A comparative study to evaluate the effect of double dartos flaps in primary hypospadias repair: no fistula anymore.

Objective: The aim of this study was to compare the complication rates of the single flap and double flaps versus flapless procedure in the tubularized incised plate urethroplasty.

Methods: One hundred and seventy-two patients with any type of hypospadias underwent surgical repair by tubularized incised plate (TIP) urethroplasty between April 2002 and July 2009 in the two pediatric surgical units. Group 1 (17 patients) underwent hypospadias repair that used the standard TIP urethroplasty. Group 2 (23 patients) had a single dartos flap covering. Group 3 (132 patients) had double dartos flaps covering. Surgeries were performed by one of three surgeons.

Results: In group 3, urethrocutaneous fistula was detected in 1 (0.7%) patient, whereas there were 5 (29.4%) and 6 (26%) fistulas in groups 1 and 2, respectively. Penile torsion was noted in 10 (43.5%) and 5 (3.8%) patients in group 2 and 3, respectively. Four of the patients of group 3 had wound dehiscence (3%). Meatal stenosis was seen in 1 (5.8%), 1 (4.3%) and 6 (4.5%) patients in groups 1, 2 and 3, respectively.

Conclusions: The additional covering of the neourethra with a second layer dartos flap is an improvement in the TIP urethroplasty, in terms of fistula formation avoidance.