treatment and predictive factors causing urethrocutaneous fistula and external urethral meatus stenosis in TIPU: Clinical study

“…Some authors used it to identify a < 8 mm narrow urethral plate (Holland & Smith, 2000; Nguyen, Snodgraas, & Zaontz, 2004). However, according to the more recent classification (Bhat, Bhat, et al, 2014; Bhat, Sabharwal, et al, 2014), it has been reported that it is unreasonable to define a fix value for each patient, instead the native urethral diameter should be referenced to determine the width of the urethral plate. Though debates about the optimum urethral plate width continue, as the urethral plate diameter increases, post‐operative complications are known to reduce.…”

Hypospadias in toddlers: a multivariable study of prognostic factors in distal to mid-shaft hypospadias and review of literature

“…It has been shown that complications can increase with age when comparing early childhood with late childhood. 28 29 UP dimensions vary as age increases, and considerable changes develop in the UP structure. Older UPs consist more of collagen content, fewer cells, and elastic tissue and are depleted of vascular sinusoids.…”

Double breasting spongioplasty in tubularized/tubularized incise plate urethroplasty: A new technique

“…The quality of the spongiosum and width of the urethral plate were graded intraoperatively as per published literature into poorly, moderately and well developed. [11] Similarly, the width of urethral plate is assessed and categorized into wide, when it can be tubularized easily without incision (on the largest acceptable size catheter in normal proximal urethra). If urethral plate requires a superficial incision for tubularization; then, it is considered to be an average one, and when it requires a deep incision then urethral plate is considered as narrow.…”