Hypospadias is an extremely common anomaly. There are different procedures that have been described for the adjustment of hypospadias since of the presence of various hypospadias presentations. Be that as it may, no single technique had 100% satisfactory result (12). The goals of hypospadias surgery include development of a urethra of sufficient caliber and length, orthotopic meatus at the tip of the glans permitting the patient to void in a straight stream without maddening spreading.
Moreover, obtaining a conical glans and rearrangement of the dorsal skin provides a uniform ventral skin cover and correction of penile curvature just to achieve proper sexual intercourse and effectively inseminate (13).
Hypospadias surgery is continuously evolving, since its description by Galen in the first and second centuries AD, to improve a suboptimal functional and cosmetic results. The aim of hypospadias surgery is the creation of a straight penis with a slit-like meatus at the tip of the glans 7.
In spite of the recognition of the urethral plate as the tissue distinct from the glans and penile skin that would have formed the urethra and as having a well vascularized connective tissue and its incorporation in hypospadias repair, an objective way of assessing the impact of urethral plate on outcome is yet to be established.
Snodgrass in 1994 reported his own technique of tubularized incised plate urethroplasty (TIP) repair for distal hypospadias that gained a widespread use for its perceived simplicity and good cosmetic outcomes in the majority of cases . However, unfortunately, when the urethral plate is narrow the rate of urethrocutaneous ﬁstula, meatal/neo-urethral stenosis is increased .
In the current study, we evaluated the effect of width of the urethral plate and glanular width on outcome of hypospadias repair.
Most of our patients had coronal and midpenile hypospadias (38.5 %%), the same findings by Prat et al (14). The reason for this is not clear but might be explained by the geographical location.
Hypospadias Objective Penile Evaluation (HOPE) which assessed the cosmetic outcome, there was a statistical significance correlation (p = 0.06). This finding agrees with the result from some previous studies (15). However, Aboutaleb et al (6) in their study
We used 8 mm in the present study because urethral plate width 8mm or greater is essential for creation of adequate neourethra and successful hypospadias repair (16), while, Da Silva et al1 (15) in their study had 41.9% of their patients in the narrow urethral plate group and 58.1% in the wide urethral plate group.
Comparing both studies, the slight difference in percentages may be explained by the fact that Da Silva used 10 mm as the dividing line between narrow and wide urethral plates while we used 8 mm in the current study. Nguyen et al (9) and Aboutaleb et al (6) in their studies also used 8 mm as the dividing line. Urethral plate of more than 8 mm is associated with good cosmetic outcome (16, 17)
On the assessment of the functional outcome, 20 (83.3 %) patients in group A had good urinary stream while twenty patients 12 (85.7%) in group B had good urinary stream. Statistical analysis showed that there is a statistically significant difference between the 2 groups (p value of 0.05). This agrees with findings of some other studies that concluded that narrow urethral plate is associated with poor functional outcome such as poor urinary stream and complications such as meatal stenosis and urethrocutanous fistula (17-19).
However, Nguyen et al8 and Da Silva et al (15) in their study concluded that width of urethral plate do not affect the functional outcome of hypospadias repair. This is related to the fact that there were confounding variables in their study such as penile size, glans shape and vascularity of the prepuce which were not separately analyzed. We did not assess penile size, glans shape and vascularity of the prepuce in the current study.
There are a diversity in the complications following hypospadias repair. It ranges from 6-30% (20, 21). The most common complication we recorded was urethrocutanous fistula. These differences in complication rates may be explained by the differences in surgical expertise due to low volume of hypospadias repairs done per year in our setting. The rate of urethrocutanous fistula in our study is not correlated with narrow urethral plate, a similar to (20).
While, Aboutaleb reported higher incidence in fistula in patients with narrow urethral plates when compared to those with wide urethral plate (6, 21).
Though this study was a prospective study, it was limited by a small sample size that hindered the significant statistical difference detection in complications. Moreover, single surgeon series cannot be generalized as the outcome of repair, including complications, may be related to the skill of the surgeon.