The Effect of Pre-Incision Urethral Plate Width and Granular Width on the Outcome of Tabularized Incised Urethral Plate Repair Surgery in Distal Penile Hypospadias, A Prospective Study

Objective: To determine the cosmetic and functional outcomes of hypospadias repair in relation to the width of the urethral plate in addition to granular width and configuration.

Materials and methods: The study was a prospective evaluation of patients operated for hypospadias. The urethral plate width (UPW) and glans width (GW) of the patients were measured preoperatively using standard calipers. The width of the urethral plate was correlated to the cosmetic outcome (using hypospadias objective penile evaluation [HOPE]) and functional outcome (using the urinary stream) of hypospadias repair. All patients were managed via the same technique using Snodgrass tabularized incised plate repair (TIP). All operations were performed by a single surgeon. All intaoperative data were recorded. All patients were followed up for 1 year. Success was defined as slit shaped meat us at the tip of the glans with no stenosis, fistula or diverticulum.

Results: All 38 patients were evaluated at 6 months and 1 year follows up. The mean age at surgery was 4.5 ± 2.1 years. Overall, the mean ± SD of UPW was 10.92 ± 1.24 mm. a 24 patients (61.5 %) (Group A) had a urethral plate width of less than 8 mm while 14 patients (35.9 %) (group B) had a urethral plate width greater or equal to 8 mm. the mean ± SD of GW was 9.52 ± 1.56 mm. Success was documented in 36/38 patients (94.3%). The only complication was Fistula in two patients (6.7 %), glans dehiscence in three patients (10%). Success rate was not statistically different in correlation of UPW and GW (p=0.5). The only statistically significant difference between all patients was a longer operative time in the patients with deficient urethral plate compared to others with adequate urethral plate (p= 0.005). The urinary stream was straight in 32 boys and sprayed in 6. Overall, mean ± SD HOPE score was 39.1 ± 8.83. A significant correlation found between the cosmetic outcome of the two groups and HOPE score (p = 0.06).

Conclusion: The pre-incision urethral plate width and granular width was not correlated with the TIP outcome. A better HOPE score is associated with wide urethral plate.

Keywords: Hypospadias; Urethral plate; Tabularized incised plate repair (TIP); Hypospadias objective penile evaluation