| Background:Hypospadias,an urological abnormality present from birth,is relatively common with an incidence of approximately 0.3%.Hypospadias was characterized by ectopic urethral opening,penile curvature,and abnormal foreskin distribution.Surgical is the sole viable option for the treatment of hypospadias,with over 300 available surgical techniques;however,no single approach that can treat all types of hypospadias.There are several surgical procedures commonly used to treat hypospadias,including tubularized incised plate urethroplasty(TIP),onlay island flap urethroplasty(Onlay),meatal advancement and glanuloplasty incorporated procedure(MAGPI),flip-flap urethroplasty(Mathieu)and transverse preputial island flap urethroplasty(Duckett).Of these,the TIP procedure was first introduced by Snodgrass in 1994 and has been widely recognized and adopted by experts both domestically and internationally due to its comparative simplicity and relatively low risk of postoperative complications.However,the TIP procedure is limited by the width and quality of the urethral plate.Research has revealed that postoperative complications in the TIP procedure for hypospadias are often associated with the width of the urethral plate.This has led to a growing interest among pediatric urologists in exploring ways of conducting the TIP procedure in cases with a narrow urethral plate,while minimizing the risk of complications.Purpose:An analysis was conducted on the results of a modified TIP procedure used in the treatment of hypospadias.This modification involved widening the urethral plate by utilizing the skin on both sides of the urethral plate from the penis.Methods:In this retrospective analysis,we aimed to evaluate the clinical records of pediatric patients diagnosed with mid-distal hypospadias and penile hypospadias below 30°,who were admitted to the Department of Pediatric Urology at Shandong Provincial Hospital from May 2018 to March 2022.The experimental design involved two groups of children:the control group,where the width of the urethral plate was ≥6mm,and TIP was carried out;and the modified group,where the width of the urethral plate was ≤6mm,and the modified TIP was implemented.The modified TIP procedure including creating incisions in the skin on both sides to widen the urethral plate and from a new urethra.After 6 months of surgical treatment,the incidence of complications like urethral fistula,external urethral stricture,and dehiscence of the penis’ head were considered to compare the two groups.Furthermore,urinary flow rate results after 1 year were also analyzed.Results:A total of 109 children were involved in this study,with 52 cases in the control group and 57 cases in the modified group.The results showed no significant differences between the two groups in terms of age at surgery(P=0.319),urethral repair length(P=0.454),and urethral plate width after median incision(P=0.901).However,a significant difference was observed between the modified group and the control group in terms of the width of the head of the penis(P=0.001)and the proportion of mid-type hypospadias(P=0.003),with the modified group exhibiting a narrower head of the penis and a higher incidence of mid-type hypospadias.The control group had an overall complication rate of 21.15%(11/52),which included 8 cases of urethral fistula,2 cases of external urethral stricture,and 1 case of penis head dehiscence.Meanwhile,the modified group had an overall complication rate of 24.56%(14/57),consisting of 11 cases of urethral fistula,3 cases of external urethral stricture,and 1 case of penis head dehiscence(1 child had both urethral fistula and external urethral stricture).The urinary flow rate results of 29 children at 1 year post-surgery were analyzed,and there was no significant difference in the maximum and mean urine flow rates between the two groups(P>0.05).Conclusion:Further exploration and promotion of the reliable and satisfactory application of the modified TIP procedure in children with hypospadias,whose urethral plate width is less than 6 mm,is warranted. |
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