Results of Tubularized Incised Plate (TIP) Urethroplasty with Button Hole Flap in Hypospadias Repair

Jang, Sang Woong; Kim, Young Gon

Abstract

PURPOSE: Tubularized incised plate (TIP) urethroplasty, with good results for hypospadias, has recently been reported. We analysed the surgical outcomes according to the site of the urethral opening in children with hypospadias, using TIP urethroplasty with a button hole flap.
MATERIALS AND METHODS
Between August 1996 and May 2004, 40 patients with hypospadias were primarily corrected using TIP urethroplasty, with both a conventional and a button hole flap by one surgeon. The medical records of all patients; the levels of meatus, age at surgery, surgical outcomes, complications, methods of second operation and their outcomes, were reviewed retrospectively. The preoperative types of hypospadias were glanular, coronal, anterior penile, mid-shaft, posterior penile and penoscrotal in 8, 7, 9, 6, 4 and 6 boys, respectively.
RESULTS
The mean age of the patients was 8.2 years. The overall success rate was 75.0% (30/40). The success rates, according to the type of hypospadias, were 87.5% (7/8), 75.0% (6/8), 77.8% (7/9), 66.7% (4/6), 75.0% (3/4) and 50.0% (3/6) in the glanular, coronal, anterior penile, mid-shaft, posterior penile and penoscrotal types, respectively. Postoperative penile distortion was seen in 37.5 (3/8) and 6.2% (2/32) of the conventional and button hole flap groups, respectively. The incidence of postoperative penile distortion in the button hole flap group was significantly lower than in the conventional group (p=0.046). Complications occurred in eleven patients, including urethrocutaneous fistula (9/11), urethral stricture (2/11) and depressed meatus (1/11). The patients with complications were treated with fistula repair, urethral dilatation and repeated TIP urethroplasty.
CONCLUSIONS
Our surgical experiences and outcomes show a high success rate, low complication rate and excellent cosmetic appearance for all types of hypospadias. The incidence of postoperative penile distortion was significantly low. Therefore, TIP urethroplasty, with a button hole flap, can be used as a first choice for all types of hypospadias.