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

Abstract

Hypospadias is the most common genital malformation occurring due to incomplete development of the urethral folds in neonate infants. The prevalence varies from 3 to 8 per 1,000 live births. Studies in recent times have reported this has increased in the last 30 years in the USA. On attendance, more than 50% are known to have distal localization. At present, about 300 surgical techniques have been described, with continuing debates about the topic of which is better. The main aim of surgical methods is to obtain a urethra with normal calibration and provide good cosmetic appearance. Additionally, it should be easy to learn, simple, applicable to most cases, be completed in a single session and have low complication rates (Bhat et al., 2016). Snodgrass first described the TIPU method in 1994, and it is currently the most commonly chosen surgical method. Neourethral tube length, suture technique, urinary diversion selection, stent use, surgical technique and anatomic features like distal urethral plate and glandular groove are known to affect the success of TIPU surgery. Currently, the surgical method has been modified to include transfer of tissue like dorsal or ventral-lateral dartos fascia flap or corpus spongiosum flap over the neourethral tube to increase the success of surgery or reduce complication rates (Yildiz et al., 2012). The most commonly observed complications are urethrocutaneous fistula or meatal stenosis. Other less commonly observed complications include glans dehiscence, proximal dehiscence of the meatus, skin necrosis and wound site infections.

Glans Diameter and Meatus Localization Are the Sole Predictors of Primary Distal Hypospadias Surgery Complications: A Multivariate Analysis of Single Surgeon Series

“…In a multicentric study of 591 cases with a fistula rate of 15.3%, binary logistic regression analysis indicated old age, not putting a cystostomy, and greater splint size as predictors of fistula [12]. Urethral plate, glandular grove, and glans shape were listed as fistula predictors in a study investigating 162 TIPU cases with a total fistula complication rate of 15.2% [1]. In contrast to the previous study, urethral plate/glans width proportion and proximal hypospadias were proposed as predictor factors in a study of 442 patients with a 10.8% fistula rate [13].…”

“…Hypospadias, with an incidence that varies from 0.3% to 0.8% in live male births, is one of the most frequent congenital urogenital abnormalities [1,2]. Hypospadias surgery is among the most challenging conditions in pediatric surgery practice.…”

“…Although there have been many improvements in instrumentation, suture materials, anatomical knowledge, and surgical details, a surgical golden standard equally applicable to all levels of hypospadias is still lacking. The existence of more than 300 different surgical procedures is a testament to this surgical challenge [1]. A variety of differentiating elements such as the size of the penis and urethral plate, level of division of the corpus spongiosum, presence of curvature, and position of the scrotum add to the complexity of these cases [1,2].…”

“…The existence of more than 300 different surgical procedures is a testament to this surgical challenge [1]. A variety of differentiating elements such as the size of the penis and urethral plate, level of division of the corpus spongiosum, presence of curvature, and position of the scrotum add to the complexity of these cases [1,2].…”

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

“…Chordee or ventral curvature (VC) was recorded visually with parents' cell camera photos while erection or micturition at the first or second visit and most reliably and quantitively after performing the erection test before making skin incisions. Chordee was defined as a penile shaft curvature and is categorized based on its degree measured by a goniometer: mild (<30), moderate (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45), and severe (>45) curvature. 10 The variables were measured and the operations were performed by a single surgeon to remove potential interobserver variations in the measurements and observations and surgical outcomes.…”