Staff Members - Benha University
A Critical Analysis of Stented and Unstented Tubularized Incised Plate Urethroplasty Through a Prospective Randomized Study and Assessment of Factors Influencing the Functional and Cosmetic Outcomes
• 2017
Publication Information
Authors
Tarek M. El-Karamany, Ahmed M. Al-Adl, Rabea G. Omar, Ashraf M. Abdel Aal,
Amr S. Eldakhakhny, and Shabieb A. Abdelbaki
Keywords
Not Available
Journal
Not Available
Publisher
Not Available
Volume
Not Available
Issue
Not Available
Pages
Not Available
publication.type
International
Paper Link
Not Available
Supplementary Materials
Not Available
Abstract
OBJECTIVE To compare, functionally and aesthetically, stented and unstented tubularized incised plate urethroplasty
(TIPU). In addition, predictors of repair success were investigated.
MATERIALS AND
METHODS
One hundred ten children with distal hypospadias were included in this study. The length and
width of the urethral plate (UP) and transverse glans diameter (TGD) were measured. Patients
were randomized into two groups: stented and unstented TIPU. Postoperative assessment of pain
was done using Face, Legs, Activity, Cry, Consolability (FLACC) scale, and cosmetic outcome
was evaluated using hypospadias objective scoring evaluation. Uroflow was assessed at 6 months
in toilet-trained boys. Complications were graded by the Clavien classification system.
RESULTS In 93 cases, Face, Legs, Activity, Cry, Consolability score, hospital stay, and dressing time were
in favor of the unstented group, whereas hypospadias objective scoring evaluation score and uroflow
parameters were comparable. TGD and UP width varied significantly between successful and failed
cases. Cutoff values of 13.5 mm and 8.5 mm for TGD and UP width, respectively, are required
for successful outcome. Acute urinary retention was 12.8% after unstented repair. Detrusor spasm
was 47.8% after stented and 8.5% after unstented repair. In both groups, urethrocutaneous fistula
of 5.4%, glanular dehiscence of 1.1%, and meatal stenosis of 5.4% were found in cases with small
TGD and narrow UP.
CONCLUSION Unstented TIPU evades the associated drawbacks of the stent along with lower postoperative pain,
hospital stay, and dressing time. Even without a postoperative stent, the complication rate in infants
with distal hypospadias is low, and short-term functional and aesthetic outcomes were not
compromised. UROLOGY 107: 202–208, 2017. © 2017 Elsevier Inc.
(TIPU). In addition, predictors of repair success were investigated.
MATERIALS AND
METHODS
One hundred ten children with distal hypospadias were included in this study. The length and
width of the urethral plate (UP) and transverse glans diameter (TGD) were measured. Patients
were randomized into two groups: stented and unstented TIPU. Postoperative assessment of pain
was done using Face, Legs, Activity, Cry, Consolability (FLACC) scale, and cosmetic outcome
was evaluated using hypospadias objective scoring evaluation. Uroflow was assessed at 6 months
in toilet-trained boys. Complications were graded by the Clavien classification system.
RESULTS In 93 cases, Face, Legs, Activity, Cry, Consolability score, hospital stay, and dressing time were
in favor of the unstented group, whereas hypospadias objective scoring evaluation score and uroflow
parameters were comparable. TGD and UP width varied significantly between successful and failed
cases. Cutoff values of 13.5 mm and 8.5 mm for TGD and UP width, respectively, are required
for successful outcome. Acute urinary retention was 12.8% after unstented repair. Detrusor spasm
was 47.8% after stented and 8.5% after unstented repair. In both groups, urethrocutaneous fistula
of 5.4%, glanular dehiscence of 1.1%, and meatal stenosis of 5.4% were found in cases with small
TGD and narrow UP.
CONCLUSION Unstented TIPU evades the associated drawbacks of the stent along with lower postoperative pain,
hospital stay, and dressing time. Even without a postoperative stent, the complication rate in infants
with distal hypospadias is low, and short-term functional and aesthetic outcomes were not
compromised. UROLOGY 107: 202–208, 2017. © 2017 Elsevier Inc.