Short-term catheterization after TIP repair in distal hypospadias: who are the best candidates?

Over the last decade, tubularized incised plate (TIP) urethroplasty has become the first choice of surgical technique in patients with distal hypospadias. Despite the excellent cosmetic and functional results, prolonged catheterization (7-14 days) remains the main disadvantage of the TIP repair. In this study, we investigated the outcomes of the short-term catheterization in children with distal hypospadias in order to elucidate any relationship between the length of catheterization and the patients' age, meatal localization and postoperative complication rates. The charts of 183 patients who underwent TIP repair for distal hypospadias in two different centers were reviewed retrospectively. Patients were grouped based on their catheter removal time (before 24 h vs. after 24 h) and the toilet status of children (toilet-trained vs. in-diaper). Children who had at least 6 months of follow-up and regular office visits were included in the study group, and the results were compared to the literature as well as the subgroups were also evaluated in terms of complications and catheterization period. A total of 128 patients with 40.4 months of the mean age (6-180 months) and 22.7 months of the follow-up (6-49 months) were included in the study. For the group 1 patients (n = 99) in whom the urethral catheter was removed before 24 h, the mean age and follow-up were 33.4 months (6-150 months) and 22.3 months (6-48 months), respectively. The catheters of group 2 patients (n = 29) were removed after 24 h, and their mean age and follow-up were 64.4 months (6-180 months) and 24.2 months (6-49 months), respectively. The group 2 patients were significantly older than those of group 1 (P < 0.05). The complications, such as fistula, meatal stenosis, tube dehiscence and buried penis, were seen in 11.1% of the group 1 and 13.8% of the group 2 (11.7% in overall), showing no statistically significant difference. On the other hand, 44% of the patients (n = 56) were toilet-trained at time of surgery. Although the mean age (79 months vs. 10.4 months) and the catheter removal time (64.3% vs. 87.5% before 24 h) of this group were significantly longer than the patients in diaper (P < 0.05), no significant difference was determined in terms of complication (14.2% vs. 9.7%). TIP repair with short-term catheterization has similar outcomes to the patients who conventionally carry their stent 7-14 days. The meatal position and the toileting status of the patients are not important in the use and length of catheterization.