Factors affecting outcome of tubularized incised plate (TIP) urethroplasty: single-center experience with 500 cases
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Updated: Jun 21, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Osama M Sarhan1, Ahmad S El-Hefnawy, Ashraf T Hafez
1Pediatric Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. o_sarhan2004@yahoo.com
Insights
Tubularized incised plate (TIP) urethroplasty is a reliable surgical technique for hypospadias repair in children, achieving an 81.4% success rate. Factors like distal hypospadias and neourethral coverage improve outcomes.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
- Hypospadias Treatment
Background:
- Hypospadias is a common congenital condition requiring surgical correction.
- The tubularized incised plate (TIP) urethroplasty is a widely used technique for hypospadias repair.
Purpose of the Study:
- To evaluate the efficacy and complication rates of TIP urethroplasty in a pediatric population.
- To identify factors influencing the success of TIP urethroplasty for hypospadias defects.
Main Methods:
- Retrospective review of 500 children undergoing TIP urethroplasty for hypospadias.
- Analysis of primary and re-operative cases, various hypospadias severities, and chordee presence.
- Complications requiring re-operation and overall appearance were recorded.
Main Results:
- An overall success rate of 81.4% was observed with a mean follow-up of 34 months.
- Re-operation was needed in 18.6% of cases, primarily for urethrocutaneous fistula (9.4%) and complete disruption (6.4%).
- Independent risk factors for complications included posterior hypospadias, lack of neourethral coverage (spongioplasty), and early study experience.
Conclusions:
- TIP urethroplasty is a reliable and effective method for treating both distal and proximal hypospadias in primary and re-operative settings.
- Optimal outcomes are associated with distal hypospadias, spongioplasty or flap coverage of the neourethra, and surgeon experience.
- Stenting, patient age, and prior failed repairs did not significantly impact the success rate.
Purpose:
To review our experience of tubularized incised plate (TIP) urethroplasty in children with hypospadias defects.
Methods:
Of 500 children (mean age 6 years) who received a TIP urethroplasty, 439 (87.8%) had primary hypospadias and 61 had one failed previous repair. The hypospadias defects were coronal in 110 (22%), distal penile in 261 (52.2%), midpenile in 78 (15.6%) and proximal in 51 (10.2%). Chordee was present in 98 (19.6%) patients. Presence of complications requiring re-operation and overall general appearance was recorded.
Results:
The mean (SD, range) follow-up was 34 (18, 7-77) months. Overall success rate was 81.4%. Re-operation was required in 93 patients (18.6%); for urethrocutaneous fistula in 47 (9.4%), complete disruption of the repair in 32 (6.4%) and meatal stenosis in 14 (2.8%). In univariate analysis, complications were significantly higher in stented repairs, posterior hypospadias, those with no neourethral coverage (spongioplasty), and repairs early in the study. The last three factors were the only significant independent risk factors in multivariate analysis.
Conclusions:
TIP is a reliable method for treating both distal and proximal hypospadias and is suitable for both primary and re-operative cases with a low rate of complications. A significantly better outcome is achieved with distal hypospadias, covering the neourethra with the mobilized corpus spongiosum (spongioplasty) or a flap, and experience. Stenting of the repair, patient age, or previous failed repair has no statistically significant impact on outcome.
