Tubularized incised plate urethroplasty for hypospadias reoperation: a review and meta-analysis

Purpose Tubularized Incised Plate (TIP) urethroplasty is a technique for urethral reconstruction of hypospadias although there are some controversies for its use in recurrent cases. The aim of this study was to review the results of TIP technique in various studies and the usage of different flaps for covering the repair site. Material and Methods Extensive Search was performed for articles published between 1994 and 2013 in common electronic databases. The overall TIP complication rates were estimated by a fixed effects model meta-analysis. Results 17 articles of hypospadia repair using the TIP method were reviewed. All studies performed surgery and repair on the basis of the Snodgrass’s method; however, some introduced modifications to the method. The prevalence of complications in repeated TIP surgery was 11.1 to 33.3% and the most prevalent complication in different studies was fistula. Based on the meta-analysis, the overall estimation of complications was 21.8 % (95% CI: 18.3 to 25.5). Conclusion Most studies performed the incision of the urethral plate to create a supportive coverage upon neourethra, and confirmed its success. We recommend further investigation on using different flaps in well-designed randomized controlled trials to choose the best surgical method for repairing recurrent hypospadias.

研究目的：切开管状尿道板（Tubularized Incised Plate, TIP）尿道成形术是用于尿道下裂尿道重建的手术技术，但其在复发病例中的应用尚存争议。本研究旨在综述不同研究中TIP术式的临床效果，以及采用不同皮瓣覆盖手术修复创面的应用情况。研究材料与方法：本研究在主流电子数据库中对1994年至2013年间发表的相关文献进行了全面检索，并采用固定效应模型Meta分析估算TIP术式的总体并发症发生率。研究结果：本研究共纳入17篇采用TIP术式修复尿道下裂的文献进行综述。所有研究均以斯诺德格拉斯（Snodgrass）术式为基础开展手术修复，但部分研究对该术式进行了改良。复发性TIP手术的并发症发生率为11.1%~33.3%，且不同研究中最常见的并发症为尿瘘。经Meta分析，总体并发症发生率估算值为21.8%（95%置信区间：18.3%~25.5%）。研究结论：多数研究通过尿道板切开为新尿道提供支撑性覆盖，并证实了该术式的临床有效性。我们建议开展设计良好的随机对照试验，进一步探究不同皮瓣的应用效果，以筛选出修复复发性尿道下裂的最优手术方案。