DefinePK

Research Objective

To determine the incidence of urethrocutaneous fistula following Tubularized Incised Plate Urethroplasty (TIPU) and Urethral Advancement and Glanuloplasty Incorporated (URAGPI) repairs in children with coronal hypospadias.

Methodology

A randomized prospective study conducted in the Department of Paediatric Surgery, Pak Emirates Military Hospital, Rawalpindi. Forty children with hypospadias were randomly assigned to either TIPU (n=20) or URAGPI (n=20) techniques. Data was collected on a proforma, and the primary outcome measured was the incidence of urethrocutaneous fistula one month post-surgery. Statistical analysis was performed using SPSS version 20.0, with chi-square test for comparing fistula rates and a p-value <0.05 considered significant.

Methodology Flowchart

                        graph TD;
    A[Enroll 40 children with hypospadias] --> B[Randomly allocate to TIPUn=20 or URAGPIn=20];
    B --> C[Perform surgical repair];
    C --> D[Follow-up for 1 month];
    D --> E[Assess for urethrocutaneous fistula];
    E --> F[Analyze fistula incidence in each group];
    F --> G[Compare rates using chi-square test];
    G --> H[Conclude on technique superiority];                    

Discussion

The study suggests that the TIPU technique is associated with a significantly higher rate of urethrocutaneous fistula compared to the URAGPI technique in coronal hypospadias repair. This is attributed to the neo-urethra construction in TIPU, which involves incising the urethral plate, potentially leading to suture line dehiscence. In contrast, URAGPI mobilizes and advances the existing urethra, theoretically reducing fistula formation. Age was also noted as a potential factor, with fistula occurring in children older than 24 months in the TIPU group.

Key Findings

The incidence of urethrocutaneous fistula was 20.0% (4 out of 20) in the TIPU group, compared to 0.0% (0 out of 20) in the URAGPI group. This difference was statistically significant (p-value = 0.03).

Conclusion

The incidence of urethrocutaneous fistula is significantly greater with the TIPU technique compared to the URAGPI technique. URAGPI is suggested as an effective and complication-free method for hypospadias repair in the local community.

Fact Check

* Sample Size: 40 children were enrolled in the study, equally divided into two groups (n=20 for TIPU, n=20 for URAGPI).
* Fistula Rate in TIPU: 4 out of 20 children (20.0%) in the TIPU group developed a urethrocutaneous fistula.
* Fistula Rate in URAGPI: 0 out of 20 children (0.0%) in the URAGPI group developed a urethrocutaneous fistula.
* Statistical Significance: The difference in fistula proportions between the two groups was statistically significant with a p-value of 0.03.

Mind Map