Comparison of Dartos flap and spongioplasty in Snodgrass urethroplasty in distal penile hypospadias

Abstract

BackgroundHypospadias surgery has been continuously evolving, although there is no single technique which can be said to be perfect and suitable for all types of hypospadias. Tubularized incised plate (TIP) urethroplasty (Snodgrass procedure) is presently the most common surgical procedure performed for distal penile hypospadias (DPH). The aim of this study was to compare the outcome of TIP urethroplasty using Dartos flap (DF) and spongioplasty as second layer in DPH.MethodsA total of 30 patients of DPH were repaired using TIP urethroplasty with DF or spongioplasty as second layer from January 2017 to June 2018. Out of 30 patients, TIP with DF was done in 15 patients (group A) and TIP with spongioplasty was done in the remaining 15 patients (group B). Preoperative mean age and weight were comparable in both groups. Postoperative complications, namely, postoperative edema, residual chordee, urethrocutaneous fistula (UCF), meatal stenosis and final cosmesis, were recorded.ResultsIn both groups, complications included postoperative edema (Gp A-1Gp B-1), residual chordee (Gp A-1, Gp B-1), UCF (Gp A-3, Gp B-4), meatal stenosis (Gp A-1, Gp B-5) and poor cosmesis (Gp A-3, Gp B-4). Wound infection was managed with appropriate antibiotics, and meatal stenosis responded to calibration in five patients.Although it seems that DF has a better outcome clinically, the difference between the two techniques was statistically not significant.ConclusionDF as an additional cover to TIP is associated with an acceptable complication and has good cosmesis compared with spongioplasty; however, the difference is not statistically significant.

Evaluation of Tubularized Incised Plate Urethroplasty with Spongioplasty–Dartosoraphy Reinforcement in Pediatric Hypospadias: A Randomized Controlled Study

“…TIPU spongioplastydartosoraphy group had only 4 of 110 cases (3.6%), whereas the TIPU with dartos flap group had 8 of 110 cases (7.2%). However, the incidence of meatal stenosis was five cases in the TIPU with spongioplasty-dartosoraphy group, which is similar to the findings reported by Verma et al 5 A prospective study was conducted by Bhat et al, 21 which involved 113 patients with hypospadias who underwent TIPU with spongioplasty. Among the 93 cases of distal and midpenile hypospadias, 4 out of 93 cases had a urethrocutaneous fistula (4.3%).…”

“…These modifications have resulted in significant improvements in the surgical outcomes. 4,5 The use of vascularized flaps between the tubularized neourethra and skin sutures is one of the recommended modifications to reduce the occurrence of complications, especially urethrocutaneous fistula, glanular dehiscence, and complete disruption. Commonly used flaps include the dartos fascia, 6,7 tunica vaginalis flap, 8,9 de-epithelialized skin, 10 and corpus spongiosum.…”

Outcome Of Spongioplasty As A Standalone Covering Layer After Urethroplasty In Distal Hypospadias

“…Hypospadias is an abnormally positioned external urethral meatus in male infants sometimes linked to a ventral bending of the penis or dorsal hood, which may affect the function of the urethra and the genital organs (12) . TIP urethroplasty is a flexible repair that may be used to treat a variety of abnormalities (14) .…”

“…In this study we decided to follow the footsteps of some of the recent reports using the mobilized approximated spongiosum as a standalone covering layer after urethroplasty (17,19) but other publications choose to assess the supporting effect of spongioplasty in conjunction with the standard TIP urethroplasty repair, including dorsal preputial dartos flap (7,10) . Many attempts were done trying to select the best second layer cover for repairing different forms of hypospadias that some of them investigated the extra added effect of reconstructing forked corpus spongiosum compared to the standard standalone dartos flap as a second layer (1,9and18) and others divided the study sample into two halves and compared between the dartos flap and the spongioplasty as the second layer (12) . Some authors utilized spongioplasty, dartos flap, and both (6) and others compared between tunica vaginalis flap, dartos flap and spongioplasty as the one and only second layer (15) .…”

“…A fasting regimen was instructed by the anesthetist and single dose IV prophylactic antibiotic was given. The procedure was done similar to that which was done by (12) General anesthesia followed by caudal anesthesia, optical magnification, using fine instruments and bipolar cautery all by staff surgeons under similar circumstances. Sterilization from the umbilicus to the knee joint and draping.…”