Comparison of the Surgical Results of Ventral and Dorsal Dartos Flaps in Tubularized Incised Plate Urethroplasty for Distal Hypospadias: A Randomized Clinical Trial

TL;DR

This study compares two surgical techniques for hypospadias repair and finds that the ventral Dartos flap leads to fewer complications than the dorsal Dartos flap.

Contribution

A randomized clinical trial comparing ventral and dorsal Dartos flaps in hypospadias surgery, providing new evidence on complication rates and outcomes.

Findings

The dorsal Dartos flap group had higher complication rates, including fistulas, necrosis, and penile torsion.

The ventral Dartos flap group experienced fewer complications and lower reoperation rates.

No significant difference was found in HOSE scores between the two groups at 6 months.

Abstract

Hypospadias is one of the most common congenital anomalies of the urogenital system. Various surgical methods exist to repair this condition, all aiming to create a straight penis, ensure proper placement of the meatus, and achieve a sufficient diameter for the urethra with optimal flow. Despite following precise surgical techniques, many patients in reported studies still experience complications. The aim was to evaluate and compare the surgical outcomes of distal hypospadias repair utilizing ventral versus dorsal Dartos flaps.

In this randomized clinical trial, patients who were candidates for surgical treatment were randomly assigned to 2 groups. Both groups underwent hypospadias repair using the tubularized incised plate (TIP) method. The first group received a ventral Dartos flap, while the second group received a dorsal Dartos flap for urethral reconstruction. Patients were monitored for complications, and the Hypospadias Objective Scoring Evaluation (HOSE) questionnaire was used to assess the surgical outcomes.

The dorsal flap group had higher complication rates, including 3 fistulas (10%), 6 cases of mild necrosis (20%), 2 cases of severe necrosis (6.7%), and 4 instances of penile torsion (13.3%). The ventral flap group had 2 cases (6.7%) of postoperative bleeding and 2 fistulas (6.7%). At the 6-month follow-up, no significant difference was observed between the 2 groups in terms of HOSE score. The need for reoperation was higher in the dorsal flap group.

The findings suggest that the ventral Dartos flap provides better results and fewer complications than the dorsal Dartos flap in the repair of hypospadias.

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