European Urology European Urology 44 (2003) 714–719 ComprehensiveAnalysis of SixYears Experiencein Tubularised Incised Plate Urethroplastyandits Extended Applicationin Primaryand Secondary Hypospadias Repair Marcus Riccabona * , Josef Oswald 1 , Mark Koen, Goedele Beckers, Anton Schrey, Lukas Lusuardi Department of Paediatric Urology, Krankenhaus Barmherzige Schwestern, Seilersta ¨tte 4, A-4010 Linz, Austria First published online 26 August 2003 Abstract Objective: We evaluated the potential of tubularised incised plate (TIP) urethroplasty in primary and secondary hypospadias repair focusing on the extended application of this procedure, the utility and handling of the urethral plate and operative results. Methods: In this retrospective study, we analysed the medical records of 228 children with different levels of the hypospadiac meatus who underwent a TIP procedure between February 1997 and December 2002. The children were followed a mean of 42 months. Our medical records provided us with details about the location of the hypospadiac meatus, the width of the urethral plate before and after midline incision, primary versus secondary surgery, complications as well as notes on the extended application of the TIP procedure. Results: The overall postoperative complication rate was 7.8%. The overall fistula rate was 5.7%, with 4.1% in primary distal, 9.6% in primary proximal and 7.5% in secondary repair respectively. We had one case of meatal stenosis (0.4%) and one of urethral stricture (0.4%) and 3 cases of glandular dehiscence (1.3%). Due to the encouraging results, the frequency of TIP procedure in hypospadias surgery increased from 33% in 1997 to 82% in 2002. Conclusion: In our study the TIP procedure has emerged as the first-choice technique in primary hypospadias repair—irrespective of the level of the hypospadiac meatus and the width of the original urethral plate. This procedure has also proved to be favourable for many cases at secondary surgery. # 2003 Elsevier B.V. All rights reserved. Keywords: Hypospadias; Tubularised incised plate; Snodgrass; Urethral plate; Complications; Outcome 1. Introduction Recent data show that the prevalence of hypospadias has nearly doubled over the past 30 years [1,2]. Hypos- padias therefore continues to be a challenging problem for paediatric urologists. The current operative concept in hypospadias surgery is based on a perfect single- stage repair of the malformation and should result in functional excellence and a cosmetically normal look- ing penis. A successful hypospadias repair includes a vertical slit-like glandular meatus, a conically shaped glans, a straight penis during erection, good skin cover- age and a normal position of the scrotum in relation to the penis. These parameters reflect the expected stan- dard in current hypospadias surgery [3]. Over the last 5–8 years hypospadias surgery has changed, especially since the identification of the urethral plate as an anatomical entity, which has con- siderably simplified surgery. Today, two principles which can be used for more than 90% of all repairs enjoy widespread popularity. The first is the preserva- tion of the urethral plate whenever possible; the second is the in situ tubularisation of the plate, with or without dorsal longitudinal midline incision. * Corresponding author. Tel. þ43-732-7677-7470; Fax: þ43-732-7677-7497. E-mail address: marcus.riccabona@bhs.at (M. Riccabona). 1 Present address: Department of Urology, University of Innsbruck, Austria. 0302-2838/$ – see front matter # 2003 Elsevier B.V. All rights reserved. doi:10.1016/S0302-2838(03)00386-5