Objective: To compare the outcome of transverse island flap (TVIF) onlay with tubularized incised plate urethroplasty (TIP) in primary hypospadias repair.
Patients and methods: We retrospectively evaluated 76 consecutive patients who underwent TVIF onlay (n = 42) and TIP (n = 36) between January 1997 and April 2006. The success rate and complications were compared according to the surgical technique and the severity of the defect (meatal position prior to surgery).
Results: The mean patient age at surgery was 48 (range, 9-132) months in the TVIF onlay group and 49 (range, 10-348) months in the TIP group. All patients were followed-up for at least 12 months. With mean follow-ups of 40 months and 32 months, the overall complication rates were 30.9% (13/42) and 23.5% (8/34) in the TVIF onlay group and TIP group respectively (p = 0.305). Urethrocutaneous fistula rates were 23.8% (10/42) in the TVIF onlay group compared to 14.7% (5/34) in the TIP group (p = 0.393). No complications were found in either group with distal hypospadias. In proximal hypospadias, the complication rate was 30% (6/20) in the TVIF onlay group, compared to 37.5% (6/16) in the TIP group (p = 0.751).
Conclusion: In this study, the surgical outcomes of TVIF onlay and TIP were comparable. The TIP procedure should be preferred for distal and midshaft defects because of its simplicity and low complication rate. In proximal hypospadias repair, TVIF onlay might be better than TIP; this will be clearer once the number of patients have increased sufficiently to show statistical significance.