Inlay Grafts in Distal Hypospadias Repair-How and When?

Abstract

Background: Tubularized incised plate (TIP) urethroplasty is widely used for distal hypospadias but may be suboptimal in patients with narrow or scarred urethral plates. Grafted TIP (GTIP), incorporating a dorsal inlay graft, is an emerging alternative to improve outcomes in such cases. Objective: To describe the indications, techniques, outcomes, and evolving perspectives on inlay graft use in distal hypospadias repair. Methods: A narrative review was conducted using published studies, prospective trials, and network meta-analyses comparing TIP and GTIP outcomes, with attention to complication rates, functional results, and decision-making tools. Results: GTIP offers superior healing and reduced complications in patients with unfavorable urethral plates. While operative time is longer, uroflowmetry and cosmetic outcomes are comparable. Technical success relies on graft type, accurate incision, and tension-free multilayer closure. Conclusion: GTIP represents a valuable adaptation of TIP for selected patients with distal hypospadias. GTIP should be considered when urethral plate characteristics predict poor healing. Further prospective studies are warranted to validate its long-term outcomes.