Comparative Analysis Of The Efficacy Of Tubularized Incised Plate And Onlay Island Flap In Mid-shaft Hypospadias Repair Of Children

Objective:To investigate the efficacy of tubularized incised plate and Onlay island flap in mid-shaft hypospadias repair of children.Method:The clinical data were retrospectively analyzed of 114 pediatric patients with mid-shaft hypospadias who were admitted to the Department of Urology II of the First Hospital of Jilin University from January 1,2014 to December 31,2018.According to the mode of operation,the patients were divided into two groups : TIP(Tubularized incised plate)group(n = 53,penis straightening + TIP);OIF(Onlay island flap)group(n = 61,penis straightening + OIF).The clinical data of operation time,age,length of reconstructed urethra,incidence rate of complications such as postoperative urethral fistula and urethral stricture were compared between the two groups,and the relevant literatures were reviewed.Result:In the TIP group,there were a total of 53 patients,aged from 1.1 to 3.0 years,with an average of(2.1±0.7)years;The length of reconstructed urethra ranged from 2.0 to 3.8 cm,with an average of(2.8±0.5)cm.In the OIF group,there were a total of 61 patients,aged from 1.0 to 2.9 years,with an average of(2.3±0.5)years;the length of the reconstructed urethra ranged from 2.3 to 4.0 cm,with an average of(2.7±0.4)cm.There was no significant difference in age and length of reconstructed urethra between the two groups(p>0.05).The operation time was(73.83±3.04)minutes in TIP group and(89.54±4.26)minutes in OIF group,The operation time in TIP group was significantly shorter than that in OIF group(P<0.05).The surgery successful rate were 77.36%(41 of 53 patients)in the TIP group and 85.25%(52 of 61 patients)in the OIF group,respectively.There was no significant difference in the success rate of operation between the two groups(P>0.05).Urethral fistulas occurred in a total of 7 patients in the TIP group,with an incidence of 13.21%.Urethral fistulas occurred in a total of 5 patients in the OIF group,with an incidence of 8.20%.Urethral stricture occurred in a total of 5 patients in the TIP group,with an incidence of 9.43%.Four of these patients were cured after regular urethral dilatation in the outpatient clinic,and one was cured by reoperation.Urethral stricture occurred in a total of 4 patients in the OIF group,with an incidence of 6.56%.Three of these patients were cured after regular urethral dilatation in the outpatient department,and one was cured by reoperation.No urethral diverticulum was present in either groupof patients.By analyzing the above data,it was found that the incidence of postoperative urethral fistula and urethral stricture was lower in the OIF group than in the TIP group,but the difference between the two groups was not statistically significant(P>0.05).Conclusion:(1)The incidence of postoperative urethral fistula and urethral stricture in OIF group was lower than that in TIP group,but there was no significant difference between the two groups;Surgery time was longer in the OIF group than in the TIP group(P<0.05).Both of them are reasonable methods for repairing mid-type hypospadias in children.(2)OIF is worthy of clinical application,with the advantages of high success rate and low requirement for urethral plate conditions.