Comparison of variables affecting the surgical outcomes of tubularized incised plate urethroplasty in adult and pediatric XXXX .

@entity1 @entity281 @entity850 @entity2650
INTRODUCTION: The American Academy of Pediatrics recommends operating on @entity2650 between the ages of 6-12 months. Since most births in developed countries are conducted in a hospital, parents are likely to be well informed and counseled about the @entity2650 . However, significant numbers of births in developing countries are still conducted at home, with illiteracy, poverty and ignorance often leading to late presentation at the hospital. Reported @entity2650 -repair complication rates are higher in adults compared with those having surgery in childhood. The present study's objective was to evaluate the factors affecting surgical outcome in @entity2650 @entity1 undergoing tubularized and tubularized incised plate urethroplasty (TIPU) in adulthood compared with childhood. MATERIALS AND METHODS: A prospective study of 60 adult @entity1 >16 years, and 60 pediatric @entity1 <5 years who underwent TIPU for @entity2650 between May 2008 and May 2012. @entity1 were operated on by a single surgeon, under similar circumstances, and were pre-operatively examined to assess meatal location, chordee, and torsion; they were also examined intra-operatively for quality of spongiosum and urethral plate width. The outcomes were assessed by @entity1 /parents for satisfaction regarding cosmesis, urinary stream and complications. RESULTS: The age of the @entity1 varied from 16 to 27 years, with a mean of 20.8 years in adults, and 6 months to 5 years, with a mean of 2.1 years, in @entity1 . The type of @entity2650 , degree of curvature, quality of spongiosum and urethral plate width were comparable in both groups, but complication rates were higher in adults (16.7%) than in the pediatric (6.7%) group (Figure  1A-D). @entity850 responded well to dilatation, but fistulae required revision surgery and had a cure rate of 100%. The median follow-up was 37 months in adults, and 39 months in @entity1 . DISCUSSION: The higher complication rates in adults may be due to more frequent erections; increased susceptibility to @entity281 along with relatively reduced vascularity lead to poor wound healing and increased complication rates. The limitation of the study was the small number of @entity1 with mid and proximal @entity2650 having lesser incidences in comparison with @entity2650 . Adequate number of @entity1 in these subgroups could have further strengthened the statistical correlation. Secondly, there was no objective criterion like uroflowmetry to assess urinary stream. CONCLUSIONS: Complication rates were higher in adults undergoing TIPU compared with pediatric @entity1 , which was also statistically significant in @entity2650 . The important factors in surgical outcome were: severity of @entity2650 , degree of curvature, quality of spongiosum, and urethral plate width.
