Discussion
hypospadias, Postoperative urinary fistulas, dehiscence, fistula, Tariq, fistulas
DEHISCENCE, COMPLICATIONS, COMPLICATION
TIPU repair for distal and mid-penile hypospadias has gained widespread acceptance because it is versatile, has a low complication rate, and reliably results in a vertically oriented meatus. Various factors affect the success rate of hypospadias repair, among which is the urethral plate [Tariq et al. concluded that the urethral plate quality plays an important role as an independent factor which can affect the postoperative results of hypospadias repair, and that the currently used methods for description of urethral plate quality are highly subjective and lacking generalizability [Many studies have compared inlay graft urethroplasty, onlay preputial flap urethroplasty, and TIPU in the repair of distal hypospadias with narrow urethral plate separately, up to our knowledge our study is the only comparative study among the three methods of narrow urethral plate augmentation.The operative time was 98 ± 14 min in inlay graft group, 86 ± 25 min in the only flap group, and 71 ± 22 min in TIPU group, the operative time was significantly increased in the inlay graft and only flap group in comparison to the conventional TIPU. In agreement with our results, Helmy et al. and Omran et al., reported that the operative time was longer for the patients who underwent the Snodgraft procedure and onlay flap urethroplasty [In our study, in the inlay graft urethroplasty group, the overall complications were occurred in 12.5% of the cases, fistula in two cases (5%), glanular dehiscence occurred in one case (2.5%), and narrow meatus occurred in two cases (5%). While, in the onlay flap urethroplasty group (In our study the success rate in TIPU was significantly low (Conversely, Helmy et al., reported that of 30 patients who underwent operations using the dorsal inlay graft technique, only two showed glandular dehiscence. The authors found no significant differences between patients who received dorsal inlay graft and those who underwent TIPU in terms of the success rate (96.7% vs 93.3% respectively), cosmetic outcome, and flow rate (including Mouravas et al. [In 2022, El-Helaly et al., compared the Snodgrass technique (33 cases) and transverse preputial onlay flap (33 cases) in distal hypospadias repair. Postoperative urinary fistulas occurred in 15.2% of cases in the Snodgrass group, whereas no cases of fistulas occurred in the transverse preputial onlay flap group (Few studies have investigated TIPU in patients with narrow urethral plates. One study performed by Holand and Smith [Limitation of the study included; retrospective nature of the TIPU group, the study should be run on large number of patients allowing more stratification of the urethral plate width; allowing comparison within the groups as regarding the success rate in relation to urethral pate width, measurement of the incised plate should be put in mind in further studies and absence of glandular size measurement and application of GMS score.