title: Technical refinements to improve outcomes following distal hypospadias repair.
abstract: BACKGROUND
  Hypospadias complications, most notably meatal stenosis, are commonly reported to occur after tubularized incised plate (TIP) hypospadias repair. We focus on a point of technique in TIP repair and its effect on outcome of this possible complication, as well as other commonly reported complications. Meatal stenosis after TIP can be avoided if the urethra and overlying glans are dissected and sutured separately with no attempt at cross suturing whether the urethra ends below, behind, or above the glans sutures. This hypothesis was evaluated by a prospective data collection before and after implementation to evaluate the effect of a technical refinement on rates of meatal stenosis in TIP hypospadias repair.
  
  
  METHODS
  All cases of coronal to midpenile hypospadias repair during two periods were included in our study. Group 1 included 140 consecutive patients over a 30 month period. Group 2 included 122 consecutive patients over a 36 month period during which the above mentioned technical changes were implemented by all participating pediatric urologists. Rates of complications between the two groups were compared with special emphasis on meatal stenosis.
  
  
  RESULTS
  Median follow up for both groups was > 1 year. Overall complication rate in Group 1 was 31.5% compared to 9.8% in Group 2. Meatal stenosis was significantly reduced from 13 patients (9.3%) in Group 1 to 2 patients (1.6%) in Group 2, p = 0.008.
  
  
  CONCLUSIONS
  The technical refinements described resulted in reduction of complication rates and a decrease in incidence of meatal stenosis.
authors.affiliation: Department of Urology, University of Kentucky Medical Center, Lexington, Kentucky, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Lacy
authors.forename: Lauren N
authors.initials: LN
authors.lastname: Hendrix
authors.forename: Raevti
authors.initials: R
authors.lastname: Bole
authors.forename: Enmar
authors.initials: E
authors.lastname: Habib
authors.forename: Cole W
authors.initials: CW
authors.lastname: Wootton
authors.forename: Ali M
authors.initials: AM
authors.lastname: Ziada
mesh_terms: D002648:Child; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D010413:Penis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D013524:Surgical Flaps; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000209:etiology; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000379:methods*