Modified TIP Urethroplasty:Approach To Penile Anatomy

Objective: To analyze retrospectively the surgical effect of modified operation in children without or with mild penile bending of middle-distal hypospadias.That is BC-P-TIP operation,tubularized incised plate urethroplasty(TIP)covered with the Buck's fascia conbind with corpora spongiosum(BC)and dorsal prepuce fascia tissue(P).Methods: There are 104 cases of middle-distal hypospadias from January 2013 to August 2018 were analyzed retrospectively.Group A(72 cases)underwent BC-P-TIP operation,and group B(32 cases)underwent traditional operation(TIP with dorsal prepuce fascia tissue),defined as P-TIP surgery.All cases were followed up at 1 month,3 months and 12 months after operation.The result of post-operation were evaluated based on the Hypospadias Objective Scoring System(HOSE).the surgical effect was evaluated.Independent samples group t test with IBM SPSS Statistics V21.0 software package was used for general information and HOSE score on cases.The complication rates of the two groups were compared by Chi-square test.P < 0.05 indicates statistically significant difference.Results: To evaluate the postoperative effect of two groups of children according to the HOSE scoring standard,including the meatal location,meatal shape,urinary stream,erection and urinary fistula.The statistical results were shown in Table 2.After operation,there were 6 of 72 patients(8.3%,4 cases were located in the coronal sulcus and 2 cases were located under the coronal sulcus.)in group A had urinary fistula after removal of urinary catheter.3 cases(4.2%)had laborious urination and thin urine line after removal of urinary catheter.Urethral dilation was performed at 2 weeks,1 month and 3 months after discharge,and then the urinate have been unobstructed.Secretions were found in 2 cases(2.8%),which were considered as incision infection.In Group B(32 cases),there were 8 cases(25%,2 cases were located in the coronal sulcus and 6 cases were located under the coronal sulcus.)had urinary fistula.There were 2 cases(6.3%)of incisional infection.No urethral stricture.The age distribution,weight,diameter of glans,width of urethra plate and length of reconstructed urethra were tested by independent sample t test(p > 0.05).Independent sample t test was performed on the HOSE score of the two groups at 3 months after operation,p<0.05(p=0.002).The incidence of urinary fistula between the two groups was compared by chi-square test,P<0.05(P=0.047).There was no significant difference in urethral stricture(P=0.591).Conclusion: Compared with the P-TIP procedure,the modified BC-P-TIP procedure can effectively reduce the occurrence of urinary fistula,with satisfactory appearance,good voiding function,simple and easy operation,easy to learn,less anatomical injury,and close to the anatomical structure of the normal penis.It is worthy of further exploration and promotion.Inadequate,this study used retrospective studies,the number of cases is not large enough,lack of randomized prospective studies.In addition,the evaluation of urethral stricture in this study is not objective enough,and does not take into account the effect of the surgical learning curve on the surgical results,all of which need to be improved in future studies,and to seek more objective evaluation methods.