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418 A prospective study to evaluate the role of different variables in results of TIPU
418
A prospective study to evaluate the role of different variables in results of TIPU Eur Urol Suppl 2013;12;e418
Bhat A.L., Bhat M., Saran R. K., Singla M., Sabbarwal K. V., Upadhaya R., Kumar V. S.P.Medical College Bikaner ,India, Dept. of Urology, Bikaner, India INTRODUCTION & OBJECTIVES: Tubularized incised plate technique is most commonly used for hypospadias repair. Various variables affecting the results in management of hypospadias are age of the child, severity of hypospadias, size of penis and glans, penile curvature, development of spongiosum, surgical skill and suture material. Purpose of the study was to evaluate the role of these variables in results of TIPU repair. MATERIAL & METHODS: We prospectively evaluated 125 patients of TIPU repair from April 2009 to October 2011. Study parameter were age, severity of hypospadias, degree of curvature & torsion,size of penis and glans, width of urethral plate, development of spongiosum and complication rate. Patients were classified into five groups by age, Group I- 6 months to 2 years, Group II- 2 to5 years, Group III- 5 to10 years, Group IV- 10 to 15 years and Group V older than 15 years. Results were analyzed with reference to different variables. Criteria for small size of the penis was taken according to age as reported in the literature. Normal size of glans was taken by measuring the glans size in 10 patients each of 1 to 15 years age group patients admitted in paediatric ward for other medical disease. Then the mean minus 2xSD was taken as the criteria for small glans size in corresponding groups . Criteria for spongiosum development were taken a thin fibrous as poorly developed, a good spongiosum tissue with good vascularisation as moderately developed and a healthy robust spongiosum, which becomes much bulkier than the native spongiousm as well developed . We have not found any unanimous objective criteria to find the normal width of the urethral plate in all age group. We took the criteria that if urethral plate can be tubularized easily without incision (on the largest size catheter accepted by normal proximal urethra as per age ); it is wide, required superficial incision as average and if it required deep incision of the plate then was considered as narrow. RESULTS: Age range from 6 months to 26 years with a mean of 8.8 years. Number of Patients were Group I- 30 (24%), Group II- 28(24.4%), Group III- 22(17.6%), Group IV- 20(16%) and Group V- 25 (20%). Over all complications reported were in 13/125(10.4%) patients. Complication rate when comparing group V and youngest patients (group I & II) was 20% Vs 3.6% (p=0.08), and comparing older children (G-III & IV) and youngest patients (group I & II) was 15% Vs 3.6% (p=0.135). Severity of hypospadias did correlate with rate of complications (30% in proximal, 5.7% in distal and 11.1% in mid penile hypospadias p value 0.001). The complication rate was 3.6% in mild, 38.8% in moderate & 35.7% in severe curvature cases. (p value 0.001 ). Complication rate in poorly developed spongiosum patient of group V were very high (p value 0.0001). Complications were 41.2% in narrow urethral plate cases and 8.3% in average width cases (p value 0.0001). Follow up period was from about 10 months to 2 years with (mean 16 months).
CONCLUSIONS: Urethral fistula and stricture were most common reported complications. Important factors in outcome of TIPU repair were degree of curvature, width of urethral plate and development of spongiosum , age of child and severity of hypospadias. The development of urethral plate and spongiosum is inversly proportional to complication rate. Complication rate in adult patients group was significantly higher than in our youngest patients group. Risk score may guide the new surgeons for case selection & referal to experienced surgeons.
A prospective study to evaluate the role of different variables in results of TIPU Eur Urol Suppl 2013;12;e418
Bhat A.L., Bhat M., Saran R. K., Singla M., Sabbarwal K. V., Upadhaya R., Kumar V. S.P.Medical College Bikaner ,India, Dept. of Urology, Bikaner, India INTRODUCTION & OBJECTIVES: Tubularized incised plate technique is most commonly used for hypospadias repair. Various variables affecting the results in management of hypospadias are age of the child, severity of hypospadias, size of penis and glans, penile curvature, development of spongiosum, surgical skill and suture material. Purpose of the study was to evaluate the role of these variables in results of TIPU repair. MATERIAL & METHODS: We prospectively evaluated 125 patients of TIPU repair from April 2009 to October 2011. Study parameter were age, severity of hypospadias, degree of curvature & torsion,size of penis and glans, width of urethral plate, development of spongiosum and complication rate. Patients were classified into five groups by age, Group I- 6 months to 2 years, Group II- 2 to5 years, Group III- 5 to10 years, Group IV- 10 to 15 years and Group V older than 15 years. Results were analyzed with reference to different variables. Criteria for small size of the penis was taken according to age as reported in the literature. Normal size of glans was taken by measuring the glans size in 10 patients each of 1 to 15 years age group patients admitted in paediatric ward for other medical disease. Then the mean minus 2xSD was taken as the criteria for small glans size in corresponding groups . Criteria for spongiosum development were taken a thin fibrous as poorly developed, a good spongiosum tissue with good vascularisation as moderately developed and a healthy robust spongiosum, which becomes much bulkier than the native spongiousm as well developed . We have not found any unanimous objective criteria to find the normal width of the urethral plate in all age group. We took the criteria that if urethral plate can be tubularized easily without incision (on the largest size catheter accepted by normal proximal urethra as per age ); it is wide, required superficial incision as average and if it required deep incision of the plate then was considered as narrow. RESULTS: Age range from 6 months to 26 years with a mean of 8.8 years. Number of Patients were Group I- 30 (24%), Group II- 28(24.4%), Group III- 22(17.6%), Group IV- 20(16%) and Group V- 25 (20%). Over all complications reported were in 13/125(10.4%) patients. Complication rate when comparing group V and youngest patients (group I & II) was 20% Vs 3.6% (p=0.08), and comparing older children (G-III & IV) and youngest patients (group I & II) was 15% Vs 3.6% (p=0.135). Severity of hypospadias did correlate with rate of complications (30% in proximal, 5.7% in distal and 11.1% in mid penile hypospadias p value 0.001). The complication rate was 3.6% in mild, 38.8% in moderate & 35.7% in severe curvature cases. (p value 0.001 ). Complication rate in poorly developed spongiosum patient of group V were very high (p value 0.0001). Complications were 41.2% in narrow urethral plate cases and 8.3% in average width cases (p value 0.0001). Follow up period was from about 10 months to 2 years with (mean 16 months).
CONCLUSIONS: Urethral fistula and stricture were most common reported complications. Important factors in outcome of TIPU repair were degree of curvature, width of urethral plate and development of spongiosum , age of child and severity of hypospadias. The development of urethral plate and spongiosum is inversly proportional to complication rate. Complication rate in adult patients group was significantly higher than in our youngest patients group. Risk score may guide the new surgeons for case selection & referal to experienced surgeons.