Learning curve for TIP urethroplasty: A single-surgeon experience.
BACKGROUND
We evaluate the influence of surgeon experience and other clinical factors on the success of primary hypospadias repair, using the tubularized incised plate urethroplasty (TIPU) technique.


METHODS
We retrospectively reviewed pediatric cases of primary hypospadias repair performed by a single pediatric urologist (soon after his fellowship training) using TIPU between July 2002 and January 2011. The surgical techniques (including the fact that the procedure was an outpatient one) were the same for each patient. The overall complication rate (CR) was analyzed for the following factors: patient age, use of a stent, meatal position, and surgeon experience. All significant covariates on univariate analysis or with a clinical relevance were entered into a multivariable logistic regression model. A non-linear model was created to estimate the change in the CR over the years.


RESULTS
Pediatric patients (median age 1.4 years old) presenting with distal (n = 251), midshaft (n = 22) or proximal (n = 30) hypospadias and with a minimum 6-week follow-up (median 13 months) were included. Most patients (87%) had a urethral stent postoperatively (mean duration 9.8 days). In total, 96 patients had 133 complications: 27 meatal stenosis, 25 meatal coronal migrations, 22 urethrocutaneous fistulas and 59 other complications. Of these, 53 patients underwent a second operation. On multivariate analysis, the only factor increasing the CR was a non-distal meatus. The non-linear model demonstrated a significant learning curve with a decreasing CR over the years. The limitations of this study are its retrospective nature and lack of long-term follow-up.


CONCLUSIONS
When using TIPU, the CR significantly increases as the meatal position gets more proximal; the learning curve stabilizes after about 50 to 75 cases.
CHU de Québec, Division of Urology, Quebec, QC;
Marie-Pier Deschênes
MP
Rompré
CHU de Québec, Division of Urology, Quebec, QC;
Geneviève
G
Nadeau
CHU de Québec, Division of Urology, Quebec, QC;
Katherine
K
Moore
CHU de Québec, Division of Biostatistics, Quebec, QC;
Yassine
Y
Ajjaouj
McMaster Children Hospital, Division of Urology, Hamilton, ON.
Luis H
LH
Braga
CHU de Québec, Division of Urology, Quebec, QC;
Stéphane
S
Bolduc