Abstract
Purpose
Tubularized incised plate urethroplasty (TIPU) is the preferred surgical option for distal and mid-shaft hypospadias repair. Neourethra dartos flap coverage is routinely used as a protective layer with good results. We modified meatus-based ventral dartos flap (MBVDF) to TIPU by dissecting the proximal mid-ventral dartos attached urethra and leaving the subcutaneous fascia connecting the meatus, and retrospectively compared the outcomes of using MBVDF with single dorsal dartos flap (DDF) on the complication rates of TIPU.
Methods
We present 2 surgeons’ experiences with 356 patients with distal and mid-shaft hypospadias between January 2010 and December 2014. Patients were divided into two groups. Group DDF included 185 patients (mean age 29 months) underwent TIPU with DDF rotated laterally covering the suture lines of the neourethra. Group MBVDF included 171 patients (mean age 26 months) underwent TIPU with MBVDF covering the suture lines of the neourethra. Statistical analysis of patient basic information and complications was performed by two independent sample t test and Chi square test or Fisher’s exact test.
Results
There were no statistical differences in age, type of hypospadias, and follow-up time between the two groups. The mean operative time in the group MBVDF (68.93 ± 8.32 min) was significantly shorter than in the group DDF (73.60 ± 9.06 min). Ventral skin necrosis (2.7 %) and penile rotation (3.8 %) in group DDF was significantly higher than group MBVDF which did not occur. The differences in other complication rates including fistula rate (2.7 vs 2.9 %) between the groups were not statistically significant.
Conclusion
DDF and MBVDF with TIPU are similarly effective methods for decreasing fistula in hypospadias repair. MBVDF with TIPU may be an easier method and can avoid ventral skin necrosis and penile rotation.
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References
Snodgrass W, Koyle M, Manzoni G, Hurwitz R, Caldamone A, Ehrlich R (1996) Tubularized incised plate hypospadias repair: results of a multicenter experience. J Urol 156:839–841
Retik AB, Mandell J, Bauer SB, Atala A (1994) Meatal based hypospadias repair with the use of a dorsal subcutaneous flap to prevent urethrocutaneous fistula. J Urol 152:1229–1231
Chatterjee US, Mandal MK, Basu S, Das R, Majhi T (2004) Comparative study of dartos fascia and tunica vaginalis pedicle wrap for the tubularized incised plate in primary hypospadias repair. BJU Int 94:1102–1104
Soygur T, Arikan N, Zumrutbas AE, Gulpinar O (2005) Snodgrass hypospadias repair with ventral based dartos flap in combination with mucosal collars. Eur Urol 47:879–884
Hayashi Y, Kojima Y, Kurokawa S, Mizuno K, Nakane A, Kohri K (2005) Scrotal dartos flap for the prevention of the urethrocutaneous fistula on hypospadias urethroplasty. Int J Urol 12:280–283
Braga LH, Lorenzo AJ, Salle JL (2008) Tubularized incised plate urethroplasty for distal hypospadias: a literature review. Indian J Urol 24:219–225
Belman AB (1988) De-epithelialized skin flap coverage in hypospadias repair. J Urol 140:1273–1276
Ross JH, Kay R (1997) Use of a de-epithelialized local skin flap in hypospadias repairs accomplished by tubularization of the incised urethral plate. Urology 50:110–112
Savanelli A, Esposito C, Settimi A (2007) A prospective randomized comparative study on the use of ventral subcutaneous flap to prevent fistulas in the Snodgrass repair for distal hypospadias. World J Urol 25:641–645
Snodgrass W (1994) Tubularized, incised plate urethroplasty for distal hypospadias. J Urol 151:464–465
Snodgrass WT (2002) Tubularized incised plate (TIP) hypospadias repair. Urol Clin North Am 29:285–290
Kamal BA (2005) Double dartos flaps in tubularized incised plate hypospadias repair. Urology 66:1095–1098
Bertozzi M, Yıldız A, Kamal B et al (2011) Multicentric experience on double dartos flap protection in tubularized incised plate urethroplasty for distal and midpenile hypospadias. Pediatr Surg Int 27:1331–1336
Cimador M, Pensabene M, Sergio M, Catalano P, de Grazia E (2013) Coverage of urethroplasty in pediatric hypospadias: randomized comparison between different flaps. Int J Urol 20:1000–1005
Thomas DT, Karadeniz Cerit K, Yener S, Kandirici A, Dagli TE, Tugtepe H (2015) The effect of dorsal dartos flaps on complication rates in hypospadias repair: a randomised prospective study. J Pediatr Urol 11:21–24
Snodgrass W, Cost N, Nakonezny PA, Bush N (2011) Analysis of risk factors for glans dehiscence after tubularized incised plate hypospadias repair. J Urol 185:1845–1849
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The authors declare that they received no financial support for this study, and they have no conflict of interests.
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Co-first author: Guo-chang Liu.
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Jia, W., Liu, Gc., Zhang, Ly. et al. Comparison of tubularized incised plate urethroplasty combined with a meatus-based ventral dartos flap or dorsal dartos flap in hypospadias. Pediatr Surg Int 32, 411–415 (2016). https://doi.org/10.1007/s00383-016-3860-y
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DOI: https://doi.org/10.1007/s00383-016-3860-y