Tabularised Incised Plate (TIP) Urethroplasty in Narrow V/S Wide Urethral Plate: A Comparative Study in a Developing Country Perspective

Abstract

Introduction: Tubularized incised plate (TIP) urethroplasty is the most commonly performed operation for distal and mid shaft hypospadias. There are controversies in the previous reports regarding the association between urethral plate width and complications in TIP repair. The aim of this study was to compare the impact of urethral plate width in TIP repair on the development of complications in the perspective of a developing country.Methods: It was a prospective comparative study carried out in the department of pediatric surgery, Chittagong Medical College Hospital, Bangladesh from December, 2017 to March, 2019. Patients with distal and midshaft hypospadias were divided into 2 groups: Group A-urethral plate less than 8 mm wide and Group B-urethral plate 8 mm or more wide. Age at surgery, penile characteristics, pre-incision urethral plate width, per-operative factors and development of complications were analyzed. Follow up period ranged from 6 months to 2.5 years.Results: A total of 43 patients (21 in group A, 22 in group B), with a mean age of 6.67 ± 3.38 years underwent TIP repair. Twenty-five (58%) patients had distal penile and 18 (42%) had mid shaft hypospadias. Age correlated with glans size and urethral plate width (P = 0.019 and 0.003, respectively) but there was no significant difference in age between patients with or without development of complications (P = 0.71). Complications developed in 18 (41.87%) patients, 9 in each group. Mean urethral plate width was 7.37 ± 0.84 mm and 7.19 ± 1.17 mm in patients who had successful repair and those developed complications, respectively (P = 0.59). Duration of tourniquet, size of catheter, layers of repair, duration of dressing or catheter were not also associated with UC fistula, the most common complication (P = 0.26, 0.58,0.76, 0.38, and 0.56, respectively). Conclusion:Width of urethral plated was not related to development of complications in TIP repair. Complication rates were high in comparison to other studies and skill development and improvement of other factors are necessary in the developing world to improve outcome.

Plate Objective Scoring Tool: A new preoperative indicator of penile curvature degree in children with distal hypospadias

“…However, the use of a numerical cutoff to demark urethral plate quality may be of limited utility, since Walid et al . recently showed that plate width gradually increases with age 22 . In contrast, our results obtained with the POST scoring system did not relate to patient age, thus supporting use of this tool as a reliable indicator of urethral plate quality across age groups and physical dimensions.…”

“…21 However, the use of a numerical cutoff to demark urethral plate quality may be of limited utility, since Walid et al recently showed that plate width gradually increases with age. 22 In contrast, our results obtained with the POST scoring system did not relate to patient age, thus supporting use of this tool as a reliable indicator of urethral plate quality across age groups and physical dimensions. At the same time, POST scores did still correlate with pre-incision urethral plate width in our cohort, confirming that POST scores do, indeed, provide a realistic reflection of urethral plate width as well.…”

The Plate Objective Scoring Tool (POST): Further Reflections and Extended Applications

“… 8 , 9 Walid et al noted that urethral plate width increases with age, making definitive cut-off values unsuitable for defining a favorable urethral plate. 10 POST instead permits objective measurement of hypospadias severity, and urethral plate quality in particular, prior to complete physiological retraction of the prepuce ( Figure 2 ), but without significant influence of patient age on assessment outcome. Therefore, the POST system can be used in outpatient clinics to help surgeons guide decision-making objectively, inform surgical planning, and assist with appropriate parent counselling.…”