Advantages and disadvantages urethral advancement with subglanular tunnel (UASGT) versus tabularized incised plate (TIP) for distal hypospadias repair: A prospective comparative study

Objectives: To assess the efficacy and safety of urethral advancement with sub glanular tunnel (UASGT) in comparison with tabularized incised plate (TIP). Methodology: This prospective comparative study included any child with distal hypospadias (sub-coronal and distal shaft). The exclusion criteria included previous failed correction surgery, sever chordee, parents' refusal, and micropenis. Sixty patients with sub-coronal and distal shaft hypospadias were enrolled from urosurgery clinic in Hilla Teaching and urosurgery private clinic from October 2020 to October 2022. Patients' ages were between 1 year to 7 years. The first group included 30 patients with sub-coronal and distal shaft hypospadias treated surgically by UASGT while the second group involved 30 patients also with sub-coronal and distal shaft treated by TIP. The choice of type of surgery depended on the parent's preference after explaining the two procedures. Results: In group 1 patients (UASGT), the mean surgical time was 40.3 minutes while in group 2 (TIP), it was 52.3 minutes. Regarding complications, in group 1, Only 1 (3.3%) patient developed wound dehiscence, and 5 (16.6%) developed meatal stenosis, which required frequent dilatation. Fistula never occurs in group 1. In group 2, 6 (20%) patients developed complete wound dehiscence. There was statistically significant less risk of wound dehiscence (p=0.05) and also less risk of fistula formation with (p<0.001) in the group of patients who were treated with UASGT. Conclusion: UASGT was used for the treatment of distal types of hypospadias (subcoronal and distal shaft) with significantly less operative time than TIP and fewer post-operative complication like wound dehiscence and fistula formation.