Comparison of the of tubularised incised plate uretheroplasty versus grafted tubularised incised plate uretheroplasty in distal hypospadias repair with narrow uretheral plate.

Background: Tubularised incised plate uretheroplasty (TIPU) repair has become the most popular technique for repairing distal hypospadias. Several complications, including meatal stenosis, have been reported. Dorsal inlay graft urethroplasty (‘Snodgraft’) has been described as an effective method for hypospadias repair with the main advantage of reducing the risk of meatal stenosis.Aim: To compare the outcomes of TIPU and grafted TIPU in cases with narrow urethral plates.Patients and Methods: This retrospective cohort study between January 2021 and December 2022. Patients with distal hypospadias with a narrow urethral plate narrower than 8 mm were included in this study. 25 patients in TIPU group and 25 patients in the grafted TIPU group. Data collected included age at repair, type of distal hypospadias, stretched penile length, and penile girth, urethral plate width, and glans width. The operative time and the presence of postoperative complications such as urethral fistula, meatal stenosis, urethral stricture, diverticulum, or failure of the repair.Results: The mean width of the urethral plate in TIPU was 5.5 mm (range 3–8 mm) and in grafted TIPU was 5.8 mm (range 5–8 mm). The mean glans width in TIPU was 13.5 mm (range 9–20 mm) and in grafted TIPU was 12.1 mm (range 8–17 mm). The mean operative time in TIPU was 92.4 min (range 86–105 min) and in grafted TIPU was 115.2 min (range 80–130 min) and the difference was statistically significant (P<0.01).Urethral fistula was detected in 2 (8%) cases of TIPU group and similarly in 2 (8%) cases of grafted TIPUU group. The failure of repair occurred in 1 (4%) case of TIPU while occurred in 2 (8%) cases of grafted TIPU. No cases of urethral strictures were detected.Conclusion: Grafting the urethral plate had no added benefit to the original TIP urethroplasty regarding the incidence of meatal stenosis and urethral stricture complications.