title: A modification of the TIP procedure for distal hypospadias: The burrowing technique.
abstract: BACKGROUND
  The tubularized incised plate urethroplasty (TIP) hypospadias repair is a commonly performed procedure for hypospadias. Multiple series document excellent cosmetic outcome in conjunction with low complication rates. We describe a modification that we have named the "burrowing technique." We believe that this technique facilitates dissection of the glans, which improves mobility, decreases tension with closure, and potentially improves outcomes.
  
  
  METHODS
  A retrospective review was performed of 193 coronal or mid-shaft hypospadias repairs by a single surgeon. The first 98 were performed using the TIP procedure, then the burrowing technique was developed and a subsequent 95 were analyzed for outcomes using this modification. Urethral plate characteristics and glandular size did not influence the choice of surgical technique. Cases were selected to allow for a "learning curve," and were consecutively accrued. None of the boys had undergone prior hypospadias surgery. Proximal 2 stage repairs and distal (glanular) repairs were excluded.
  
  
  RESULTS
  A total of 193 boys underwent repair, 98 with the traditional TIP procedure and 95 using the burrowing modification. In total, 37 (19.2%) patients required re-operation for either fistulas or dehiscence; 23 (23.5%) in the non-burrowing group and 14 (14.7%) in the burrowing group, odds ratio 0.54 (p = 0.10).
  
  
  CONCLUSIONS
  The TIP procedure has revolutionized the management of distal hypospadias. The burrowing modification increases glandular mobility simplifying the procedure and demonstrates a non-statistically significant trend in reducing reoperation rates.
authors.affiliation: Department of Surgery, Division of Urology, University of Alberta, Edmonton, AB.
authors.forename: Erin D
authors.initials: ED
authors.lastname: Wishart
authors.affiliation: Department of Surgery, Division of Urology, University of Alberta, Edmonton, AB.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Metcalfe