Functional urethral obstruction following tubularised incised plate repair of hypospadias

PurposeTo report functional urethral obstruction (FUO) following the tubularised incised plate (TIP) procedure for hypospadias repair and its management.Materials and MethodsBetween January 2003 and December 2010, 263 patients were referred with complications following TIP repair and who were reviewed on regular follow up after further correction. One hundred and twenty-nine of these patients presented with persistent obstructive voiding signs and symptoms in spite of apparently successful calibration or dilatation, 32 presented with persistent stenosis, and 97 with recurrent fistula. The mean age at surgery was 2.9 years (range 1–4). The complications were corrected using 1 of 2 techniques: modified Mathieu (112) and lateral onlay flap (17). The mean follow-up was 4 years (range 1–9).ResultsThe obstructive symptoms were corrected with a single procedure in 120 (93%). Nine patients (7%) developed complications in the form of fistula (7 patients) and glanular dehiscence (2 patients) that were corrected successfully in a second operation.ConclusionsThe incised urethral plate may heal forming a deep narrow groove resulting in FUO. Patients with FUO present with obstructive voiding symptoms in spite of successful calibration or dilatation. These symptoms disappear after reconstruction of a wide fully epithelised neo-urethra.