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INTRODUCTION AND OBJECTIVES: To evaluate the factors affecting surgical outcome in hypospadias patients undergoing Tubularized Incised Plate Urethroplasty in adulthood and compare it with pediatric patients.

METHODS: A prospective study of 60 adult >16 years (Group A) and 60 pediatric <5 years(Group B) TIPU in primary hypospadias patients was conducted from May2008 to2012. All the patients were, operated by a single surgeon under similar circumstances and were examined preoperatively to assess meatal location, chordee, torsion and intra-operatively for quality of spongiosum and width of urethral plate. Results were assessed by patient/parents satisfaction regarding cosmesis and urinary stream and complications.

RESULTS: Age of the patients varied from 16 to 27 years with a mean of 20.8 years in Group A and 6 months to 5 years with a mean of 2.1 years in the Group B. Number of patients in view of type of hypospadias, degree of curvature, quality of spongiosum and width of urethral plate were comparable in both groups but complication rates were higher in adults(16.66%)than in the pediatric(6.66%) group.Complication rate was very high in proximal hypospadias(Group A 40 %; group B 33.33 %) in comparison to distal hypospadias (Group A 9.3 % group B 0%)in both groups. Patients with severe chordee had significantly higher complication rate in both groups.Complication rates in patients with poorly developed spongiosum and narrow urethral plate were very high as compared to patients with well developed , moderately developed spongiosum and wide urethral plate in both the groups. Prepucioplasty and penile torsion in both groups was comparable but per se it did not affect results in any of the groups.The ultimate satisfaction level with the surgical outcome was much higher in Group B as compared to Group A. Meatal stenosis responded well to dilatation and fistulas required second surgery and had cure rate of 100%. Median follow up was 37 months in Group A and 39 months in Group B.

CONCLUSIONS: Complication rates were higher in adults undergoing TIPU compared to paediatric patients which was also statistically significant in the distal hypospadias subgroup. Patients should be counseled for results of TIPU in proximal hypospadias with poorly developed spongiosum, severe chordee and narrow urethral plate before surgery and/or alternative technique should be used in such patients. The important factors in the surgical outcome were severity of hypospadias, degree of curvature, quality of spongiosum and width of urethral plate.

Source of Funding: None