Cosmetic outcomes of grafted tubularized incised plate urethroplasty in primary distal penile hypospadias: prospective comparative study with the classic Snodgrass repair

Abstract

Background To compare the outcomes between classic tubularized incised plate (C-TIP), known as Snodgrass urethroplasty, and grafted TIP (G-TIP) in the repair of primary distal penile hypospadias. Methods Parents of all children presented to our tertiary care institution with primary distal penile hypospadias were asked to participate in this study. Patients were equally randomized using closed envelope method into two groups; Group A underwent repair using G-TIP and Group B underwent repair using the C-TIP. Circumcised cases and/or cases with penile chordee > 30 degrees were excluded from this study. Urethral catheter was kept for 7 to 10 days after surgery. The success rate and cosmetic outcomes assessed by HOSE score were evaluated at 6-month postoperatively. Results A total of 55 patients were recruited in each group. One hundred and seven patients of the 110 patients (54 and 53 in groups A and B, respectively) were evaluated at 6-month postoperatively using HOSE score. All preoperative data were comparable in both groups. Success was documented in 49/54 patients (90.7%) in group A. The five failures were secondary to two cases of glans dehiscence and three cases of residual postoperative chordee. Whereas, success was documented in 48/53 patients (90.5%) in group B. Complications were: a case of meatal stenosis, three cases of fistula, and a case of combined meatal stenosis and fistula. The HOSE score was comparable between the two groups (15.4 ± 1.09 vs. 15.6 ± 0.55; p = 0.29). However, the operative time was statistically longer in the G-TIP compared with the C-TIP (91.4 ± 6.2 min vs. 85.2 ± 6.3 min; p < 0.001), respectively. Conclusion The G-TIP urethroplasty provided comparable results with C-TIP in terms of cosmoses, success rate, and complications. However, G-TIP was accompanied with significantly longer operative time.

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

“…The difference in HOSE scores between the two groups was statistically significant. Our results in group A were comparable to those of the study conducted by Ahmed et al 28 The limitations of this study include the relatively short follow-up period and small sample size. The small sample size may have resulted in an underpowered subgroup analysis of complications.…”

“…Despite this, it has been validated as an objective pediatric scoring system for assessing cosmetic outcomes of hypospadias repair. 12,27, 28 Ahmed et al 28 used the HOSE score to assess cosmetic outcomes in 110 patients after 6 months of repair, comparing grafted TIPU versus classic TIPU in distal hypospadias. The mean total HOSE score was 15.4 and 15.6 in grafted TIPU and classic TIPU, respectively.…”

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

“…However, for the remaining three studies, there were some concern in the domain of randomization 7 16 and concern over missing outcome data. 10 …”

“…Mohammed et al 18 reported this outcome as a mean without range or SD. Ahmed et al 10 reported that a few of their patients failed to report for follow-up. For the meta-analysis of the outcome of operative time, we considered the total number of patients operated on by surgeons; however, for the analysis of the remaining outcome measures, we calculated the total number of patients who had completed follow-up.…”

“…A prospective randomized study by Eldeeb et al 9 also reported equivalent results for both TIP and GTIP groups with a shorter operating time in the TIP group. In their prospective comparative study, Ahmed et al 10 concluded that despite being a statistically insignificant result, GTIP repair showed better clinical outcomes. The HOSE (Hypospadias Objective Scoring Evaluation) score as a measure of cosmetic outcomes was also comparable in both groups in their study.…”