Abstract
Objective: The aim of our study was to compare the results of tubularized plate urethroplasty with interposing healthy tissue spongioplasty alone and spongioplasty with dorsal dartos flap to assess the role of dartos flap in prevention of fistulae. Patients and Methods: A retrospective study was performed on 80 patients, aged 4 months to 27 years who underwent hypospadias repair using the Snodgrass technique. The patients were assigned to two groups. In group I (40 patients) the neourethra was covered with spongioplasty only, and in group II (40 patients) the neourethra was covered with spongioplasty plus dartos flap. Integrity of the urethral plate was maintained in all the cases. The ventral curvature & torsion was corrected by penile de-gloving, mobilization of the urethral plate and spongiosum and mobilization of the proximal urethra if needed. The results were analysed in view of complication rates. The average period of hospital stay was 7 days & fol- low-up varied from 8 months to 28 months with a mean of 14 months. Results: In group I, hypo- spadias were distal penile in 31 (77.5%), mid-penile in 4 (10%) and proximal/peno-scrotal in 5 (12.5%) patients. In group II, hypospadias were distal penile in 17 (42.5%), mid penile in 9 (22.5%) and proximal/peno-scrotal in 14 (35%) patients. Sixty five percent in group I and 80% in group II had ventral curvature but the difference was not statistically significant. Good functional results were achieved in 97.5% patients in group I and in 95% patients in group II which were statistically similar (p value—0.585). Urethral fistula was encountered in 2.5% in group I & in 2 cases (5%) in group II. Meatal stenosis was noted in 7.5% each in both groups, which responded to urethral dilatation. One patient in group II had complete disruption. There was no statistically significant difference in early and late complications in both groups (p value—0.812). Conclusions: Spongioplasty with healthy spongiosal tissue is strong enough and is effective waterproofing as an * Corresponding author.
Highlights
Since its introduction in 1994, Tubularized Incised Plate Urethroplasty (TIPU) has gained widespread popularity because of its versatility, low complication rate, and good cosmetic results [1]
In group I (40 patients) the neo-urethra was covered with the paraurethral spongial tissue only and in group II (40 patients) the neo-urethra was covered with spongioplasty plus the dartos flap
In group I age of the patients varied from 1 year to 27 years with a mean of 9.2 years while in group II (40 patients) age varied from 4 months to 23 years with a mean of 8.2 years; this was comparable in both groups (χ2 value—6.252, p value—0.282 Table 1)
Summary
Since its introduction in 1994, Tubularized Incised Plate Urethroplasty (TIPU) has gained widespread popularity because of its versatility, low complication rate, and good cosmetic results [1]. Many methods have been described in the literature for the interposition of tissue to cover the neo-urethra beginning with transverse island dorsal subcutaneous flap, which was soon found to be unfavorable because of skin coverage problems and penile torsion [2]. The dorsal dartos flap is used by most surgeons, but there is still no consensus over the ideal interposing tissue in TIPU. Necrosis of skin, hematoma and torque with mobilization of the dorsal dartos flap [20] its role as an interposing tissue had been questioned [17]. In view of these complications, we analyzed our data and compared the results of TIPU repair with spongioplasty alone and with dartos flap
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