SummaryHypospadias is the most common penile congenital anomaly (Fredell et al., 2002) which occurs in approximately 1:250 to 1:300 live births (Baskin, 2000).Tubularized incised plate urethroplasty is one of several established, successful methods of repairing anterior and middle hypospadias. Since its initial description in 1994 by Snodgrass, extensive, successful and varied experience with this technique has been reported (Borer and Retik, 1999).Our study was conducted over 30 patients with 17 anterior and 13 middle hypospadias; 24 of them were primary and 6 recurrent cases. In the period in between May 2004 and May 2005. Patient ages ranged from 1.5 to 14 years with mean of 3.5 years.Positive family history founded in 4 cases; 2 for a brother and one for the father and male cousin.Penile chordee was present in 6 patients (20%) and associated congenital anomalies (inguinal hernia and undescended testis) were founded in 3 cases.All of them were operated by TIP urethroplasty according to the modification reported by Jayanthi (2003) with addition of subcutaneous flap in 18 cases and tunica vaginalis flap in 12 cases as a second layer coverage of the neourethra to minimize the risk of urethral fistula.Operative time ranged from 70 to 110 minutes which was longer in middle than in anterior and when tunica vaginalis used than when dartos used.Postoperative hospitalization period ranged from one day to 10 days with mean of 2 days. Most of our cases need from one day to 3 days. Complicated cases need longer time.Minor complications occurred in 5 patients and were 7 in number, the commonest of them was penile skin edema in 3 cases. All minor complications respond to management but in 3 of them, major complication occurred.Follow up in our study ranged from 3 to 9 months with mean of 6 months.During follow up, recording of complication, calibration and regular dilation of the meatus and urethra in cases of meatal stenosis, urethral stricture and small single fistulas was done in early postoperative period complicated cases were 7/30 (23.33%) with 11 complications.The commonest of them were fistulas and meatal stenosis 5 and 3 respectively.After the end of follow up, the complicated cases decreased to 4/30 (13.33%) with 6 complications.Cosmotic appearance was good in nearly all patients.ConclusionFrom our study, we gain the confidence with TIP urethroplasty as an ideal procedure for management of anterior and middle hypospadias.We found that addition of second layer coverage is one of the most important aides to decrease rate of fistula.Also, we agree with that meatal stenosis and urethral stricture resulted from technical errors intraoperatively and if occurred, it can be managed non-surgically with regular dilatation.Finally, we think that re-operation rate is a good parameter to evaluate TIP urethroplasty with second layer coverage but we recommend larger study with longer period of follow up to confirm our results.Also, we recommend use of uroflowmetry in toilet trained patients with measuring of post-voiding residual volume by U/S to detect subclinical urethral stricture whom need regular dilatation to prevent occurrence of stricture.ReferencesAllen, T.D. and Griffin, J.E. (1984): Endocrine studies in patients with advanced hypospadias. J Urol; 131: 310-314.Allera, A.; Herbst, M.A. and Griffin, J.E. et al. (1995): Mutations of the androgen receptor coding sequence are infrequent in patients with isolated hypospadias. J Clin Endocrinol Metab; 80: 2697.Arap, S.; Mitre, A.I. and DeGoes, G.M. (1984): Modified meatal advancement and glanuloplasty repair of distal hypospadias. J Urol; 131: 1140-1141.Barcat, J. (1973): Current concepts of treatment. Boston, Little, Brow