Double dartos flaps in tubularized incised plate hypospadias repair

Abstract

Objectives To compare the single dartos flap with double dartos flap coverage. Two overlapping layers of dartos flap were fashioned and fixed in front of the neourethra after tubularized incised plate hypospadias repair to prevent urethrocutaneous fistula and glanular torsion. Methods A total of 96 boys with distal hypospadias were treated with tubularized incised plate urethroplasty. They were divided into two groups. Group 1 (54 patients) had a single dartos flap covering. Group 2 (42 patients) had double dartos flap coverings. The dissected dorsal dartos flap was bisected vertically to form two pedicled wings. Each wing was rotated laterally from either side of the glans to cover the neourethra ventrally in a double-layer fashion. Results In group 1, 2 patients (3.7%) developed fistula, 49 (90.7%) had mild glanular torsion, and 5 (9.3%) had moderate glanular torsion. None of group 2 developed fistula or glanular torsion postoperatively. Conclusions Double dartos flaps covering of the neourethra is a simple procedure that was superior to single flap covering for the prevention of urethrocutaneous fistula after tubularized incised plate urethroplasty. Glanular torsion did not occur when double dartos flaps were used.