Use of Barrier Layer for Primary Tubularized Incised Plate Urethroplasty for Hypospadias: Comparing Outcomes of Dartos and Tunica Vaginalis Flap

Abstract

Hypospadias is as relatively common congenital disrder, but its repair remain to be among the most challenging of operations. Complications, most commonly urethrocutaneous fistula, occur even in the hands of experienced surgeons. The use of vascularized pedicled flap (i.e. dartos and tunica vaginalis flap) has been promoted of improving complication rates.

Objective: This study aimed to determine the complication rates of hypospadias repair with dartos flap versus tunica vaginalis flap using Snodgrass tecnhique.

Materials and Methods: From January 2006 to July 2015, 230 patients underwent repair of hypospadias via the Tubularized Incised Plate (Snodgrass) technique by a single surgeon. One hundred ninety had adequate records evaluable for study. Baseline characteristics gathered at surgery were 1. penile length, 2. urethral plate characteristics in terms of quality and width, 3. degree of chordee, 4. meatal location, 5. quality and blood supply of penile skin. Post-operative complication rates were determined, and specific post operative problems (urethrocutaneous urethrocutaneous fistula, meatal/urethral stenosis, skin flap necrosis, meatal regression, and recurrent chordee) were accounted for.

Results: There were 135 (71.1%) patients in the dartos flap (DF) group and 55 (28.9%) in the TVF layer group. The mean age for the whole study population was 4.70 + 4.25 years. There was no significant difference in the baseline pre-operative characteristics namely, urethral plate characteristics, degree of chordee, meatal location, and penile skin blood supply. The overall complication rate was 32.1% (61/190). There was a significant difference in overall complication rate, with 14.5% (8/55) and 39.6% (53/135) complication rate in the DF and TVF groups, respectively (p= .003). The urethrocutaneous fistula rate was 21.6% (41/190), with a significant difference between DF and TVF groups (27.6% vs 7.3%, p= .007). There was no significant difference between the 2 groups in the other listed complications.

Conclusions: Snodgrass technique in combination with tunica vaginalis flap as a second layer appears to be a reliable technique to improve complication rates, particularly urethrocutaneous fistula. Further experience in its utilization can potentially further improve future outcomes.