Foreskin reconstruction does not increase urethroplasty or skin complications after distal TIP hypospadias repair.

Aim: To compare urethral and skin complications between consecutive patients undergoing distal TIP (tubularized incised plate) hypospadias repair with prepucioplasty versus circumcision.

Methods: Prospective case-cohort study comparing urethroplasty and skin complications between consecutive patients undergoing distal TIP with prepucioplasty versus circumcision. Those with <1 month follow-up or prior circumcision were excluded. Decision for prepucioplasty or circumcision was made exclusively by caregivers. Operative technique was the same except skin closure. Postoperative foreskin retraction was deferred ≥6 weeks after prepucioplasty.

Results: Of 343 circumcision and 85 prepucioplasty cases, median age and follow-up were 8 (3-420) and 7 (1.5-97.5) months, respectively. Urethroplasty complications occurred in 30 (8.7%) circumcision patients [16 fistulas, 13 glans dehiscences, 1 meatal stenosis due to balanitis xerotic obliterans (BXO) 5 years postoperatively], versus 7 (8.0%) after prepucioplasty [4 fistulas, 2 glans dehiscences, 1 urethral stricture], p = 1.0. Skin complications resulting in reoperation occurred in 7 (2.0%) circumcision patients and 2 (2.3%) prepucioplasty patients, including an unsightly dorsal whorl in 1 and BXO 66 months postoperatively in another, p = 1.0.

Conclusion: Prepucioplasty does not increase urethroplasty or skin complications after distal TIP hypospadias repair. We found no contraindication for prepucioplasty among consecutive patients, indicating hypospadiologists can manage the foreskin in distal repairs according to caregiver preference.