Randomized controlled study comparing Combined Snodgrass tubularized incised plate (TIP) and Mathieu's meatal based flip flap urethroplasty with each of the individual procedures for distal hypospadias

Dr. G. Raghavendra Prasad; Dr. J V Subba Rao; Dr. Amtul Aziz; Dr. T M Rashmi

Volume : VIII, Issue : II, February - 2018

Randomized controlled study comparing Combined Snodgrass tubularized incised plate (TIP) and Mathieu's meatal based flip flap urethroplasty with each of the individual procedures for distal hypospadias

Dr. G. Raghavendra Prasad, Dr. J V Subba Rao, Dr. Amtul Aziz, Dr. T M Rashmi

Abstract :

Introduction: Distal hypospadias is addressed currently by two most common procedures namely Snodgrass tubularized incised plate urethroplasty and Mathieu’s flip flap urethroplasty. These procedures have their own inherent disadvantages. An attempt is being made if combining these procedures would address these deficiencies.

Aims and objectives: To test if combining Snodgrass TIP and Mathieu’s flip flap procedures would reduce specific complications by controlled randomized study.

Materials and methods:

A total number of 165 cases of distal hypospadias with 51 in Snodgrass tip and 67 Mathieu’s flip flap group and 47 in combination group. Random numbers were given for a total of 500 cases. Urethrocutaneous fistula, Meatal stenosis and total failure/dehiscence were parameters studied. A patient parent satisfaction was conducted in year 2015.Statistical tool used was Extended Mantel Haenszel Chi Square. Software used was epi info version 6.04.Consort 2010 have been followed.

Results:

Meatal stenosis was seen in 7.84% with Snodgrass procedure (p<0.05)

Urethrocutaneous fistula was seen in 11.76 %( p>0.05)

There was no total failure with combined procedure unlike with individual procedures (p<0.05)

Conclusion: Combination procedure thus reduces urethrocutaneous fistula, Meatal stenosis and total failure. Urethrocutaneous fistula although p value was not significant, total number seem to be on declined.

Limitations: Larger numbers to be studied and other confounding factors like suture used, age of child, magnification, type of dressing, stenting/ urethral catheter/ drainage need to be included in further studies.