Selective use of grafted TIP urethroplasty in distal to proximal penile hypospadias: a single-center cohort study.

PURPOSE: To compare standard tubularized incised plate urethroplasty (TIP) and selectively applied grafted TIP (GTIP) in primary single-stage penile hypospadias repair. METHODS: We retrospectively analyzed boys undergoing primary, single-stage TIP or GTIP for distal or midshaft-to-proximal penile hypospadias repair at a tertiary pediatric center between 2012 and 2022. TIP was the default technique. GTIP was reserved for urethral plates < 8 mm, atrophic plates, or plates not safely tubularizable over an 8 Ch catheter without deep incision into the corpus spongiosum. Patients with follow-up ≥ 6 months were included. Primary outcomes were postoperative complications and revision surgery. Clinically relevant ventral curvature requiring correction was assessed as a potential confounder. RESULTS: Overall, 146 patients were included, 107 undergoing TIP and 39 GTIP, with a mean follow-up of 37.2 months. Using the institutional intraoperative decision strategy, GTIP was reserved for unfavorable urethral plate characteristics or unfavorable tubularization conditions and was more frequently used in midshaft-to-proximal penile cases. Clinically relevant ventral curvature was observed in 20.6% of TIP and 17.9% of GTIP cases (p = 0.82). Observed complication rates were 34.6% after TIP and 33.3% after GTIP (37/107 vs. 13/39; RR 1.04, 95% CI 0.64-1.78), while revision rates were 29.0% and 30.8%, respectively (31/107 vs. 12/39; RR 0.94, 95% CI 0.56-1.68), without evidence of a clear between-group difference for either outcome. After adjustment for meatal location and curvature, estimates for surgical technique remained close to unity for both complications and revision. GTIP procedures had longer operative times and stent duration. CONCLUSION: Selectively applied GTIP in unfavorable cases yielded complication and revision rates closely aligned with those after TIP, supporting its use as a urethral-plate-guided adjunct when safe tension-free tubularization cannot otherwise be achieved.