BMC pediatrics · 2026
Is dorsal inlay graft (DIG) with TIP repair superior to TIP alone for primary hypospadias? A randomized clinical trial.
СтатьяРандомизированное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Negm Mohamed Ahmed, Abdelrasheed Ahmed Abdelmoneim, Daboos Mohammad, Khedre Mohammed M, Abdelrahman Mohamed F, Abo-Halawa Nezar Abd Elrouf, Ibrahim Ibrahim Ali, Shehata Mohamed Ali
Аннотация
BACKGROUND: Tubularized incised plate urethroplasty (TIP) is a widely practiced technique for hypospadias repair; however, it remains associated with complications, particularly meatal and/or neourethral stenosis. Grafting the incised plate with a dorsal inlay graft (DIG) during TIP has been proposed as a preferred modification to address these complications. Although several studies have investigated DIG in cases with a narrow urethral plate (UP), no current consensus exists regarding its use as an adjunct to TIP repair in different types of UP.
OBJECTIVES: The current study aimed to investigate whether DIG with TIP repair is superior to TIP in different types of UPs regarding surgical and cosmetic outcomes.
METHODS: In a comparative, randomized study conducted from January 2023 to December 2024, patients with primary hypospadias without chordee were randomly assigned to two groups: Group 1 underwent repair using TIP, and Group 2 underwent repair using the DIG with TIP technique. Short- and mid-term outcomes were compared between the two groups.
RESULTS: During the study period, 579 primary hypospadias cases met the inclusion criteria (290 in Group 1 and 289 in Group 2). The median age in both groups was 22 months (IQR, 13-36.25 months). Operative time was significantly longer in Group 2 (P = 0.001). Among patients with a narrow UP, surgical outcomes were better in Group 2, with statistically significant improvement in neourethral and meatal function (P = 0.001). In Group 1, meatal stenosis developed in 25 patients (8.62%); 14 cases presented early and improved with regular dilation, whereas 11 cases presented after 6 months and required meatoplasty. In patients with a wide UP (> 8 mm), better results were observed in Group 2, although the difference was not statistically significant. Regarding the final position of the meatus at the glans tip, significance was noted in Group 2 (P = 0.008). The follow-up period ranged from 6 to 23 months (mean ± SD: 13.76 ± 5.68). The hypospadias objective scoring evaluation (HOSE) score at the 6th month demonstrated statistical significance in Group 2.
CONCLUSIONS: Adding a DIG to TIP repair potentially reduces the risk of neourethral and meatal complications in patients with a narrow UP (4-8 mm). However, in wide UP (> 8 mm), comparable outcomes were observed in both groups. The dorsal inlay graft with tubularized incised plate (DIGTIP) is associated with longer operative times and greater technical demands; therefore, it should be applied only in selected patients and according to the surgeon's preference.
TRIAL REGISTRATION: [NCT07086963] "Retrospectively registered" Date of registration [Jul 17 2025] https://clinicaltrials.gov/study/NCT07086963 and Unique identifying number [SVU/MED/SUR011/4/22/12/519].
OBJECTIVES: The current study aimed to investigate whether DIG with TIP repair is superior to TIP in different types of UPs regarding surgical and cosmetic outcomes.
METHODS: In a comparative, randomized study conducted from January 2023 to December 2024, patients with primary hypospadias without chordee were randomly assigned to two groups: Group 1 underwent repair using TIP, and Group 2 underwent repair using the DIG with TIP technique. Short- and mid-term outcomes were compared between the two groups.
RESULTS: During the study period, 579 primary hypospadias cases met the inclusion criteria (290 in Group 1 and 289 in Group 2). The median age in both groups was 22 months (IQR, 13-36.25 months). Operative time was significantly longer in Group 2 (P = 0.001). Among patients with a narrow UP, surgical outcomes were better in Group 2, with statistically significant improvement in neourethral and meatal function (P = 0.001). In Group 1, meatal stenosis developed in 25 patients (8.62%); 14 cases presented early and improved with regular dilation, whereas 11 cases presented after 6 months and required meatoplasty. In patients with a wide UP (> 8 mm), better results were observed in Group 2, although the difference was not statistically significant. Regarding the final position of the meatus at the glans tip, significance was noted in Group 2 (P = 0.008). The follow-up period ranged from 6 to 23 months (mean ± SD: 13.76 ± 5.68). The hypospadias objective scoring evaluation (HOSE) score at the 6th month demonstrated statistical significance in Group 2.
CONCLUSIONS: Adding a DIG to TIP repair potentially reduces the risk of neourethral and meatal complications in patients with a narrow UP (4-8 mm). However, in wide UP (> 8 mm), comparable outcomes were observed in both groups. The dorsal inlay graft with tubularized incised plate (DIGTIP) is associated with longer operative times and greater technical demands; therefore, it should be applied only in selected patients and according to the surgeon's preference.
TRIAL REGISTRATION: [NCT07086963] "Retrospectively registered" Date of registration [Jul 17 2025] https://clinicaltrials.gov/study/NCT07086963 and Unique identifying number [SVU/MED/SUR011/4/22/12/519].