Two Different Suturing Techniques in Distal Hypospadias Repair using Tubularized Incised Plate Urethroplasty: A Prospective Randomized Study

Abstract

Background: Hypospadias is one of the most common congenital anomalies, occurring in Bone of 200 to one of 300 live births. Tubularized incised plate (TIP) urethroplasty or the Snodgrass procedure has gained worldwide acceptance for distal hypospadias repair because of its low complication rate and technical simplicity.

Objective: We compared two refinements in TIP repair for primary distal hypospadias, namely, a subcuticular uninterrupted suturing technique and full-thickness interrupted sutures. In addition, we compared the impact of these surgical modifications on the complication rate and surgical outcome of the Snodgrass procedure.

Patients and methods: Eighty boys with primary distal hypospadias were treated using the TIP procedure between January 2009 and December 2011. Patients were prospectively randomized into two equal groups on the basis of the suturing technique. A neourethra was constructed using a subcuticular uninterrupted suturing technique (group A) or using full-thickness interrupted sutures (group B). All patients were subjected to the same preoperative, operative, and follow-up protocols. Both groups were compared as regards the complication rate.

Results: The age ranged between 8 and 48 months, with a mean age of 13.6 ± 6.9 months at the time of repair. The overall success rate was 90% (97.5% for group A and 82.5% for group B). Late complications in the form of a urethrocutaneous fistula, meatal stenosis, and wound dehiscence or infection developed in eight (10%) patients (one patient of group A and seven of group B). The mean follow-up duration was 8.1 ± 2.4 months (range 4–13 months).

Conclusion: The subcuticular uninterrupted suturing technique seems to have a lower complication rate when compared with the use of full-thickness interrupted sutures in the repair of distal hypospadias by TIP urethroplasty.

Keywords: Hypospadias, Tubularized Incised Plate, Urethroplasty