Journal of Pediatric Surgery Open (Dec 2023)
Surgical efficacy of tubularized incised plate urethroplasty applying for Buck's fascia coverage in the treatment of hypospadias
Abstract
Objective: The aim of this study was to compare the effectiveness of Buck's fascia and dartos fascia in covering the neourethra during tubularized incised plate urethroplasty (TIPU) for treating hypospadias in children. Methods: We conducted a retrospective analysis of 100 cases of hypospadias treated with TIPU at the Department of Urology, Beijing Children's Hospital from January 2019 to September 2021. The cases were divided into two groups (A and B) based on the type of intraoperative neourethral covering used during surgery. Group A (n = 53) was covered with Buck's fascia, while group B (n = 47) was covered with dartos fascia. Two experienced surgeons performed the surgeries in their respective groups. We recorded general clinical data, intraoperative measurements, and postoperative follow-up data for both groups and analyzed the results statistically. Results: There were no significant differences in clinical data, such as mean age, urethral opening position, penile length, urethral plate width, urethral defect length, preoperative penile curvature and follow-up time (P > 0.05) between the two groups. However, group A had a wider glans and a lower proportion of dorsal tunica albuginea plication to correct penile curvature but a higher proportion of 6F catheters left in place (P < 0.05). c, group A reported 12 cases (22.6 %) of complications including eight cases (15.1 %) of urethral stricture and five cases (9.4 %) of urethral fistula; four cases were related to penile corporal fistula while one related to coronal fistula. On the other hand, group B reported 17 cases (36.2 %) of complications including three cases (6.4 %) of urethral stricture and fourteen cases (29.8 %) of urethral fistula; four cases were related to penile corporal fistula while one related to coronal fistula. A multifactorial analysis incorporating confounding factors revealed a lower incidence rate for urethral fistulas in group A compared to group B(P < 0 0.05). Conclusion: The application of Buck's fascia to cover the new urethra can effectively reduce the incidence of urethral fistula in TIPU, and the quality of Buck's fascia and suture tension should be taken into account to avoid the formation of urethral strictures.
