Ahmed Mahmoud Ahmed El-Adl
Professor
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
Urology • 2017
Publication Information
Authors
Tarek M. El-Karamany, Ahmed M. Al-Adl, Rabea G. Omar, Ashraf M. Abdel Aal, Amr S. Eldakhakhny, Shabieb A. Abdelbaki
Keywords
Hypospadias; Tubularized incised plate; unstented; outcome.
Journal
Urology
Publisher
Elsevier Inc.
Volume
107
Issue
Not Available
Pages
202
publication.type
International
Paper Link
Open Link
Supplementary Materials
Not Available
Abstract
(1) Objectives: To compare functionally and aesthetically between stented and unstented tubularized incised plate urethroplasty (TIPU). In addition, predictors of repair success were investigated.
(2) Methods: 110 children with distal hypospadias included in this study. 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 using Face, Legs, Activity, Cry, Consolability
(FLACC) scale and cosmetic outcome using hypospadias objective scoring
evaluation (HOSE). Uroflow was assessed at 6 months in toilet- trained boys.
Complications were graded by the Clavien classification system.
(3) Results: In 93 cases, FLACC score, hospital stay and dressing time were in
favour of unstented group, while HOSE score and uroflow parameters were
comparable. TGD and UP width varied significantly between successful and failed
cases. Cutoff values of 13.5mm and 8.5mm of TGD and UP width respectively, are
required for successful outcome. Acute urinary retention (AUR) in 12.8% after
unstented repair. Detrusor spasm 47.8% after stented and 8.5% after unstented
repair. In both groups, urethrocutaneous fistula (UCF) in 5.4%, glanular dehiscence
in 1.1%, and meatal stenosis in 5.4% were found in cases with small TGD and
narrow UP.
(4) Conclusion: Unstented TIPU evade 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.
(2) Methods: 110 children with distal hypospadias included in this study. 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 using Face, Legs, Activity, Cry, Consolability
(FLACC) scale and cosmetic outcome using hypospadias objective scoring
evaluation (HOSE). Uroflow was assessed at 6 months in toilet- trained boys.
Complications were graded by the Clavien classification system.
(3) Results: In 93 cases, FLACC score, hospital stay and dressing time were in
favour of unstented group, while HOSE score and uroflow parameters were
comparable. TGD and UP width varied significantly between successful and failed
cases. Cutoff values of 13.5mm and 8.5mm of TGD and UP width respectively, are
required for successful outcome. Acute urinary retention (AUR) in 12.8% after
unstented repair. Detrusor spasm 47.8% after stented and 8.5% after unstented
repair. In both groups, urethrocutaneous fistula (UCF) in 5.4%, glanular dehiscence
in 1.1%, and meatal stenosis in 5.4% were found in cases with small TGD and
narrow UP.
(4) Conclusion: Unstented TIPU evade 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.