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.

Autor: El-Karamany TM; Urology Department, Benha University, Benha, Egypt., Al-Adl AM; Urology Department, Benha University, Benha, Egypt. Electronic address: ahmed.aladl@fmed.bu.edu.eg., Omar RG; Urology Department, Benha University, Benha, Egypt., Abdel Aal AM; Urology Department, Benha University, Benha, Egypt., Eldakhakhny AS; Urology Department, Benha University, Benha, Egypt., Abdelbaki SA; Urology Department, Benha University, Benha, Egypt.
Jazyk: angličtina
Zdroj: Urology [Urology] 2017 Sep; Vol. 107, pp. 202-208. Date of Electronic Publication: 2017 Jun 15.
DOI: 10.1016/j.urology.2017.04.056
Abstrakt: 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.
(Copyright © 2017 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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