Outcomes of double-breasted spongioplasty as additional tissue coverage in tubularized incised plate urethroplasty

Abstract

Background: Modern hypospadiology is constantly developing new ideas to improve functional outcomes. Tubularized incised plate urethroplasty (TIPU) with neourethral covering by vascularized tissue (dartos flap, corpus spongiosum) is presently the most common procedure performed. Aim of this study was to evaluate the effectiveness of double-breasted spongioplasty (DBS) as additional tissue coverage in TIPU by comparing it with TIPU without spongioplasty. Methods: We conducted a prospective comparative study from September 2022 to October 2023 on 120 midshaft and distal hypospadias cases aged 1 to 12 years. Group A (n = 60) underwent TIPU without spongioplasty; Group B (n = 60) underwent TIPU with DBS. Pre-operative patient parameters were categorized according to Glans-Meatus-Shaft (GMS) Score. Follow-up was 4 months to one year. Complications like urethrocutaneous fistula (UCF) and meatal stenosis (MS) were recorded. Functional outcomes were assessed using Hypospadias objective scoring evaluation (HOSE). Results: Average age was 5.68 ± 2.26 in group A and 6.40 ± 2.10 in group B. Group A had mean GMS 5.32 ± 1.09; Group B had 5.45 ± 1.12 (p = 0.49). In group A, 4 (6.66 %) had MS, 5 (8.33 %) had UCF; in group B, 5 (8.33 %) had MS, 2 (3.33 %) had UCF (p > 0.05). Dorsal plication for ventral curvature was avoided in 7 patients after DBS. Surgeon evaluated mean HOSE was 14.73 ± 1.87 in Group A and 15.40 ± 1.26 in B (p = 0.02); in group A, 83.33 % while in group B 95 % cases had acceptable HOSE (≥14) (p = 0.04). Conclusion: Double-breasted spongioplasty in TIPU has better functional outcomes when compared with TIPU without spongioplasty and may correct ventral curvature of mild to moderate severity. Level of evidence: LEVEL II.

Keywords

• Hypospadias
• TIPU
• Snodgrass repair
• Double breasted spongioplasty
• HOSE
• Fistula