Factors Affecting Results of Hypospadias Repair: Single Technique and Surgeon
Wit Viseshsindh MD*
Affiliation : * Department of Surgery, Ramathibodi Hospital, Bangkok, Thailand
Objective : To review our experience of using the tubularized incised plate (TIP) urethroplasty to treat all type of hypospadias
and identify factors that affect the results and complications.
Material and Method: A retrospective medical records review of 90 patients with hypospadias treated with TIP urethroplasty
between November 2007 and March 2012 was performed. The operation was done by TIP technique in eighty patients. The
entire length of the urethral plate was incised along the midline and the neourethra was tubularized over a 6 or 8 Fr feeding
tube with Maxon or Vicryl 6-0 suture. The urethral stent was removed on the third to seventh post-operative day. All operations
were done by the same surgeon. Postoperative follow-up was at least one year in all patients. Presence of complications
requiring reoperation and overall general appearance were recorded.
Results : TIP was performed in 80 boys, age ranged from 11 months to 15 years (mean age 2.5 years). Distal hypospadias
was found in 15, midshaft in 18, proximal in 16, and penoscrotal in 31 patients. Overall success rate was 76.25%.
Re-operation was required in 19 patients (23.75%): for urethrocutaneous fistula in 12 (15%), complete disruption of the
repair in three (3.75%) and meatal stenosis in four (5%). The meatal stenosis was managed by simple dilatation in all
patients. All fistulas, except for one, were successfully repaired in a single operation. Complications increased in penoscrotal
hypospadias and repaired at early period. Age at surgery did not increase complications rate.
Conclusion : TIP repair is a reliable method for treating all types of hypospadias. Complications rate may depend on type
of hypospadias and increase in proximal and penoscrotal location. Our data indicate age at surgery does not increase
urological complications. A better outcome is achieved with good experience.
Keywords : Hypospadias, TIP, Urethrocutaneous fistula, Urethroplasty
