Advanced Visualization, superior results: Microscope-Assisted approach in distal hypospadias surgery.

OBJECTIVE: To compare the impact of surgical microscope versus optical loupe magnification on postoperative complications and operative time in distal hypospadias repair performed by a single surgeon, and to evaluate the learning-curve effect of microscope use. METHODS: A retrospective cohort study was conducted on 52 boys who underwent tubularized-incised-plate urethroplasty (TIPU) for distal hypospadias by the same surgeon between 2021 and 2024. Twenty-four operations were performed under a surgical microscope (2.4–14.6×), and twenty-eight under 3.5× loupes. The primary outcomes were urethrocutaneous fistula, meatal stenosis, and glans dehiscence. The secondary outcome was operative duration. Complication rates were compared using Fisher’s exact test; operative-time trends were analyzed by linear regression. RESULTS: The total complication rate was significantly lower in the microscope group (8.3% vs. 39.3%; p = 0.012), with marked reductions in fistula (4.2% vs. 21.4%) and in meatal stenosis (0% vs. 14.3%). Median operative time was initially ~ 75 min longer with the microscope but decreased significantly over time (p = 0.029), reflecting a learning-curve effect. CONCLUSION: Microscope-assisted TIPU substantially reduced common complications despite longer early operative times. These findings support selective microscope use—especially for more complex repairs—where its magnification and illumination may improve tissue handling and long-term outcomes.