To objectively compare functional and cosmetic outcomes between the extended Tabularized Incised Plate (e-TIP) and standard TIP (s-TIP) techniques and assess the impact of pre-operative parameters on these outcomes between both techniques.
Patients and Methods: In this randomized prospective study, 106 patients with primary distal hypospadias recruited from outpatient clinic of Benha university hospital between June 2016 and January 2019. These patients were randomized to undergo either e-TIP (Group A) or s-TIP (Group B). Group A was repaired with e-TIP where the midline relaxing incision of the urethral plate (UP) was extended beyond its distal end to the very tip of the glans. The UP is tubularized beginning distally at the neomeatus after having made an adequate diameter so the creation of the meatus precedes tabularization. The cosmetic outcome was objectively evaluated 6-month postoperatively using HOPE score and proportional relationship between meatal length (ML) and ventral glans closure length (VGCL). The functional outcome was assessed by post-voiding residual (PVR), and uroflowmetry. The Q-max and Q-ave values were plotted against a recently published flow-rate nomogram from normal children. The effect of pre-operative parameters on the outcomes was assessed by linear regression analysis.
Results: A total of 53 patients were recruited for e-TIP group and s-TIP group. There were no significant differences between both groups in terms of age, meatal location, Glans shape, TGDmax, UP width (p=0.18; p=0.59; p=0.31, p=0.37; p=0.66), respectively. Similarly, there was no significant difference between both groups in terms of postoperative complications (p= 0.74). Regarding cosmetic outcome, the mean total HOPE score was significantly higher in e-TIP group compared with s-TIP group (57 vs. 56; p= 0.023), respectively. Furthermore, the mean ML to VGCL was significantly lower in e-TIP group compared with s-TIP group (0.85 vs. 2.42; p |
