Results of distal hypospadias repair after considering artificial erection test as a mandatory step ;Minia university pediatric surgery unit experience

Background: The tubularized incised plate (TIP) urethroplasty is a widely adopted technique. Artificial erection testing (AET) during surgery is crucial for hypospadias repair, but its routine use remains inconsistent. Patients and Methods: This prospective descriptive study was conducted at the Pediatric Surgery Unit, Minia University Hospital, involving 50 patients aged 6 months to 14 years with distal hypospadias. All patients underwent TIP urethroplasty with routine AET. Outcomes were assessed based on intraoperative findings, postoperative complications, and follow-up evaluations over six months. Results: The mean patient age was 2.46 ± 1.4 years. Most cases had subcoronal hypospadias (40%), followed by coronal (24%), glanular (24%), and mid-penile (12%) variants. AET revealed that 58% of patients had minimal curvature (≤15°), while 42% had moderate curvature (16–30°), requiring additional correction. TIP urethroplasty was performed in 62% of cases, with dorsal plication added in 32%. Postoperative complications included fistulas in 10% of cases, residual curvature in 6%, meatal stenosis in 2%, and wound infection, hematoma, or dehiscence in 2% each. The mean operative time was 56 ± 13 minutes, with no intraoperative bleeding or fistulas. Conclusion: The inclusion of AET as a mandatory intraoperative step in distal hypospadias repair improves surgical outcomes by reducing residual curvature and complications.