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Updated: Feb 28, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
A Critical Analysis of Stented and Unstented Tubularized Incised Plate Urethroplasty Through a Prospective Randomized
Tarek M El-Karamany1, Ahmed M Al-Adl1, Rabea G Omar1
1Urology Department, Benha University, Benha, Egypt.
Insights
Unstented tubularized incised plate urethroplasty (TIPU) offers lower pain and shorter recovery without compromising outcomes in distal hypospadias repair. This approach avoids stent-related complications, demonstrating comparable functional and aesthetic results.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Hypospadias Repair
Background:
- Distal hypospadias is a common congenital condition requiring surgical correction.
- Tubularized incised plate urethroplasty (TIPU) is a widely used technique.
- The role of postoperative stenting in TIPU remains debated.
Purpose of the Study:
- To compare the functional and aesthetic outcomes of stented versus unstented TIPU in pediatric hypospadias repair.
- To identify predictors of successful TIPU outcomes.
Main Methods:
- A randomized controlled trial involving 110 children with distal hypospadias.
- Assessment of urethral plate (UP) width and transverse glans diameter (TGD).
- Postoperative pain (FLACC scale), cosmetic outcome (hypospadias objective scoring), uroflow, and complications (Clavien classification) were evaluated.
Main Results:
- Unstented TIPU showed lower postoperative pain, shorter hospital stay, and reduced dressing time.
- Functional and aesthetic outcomes were comparable between stented and unstented groups.
- Successful repair was associated with TGD >13.5 mm and UP width >8.5 mm; smaller dimensions correlated with fistula, dehiscence, and meatal stenosis.
Conclusions:
- Unstented TIPU is a viable alternative to stented repair, reducing stent-associated morbidity.
- The technique offers comparable short-term functional and aesthetic results with improved patient comfort.
- Preoperative measurements of TGD and UP width can help predict surgical success.
Objective:
To compare, functionally and aesthetically, stented and unstented tubularized incised plate urethroplasty (TIPU). In addition, predictors of repair success were investigated.
Materials And Methods:
One hundred ten children with distal hypospadias were included in this study. The length and width of the urethral plate (UP) and transverse glans diameter (TGD) were measured. Patients were randomized into two groups: stented and unstented TIPU. Postoperative assessment of pain was done using Face, Legs, Activity, Cry, Consolability (FLACC) scale, and cosmetic outcome was evaluated using hypospadias objective scoring evaluation. Uroflow was assessed at 6 months in toilet-trained boys. Complications were graded by the Clavien classification system.
Results:
In 93 cases, Face, Legs, Activity, Cry, Consolability score, hospital stay, and dressing time were in favor of the unstented group, whereas hypospadias objective scoring evaluation score and uroflow parameters were comparable. TGD and UP width varied significantly between successful and failed cases. Cutoff values of 13.5 mm and 8.5 mm for TGD and UP width, respectively, are required for successful outcome. Acute urinary retention was 12.8% after unstented repair. Detrusor spasm was 47.8% after stented and 8.5% after unstented repair. In both groups, urethrocutaneous fistula of 5.4%, glanular dehiscence of 1.1%, and meatal stenosis of 5.4% were found in cases with small TGD and narrow UP.
Conclusion:
Unstented TIPU evades the associated drawbacks of the stent along with lower postoperative pain, hospital stay, and dressing time. Even without a postoperative stent, the complication rate in infants with distal hypospadias is low, and short-term functional and aesthetic outcomes were not compromised.
