NOVEL TIP-M TECHNIQUE FOR DISTAL HYPOSPADIAS REPAIR IN CHILDREN: A COMPARATIVE STUDY OF CLINICAL OUTCOMES AND COMPLICATIONS

Hypospadias is one of the most common congenital anomalies of the male genitourinary system, with distal forms accounting for 80-85% of all cases. Despite over 300 described surgical techniques, complication rates remain significant, ranging from 5% to 50%. Objective: To evaluate the clinical effectiveness of a novel TIP-M (Tubularized Incised Plate-Modified) technique compared to classical surgical approaches for distal hypospadias repair in children. A retrospective-prospective cohort study was conducted involving 191 children aged 1-18 years with distal hypospadias treated between 2016-2023. Patients were divided into three groups: TIP-M (n=56), classical TIP (n=58), and Duplay (n=77). The TIP-M technique involves limited urethral plate incision to 2mm depth with vascularized flap coverage from the inner prepuce. Primary outcomes included early and late complications, functional results, and cosmetic outcomes. The TIP-M group demonstrated significantly lower early complication rates (26.8% vs 50.0% for TIP vs 76.6% for Duplay, p<0.001) and late complications (7.1% vs 25.9% vs 42.9%, p<0.001). Excellent overall results were achieved in 73.2% of TIP-M patients compared to 34.5% (TIP) and 15.5% (Duplay). Primary wound healing occurred in 73.2% of TIP-M cases versus 50.0% (TIP) and 23.4% (Duplay). Reoperation rates were 5.4%, 19.0%, and 32.5%, respectively. The novel TIP-M technique significantly reduces complication rates and improves outcomes in pediatric distal hypospadias surgery, particularly in cases with unfavorable anatomical conditions. The technique offers superior clinical and economic effectiveness compared to traditional approaches.