Minimal modifications could decrease fistula rate during tubularized incised plate procedure in distal hypospadias repair.

AIM: To report outcome of technical modifications to minimize fistula after TIP procedure. PATIENTS AND METHODS: 369 boys presenting with distal hypospadias were divided into two groups. In group 1, 196 underwent the standard TIP procedure. In the 173 patients in group 2, several modifications were incorporated into the TIP repair: 1) the first proximal suture was U-shaped subepithelial, 2) dartos flap was created on ventral aspect of penis to cover the proximal suture, and 3) the midline release incision was done as a first step. Patients were monitored prospectively for fistulae, chordee, meatal position, stenosis, and evaluated postoperatively at regular intervals.
RESULTS: 362 patients had a good cosmetic appearance with slit-shaped meatus. Urethrocutaneous fistula was seen in 9 (4.6%) in group 1 and 4 (2.3%) in group 2. Urinary streams were of good quality and without fistula in 187 in group 1 and 169 in group 2. Glans dehiscence was seen in 7 (4 in group 1 and 3 in group 2), meatal stenosis and new urethral stricture in 15 (6 in group 1 and 9 in group 2). Glanular appearance was excellent except in those 7 patients who had glans dehiscence, and the phallus was straight in all.
CONCLUSION: The Snodgrass repair has revolutionized the treatment of hypospadias. These technical modifications combined with careful patient selection achieved a low fistula rate.