Double dartos flap layer in tubularized incised plate urethroplasty to prevent urethrocutaneous fistula in uncircumcised patients with distal hypospadias

Urethrocutaneous fistula may complicate hypospadias repair.We noticed that double-layered preputial dartos flaps added to tubularized incised plate urethroplasty can reduce the risk of urethrocutaneous fistula.The aim of this study was to compare the outcomes of tubularized incised plate urethroplasty with double-layered preputial dartos flaps to with single-layered local fascial flaps in preventing urethrocutaneous fistula.A retrospective cohort study was conducted between January 2017 and December 2020 at Jordan University Hospital(Amman,Jordan).Boys who were aged between 6 months and 5 years,diagnosed with distal hypospadias,and not circumcised were included.The primary outcome was the occurrence of urethrocutaneous fistula in patients who underwent tubularized incised plate urethroplasty with a double-layered fascial flap.The results showed a total of 163 boys with distal hypospadias;among them,116 patients underwent tubularized incised plate urethroplasty with a single-layered fascial flap,and 47 underwent tubularized incised plate urethroplasty with a double-layered fascial flap.The development of urethrocutaneous fistula was higher in the group receiving tubularized incised plate urethroplasty with a single-layered fascial flap than in the group receiving tubularized incised plate urethroplasty with a double-layered fascial flap after 1 month,6 months,and 12 months(6.9%vs 0,10.3%vs 0,and 5.2%vs 0,respectively),and the difference after 6 months was statistically significant(P=0.02).

Application and efficacy of reconstructing forked corpus spongiosum in distal/midshaft hypospadias repair

We reviewed our experience in reconstructing forked corpus spongiosum(FCS)in distal/midshaft hypospadias repair and analyzed the efficacy of this surgical technique.From August 2013 to December 2018,137 consecutive cases of distal/midshaft hypospadias operated by the same surgeon in Urology Department,Children’s Hospital of Fudan University(Shanghai,China),were retrospectively analyzed.Sixty-four patients who underwent routine tubularized incised plate(TIP)or onlay island flap(ONLAY)surgery were included in the nonreconstructing group,and 73 patients who underwent reconstructing FCS during TIP or ONLAY surgery were included as the reconstructing group.Thirty-eight cases underwent TIP,and 26 underwent ONLAY in the nonreconstructing group,with a median follow-up of 44(range:30-70)months.Twenty-seven cases underwent TIP,and 46 underwent ONLAY in the reconstructing group,with a median follow-up of 15(range:6-27)months.In the nonreconstructing/reconstructing groups,the mean age at the time of surgery was 37.55(standard deviation[s.d.]:29.65)/35.23(s.d.:31.27)months,the mean operation duration was 91.95(s.d.:12.17)/93.84(s.d.:14.91)min,the mean neourethral length was 1.88(s.d.:0.53)/1.94(s.d.:0.53)cm,and the mean glans width was 11.83(s.d.:1.32)/11.56(s.d.:1.83)mm.Twelve(18.8%)/5(6.8%)postoperative complications occurred in the nonreconstructing/reconstructing groups.These included fistula(5/2),glans dehiscence(3/0),diverticulum(1/2),residual chordee(3/0),and meatus stenosis(0/1)in each group.There was a significant difference in the overall rate of complications(P=0.035).These results indicate that the technique of reconstructing FCS provides excellent outcomes with fewer complications in distal/midshaft hypospadias repair.