Outcome analysis of tubularized incised plate repair in hypospadias: is a catheter necessary?

OBJECTIVE

Tubularized incised plate (TIP) urethroplasty is performed by many pediatric urologists and has been widely accepted for repair of distal and mid-shaft hypospadias. However, the role of urethral catheter placement in TIP repair remains controversial. In this study, the surgical outcomes of indwelling urethral catheter and non-catheter TIP repairs in boys with hypospadias were compared.

METHODS

A total of 254 patients with primary distal and mid-shaft hypospadias underwent TIP repair and were evaluated retrospectively. A urethral catheter was placed in 103 patients (group A) and non-catheter repair was performed in 151 patients (group B). Information obtained included age, toilet training, chordee, type of hypospadias, presence or absence of a catheter, and postoperative complications. The complications recorded included wound infection, urinary tract infection, bladder spasm, urinary retention, urinary extravasation, meatal stenosis, urethral stricture, and urethrocutaneous fistula.

RESULTS

There was no statistical difference in age, toilet training, chordee, hypospadias site, or performing surgeon between the two groups. The median follow-up time was 22 and 24 months for groups A and B, respectively. The rate of bladder spasms (10.7 vs. 0%, p < 0.001) and urinary tract infection (9.7 vs. 3.3%, p = 0.034) was significantly higher for group A than group B. Although the rate of urinary retention was higher in group B than in group A (4.0 vs. 0%), there was no statistically significant difference between the two groups (p = 0.084). Likewise, the incidence of urethrocutaneous fistula and meatal stenosis was not significantly different.

CONCLUSION

Non-catheter TIP repair is feasible and positive outcomes can be achieved with minimal complications and less patient discomfort.