Department of Pediatric Surgery, Cairo University Children Specialized Hospital, Cairo, Egypt.
Department of Pediatric Surgery, Port Said University, Port Fuad, Egypt.
Afr J Paediatr Surg. 2024 Apr 1;21(2):111-116. doi: 10.4103/ajps.ajps_107_22. Epub 2023 Apr 10.
Hypospadias is a wide-world congenital malformation that accounts for 1 of 300 live male births. Many procedures were considered for its management. As the tubularised incised plate (TIP) urethroplasty, the most prevalent technique, caused many complications, several modifications were applied to the original operation to improve the outcomes and alleviate complications. The aim of this study was to compare the outcome of the ordinary TIP urethroplasty with the technique modified without dissection of the glans penis.
A total of 82 patients with a mean age of 18.8 (±14.8) months, were randomly assigned to undergo TIP with either complete glans wings mobilisation (Group A, n = 42 patients) or without glans dissection (Group B, n = 40 patients). To evaluate the effect of modified TIP urethroplasty without glanular dissection for treatment of distal hypospadias in contrast to classical TIP repair.
Both techniques showed similar outcomes regarding functional repair, with good to excellent results between 88% and 90% after 6 months of follow-up. Most confronted post-operative complications were wound infection, oedema, urethrocutaneous fistulas and meatal stenosis. Less frequently haematoma, post-operative bleeding and glans dehiscence were encountered. The differences in complication rates between the two studied groups were statistically insignificant except for oedema (P = 0.04), and need for urethral dilatation (P = 0.002) that were more prevalent among patients who were treated with classic TIP repair with complete glans wings mobilisation.
From our point of view, it seems that TIP without glanular dissection technique does not outweigh TIP with complete glans wings mobilisation regarding functional outcomes and post-operative complications.
尿道下裂是一种广泛存在的先天性畸形，占活产男婴的 1/300。许多方法都被用于其治疗。由于管状切开板（TIP）尿道成形术是最常见的技术，会导致许多并发症，因此对原始手术进行了几种改进，以改善手术效果并减轻并发症。本研究旨在比较普通 TIP 尿道成形术与不剥离龟头的技术改良后的结果。
共 82 例患者，平均年龄 18.8（±14.8）个月，随机分为 TIP 组（A 组，42 例）或不剥离龟头的改良 TIP 组（B 组，40 例）。评估改良 TIP 尿道成形术治疗远端尿道下裂时不进行龟头解剖与经典 TIP 修复的效果。
两种技术在功能修复方面均显示出相似的结果，6 个月随访时，良好至优秀结果的比例在 88%至 90%之间。最常见的术后并发症是伤口感染、水肿、尿道皮瘘和尿道口狭窄。血肿、术后出血和龟头裂开等并发症较少见。两组之间的并发症发生率差异无统计学意义，除水肿（P = 0.04）和需要尿道扩张（P = 0.002）外，这在接受经典 TIP 修复并完全剥离龟头翼的患者中更为常见。
从我们的角度来看，改良 TIP 不剥离龟头技术在功能结果和术后并发症方面似乎并不优于完全剥离龟头翼的 TIP。
