REVISITING THE RISK FACTORS FOR COMPLICATIONS POST-TUBULARIZED INCISED PLATE (TIP) URETHROPLASTY
Melissa McGrath, BASc1, Smruthi Ramesh, BSc1, Joao L. Pippi Salle, MD2, KORNELIA PALCZEK, BScN1, Armando J. Lorenzo, MD3, Luis H. Braga, M.D., MSc., PhD.1.
1McMaster University, Hamilton, ON, Canada, 2Sidra Medical Center, Doha, Qatar, 3Hospital for Sick Children, Toronto, ON, Canada.
BACKGROUND: Components of the GMS score such as meatal location and ventral curvature (VC) have been well established as risk factors for complications following Tubularized Incised Plate (TIP) uretheroplasty. The role of other factors such as urethral plate (UP) quality, glans groove and preoperative testosterone stimulation (PTS) has been disputed. Herein, we investigate whether these variables impact TIP repair complications in a large prospective hypospadias series.
METHODS: Of a prospectively collected hypospadias database (n=662), consecutive TIP repairs from 2009-2017 were selected. Staged repairs, other techniques and redo cases were excluded. Primary outcome was postoperative complication rate (fistula, glans dehiscence and meatal stenosis). Predetermined risk factors were collected (age at repair, modified GMS score, PTS (for glans width <14mm), regional block (caudal vs. dorsal penile), VC and complications were recorded. GMS score, calculated using glans groove (deep/moderate and shallow/absent), UP characteristics (robust vs. poor spongiosum), meatal location and VC (<30o, 30o-70o, >70o), ranged from 4 to 11 [worst]). Student’s t and Fisher’s exact tests and binary logistic were used for statistical analyses.
RESULTS: Of 390 patients, 285 (73%) had distal, 82 (21%) midshaft and 23 (6%) proximal penile hypospadias. Median age at surgery was 16 (3-313) mos. and mean follow-up was 18±16 mos.; 100 (26%) boys received PTS and 323 (83%) had a caudal block. Mean GMS score at initial exam was higher in PTS group vs. no PTS (7.4±1.7 vs. 5.2±1.3, p<0.01). The mean GMS score for PTS patients was similar to that of non-PTS at surgery (6±1 vs. 5.6±1, NS). Overall complication rate was 12% (9%-distal, 17%-midshaft, and 30%-proximal) and the median time to complication was 9 (0-105) mos. Contrary to previous studies, glans width, PTS and caudal block were not independently associated with complications. Logistic regression revealed that a combination of glans groove/UP quality and GMS score >7 were independently and significantly associated with TIP complications (p=0.01). (Table 1)
CONCLUSION: Our results involving a larger number of patients are consistent with previous reports that demonstrated an association between increased GMS scores and higher complication rates. Even though modified GMS scoring takes into account multiple factors such as glans diameter and VC, our analysis suggests that glans groove and UP quality have an effect on complications post TIP repair independently of GMS scores. 
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