Comparison of Results of TIPU Repair for Hypospadias with “Spongioplasty Alone” and “Spongioplasty with Dorsal Dartos Flap”

Abstract

Objective: The aim of our study was to compare the results of tubularized plate urethroplasty with interposing healthy tissue spongioplasty alone and spongioplasty with dorsal dartos flap to assess the role of dartos flap in prevention of fistulae. Patients and Methods: A retrospective study was performed on 80 patients, aged 4 months to 27 years who underwent hypospadias repair using the Snodgrass technique. The patients were assigned to two groups. In group I (40 patients) the neourethra was covered with spongioplasty only, and in group II (40 patients) the neourethra was covered with spongioplasty plus dartos flap. Integrity of the urethral plate was maintained in all the cases. The ventral curvature & torsion was corrected by penile de-gloving, mobilization of the urethral plate and spongiosum and mobilization of the proximal urethra if needed. The results were analysed in view of complication rates. The average period of hospital stay was 7 days & follow-up varied from 8 months to 28 months with a mean of 14 months. Results: In group I, hypospadias were distal penile in 31 (77.5%), mid-penile in 4 (10%) and proximal/peno-scrotal in 5 (12.5%) patients. In group II, hypospadias were distal penile in 17 (42.5%), mid penile in 9 (22.5%) and proximal/peno-scrotal in 14 (35%) patients. Sixty five percent in group I and 80% in group II had ventral curvature but the difference was not statistically significant. Good functional results were achieved in 97.5% patients in group I and in 95% patients in group II which were statistically similar (p value-0.585). Urethral fistula was encountered in 2.5% in group I & in 2 cases (5%) in group II. Meatal stenosis was noted in 7.5% each in both groups, which responded to urethral dilatation. One patient in group II had complete disruption. There was no statistically significant difference in early and late complications in both groups (p value-0.812). Conclusions: Spongioplasty with healthy spongiosal tissue is strong enough and is effective waterproofing as an * Corresponding author. A. Bhat et al. 42 interposition layer. However, more prospective studies in different hands are needed to omit the step of dorsal dartos interposition.

Spongioplasty with Dartos Flap Coverage in the Snodgrass Technique of Hypospadias Repair

“…Bhat et al reported 2 fistulae in a series of 40 patients of TIP urethroplasty using spongioplasty in addition to dartos flap coverage. 27 In the present study, we found 5 (14.28%) fistula among 35 patients using dartos flap plus spongioplasty in the TIP urethroplasty. However, Kocvara et al reported a higher complication rate (40%) using the spongiosal tissue for neourethral coverage of 37 patients.…”

Choosing an ideal vascular cover for Snodgrass repair

“…The use of a waterproofing second cover for the neourethra is well documented in literature varying from corpus spongiosum, dartos-based flaps (ventral, dorsal, and scrotal dartos flaps) to TV which is known to decrease the incidence of fistula and breakdowns. [ 2 5 6 7 8 9 10 11 13 14 15 ] We reviewed studies which used a second vascular cover following TIP repair to see if the success rates were better.…”

“…Many studies have shown good results with Snodgrass technique, but the most common complication reported is urethrocutaneous fistula which forms >60% of all complications. [ 4 ] A second vascular cover on the tube such as spongiosum, dartos, or tunica vaginalis (TV) is known to minimize or avoid this complication[ 2 5 6 7 8 9 10 11 13 14 15 ] but which flap provides a better cover is still a matter of debate since decades because results have been conflicting with different results in the hands of different surgeons. The aim of our study is to present our experience with TIP urethroplasty using tunica, dorsal, and ventral dartos as second cover and see which had a better outcome.…”

Double breasting spongioplasty in tubularized/tubularized incise plate urethroplasty: A new technique

“…[12] Patients were discharged from the hospital in 8–10 days after removal of per urethral catheter in the series.…”

“…If urethral plate requires a superficial incision for tubularization; then, it is considered to be an average one, and when it requires a deep incision then urethral plate is considered as narrow. [12] Severity of hypospadias was decided by meatal location at the level of bifurcation of spongiosum after penile degloving.…”