ABSTRACT
Hypospadias is reported in 1:200 live births. The introduction of the tubularized incised plate [TIP] procedure has revolutionized the treatment of hypospadias. The method of glanular closure during the TIP procedure, whether in single or double layers, has not been evaluated in the literature. To evaluate the optimal technique of glanular closure during the TIP repair of the distal hypospadias. Sixty-six infants and children with distal penile hypospadias were treated primarily with the TIP procedure. Age ranged between 9 months and 4 years with a mean age of 20.8 months at time of repair. Patients were randomly subdivided into two equal groups. In group A, the glans was repaired in a single layer, while in group B, the glans was closed in two layers. All cases were subjected to the same protocol of urethral stenting, penile bandage, and catheter removal by the third postoperative day. Both groups were followed up and compared with regard to the results of TIP repair and the incidence of complications. In group A, two cases developed glanular disruption versus none in group B. this was found statistically significant [p<0.05]. No statistical difference was found in between groups with regard to meatal stenosis, fistula formation, or in the overall cosmetic and functional outcomes. Medium-term follow up showed excellent results in 82.9% while good results were obtained in 17.2%. On the mid-term follow up, the TIP procedure continues to prove itself as the gold standard in treatment of the distal hypospadias. The double-layered glanuloplasty seems to hold an improved morbidity profile, with significantly lower glanular disruption rate, when compared to the single layered repair. Large-numbered studies are still needed to provide further evidence for the superiority of the double-layered glanuloplasty.