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TH
CONGRESS OF THE ESPU
S8: HYPOSPADIAS 1
Moderators: Miguel Castellan (USA), Katja Wolffenbuttel (Netherlands)
ESPU Meeting on Thursday 20, April 2017, 11:44–12:30
11:44–11:47
S8-1 (PP)
★
EFFECT OF PENILE ISCHEMIA ON SUCCESS
OF TUBULARIZED INCISED PLATE (TIP) REPAIR
FOR DISTAL HYPOSPADIAS: RANDOMIZED CONTROLLED
TRIAL
Helmy OMAR
1
, Tamer HELMY
2
, Hesham ORBAN
1
, Ahmed GALAL
1
, Ashraf HAFEZ
1
and Mohammed DAWABA
1
1) Urology and Nephrology Center, Paediatric Urology, Mansoura, EGYPT - 2) Urology & Nephrology center Mansoura,
Paediatric Urology, El Mansoura, EGYPT
PURPOSE
To assess the effects of penile ischemia using tourniquet on the surgical outcome of distal penile
hypospadias repair as regard success and complication rates.
MATERIAL AND METHODS
Between April 2014 and January 2016, 60 boys with distal penile hypospadias (who fulfill the
inclusion criteria; < 2 years, primary distal hypospadias, no chordee) were equally randomized
using envelop method into either repair with ischemia or without ischemia. All patients underwent
TIP repair. Intraoperative data were recorded including; operative and ischemia time, plate length,
width and glans width. Patients are followed up at 3, 6 and 12 months postoperative. Success was
defined as slit shaped meatus at the tip of the glans with no stenosis, fistula or diverticulum.
RESULTS
Mean age at surgery was 20.9+ 4.7 months and mean follow up period is 8.6+ 3.2 months. Both
groups (30 patients in each) were comparable as regard to patients’ age, meatus location, length
and width of urethral plate, glans width. Success rates were reported in 27 (90%) and 25 (83%)
patients in ischemia and non ischemia groups, respectively but the difference doesn’t reach statisti-
cally significant value. Failures were due to fistula in 4 patients (2 in each group), meatal stenosis
in 2 (one in each group) and partial glans dehiscence in 2 patients in non ischemia group. The only
statistically significant difference between both groups was higher mean hemoglobin deficit 0.84+
0.12 gm/dl in non ischemia group compared to 0.59+ 0.08 gm/dl in ischemia group (p 0.024).
CONCLUSIONS
The use of penile tourniquet in TIP repair for distal penile hypospadias significantly decreases blood
loss. Although ischemia was associated with higher success, the difference doesn’t reach statisti-
cally significant value.