Comparison of Urethrocutaneous Fistula Rate After Single Dartos and Double Dartos Tubularized Incised Plate Urethroplasty in Pediatric Hypospadias

Abstract

Background and objective Tubularized incised plate (TIP) urethroplasty is an easy and popular technique for repairing hypospadias, however urethrocutaneous fistula (UCF) is a frequently reported complication. Different techniques are used to reduce this complication. We aimed to compare the rate of UCF after single dartos and double dartos TIP urethroplasty in children with distal and mid penile hypospadias. Methods A randomized controlled trial (NCT 04699318) was conducted in the Department of Pediatric Surgery, Mayo Hospital, Pakistan from August 2017 to February 2018, after ethical approval. After informed consent, a total of 60 patients with distal and mid penile hypospadias who were uncircumcised, had no chordee, and/or previous surgery, were randomly allocated in two groups using computer generated table numbers. Group A underwent single dartos TIP urethroplasty and Group B underwent double dartos TIP urethroplasty. Catheter was removed on day 10 post-operatively in both groups and primary outcome (UCF) was noted after a week of catheter removal. Rate of UCF was compared using chi square and p-value of <0.05 was taken as significant. Data was stratified to check for effect modifiers. Results Out of 60 children, eight (13.3%) developed UCF. In Group A, seven (23.3%) developed UCF and in Group B, one (3.3%) developed UCF (p-value 0.02). In both groups, no patient (0%) had urethral disruption, penile torsion, skin necrosis or meatal stenosis. Conclusion Additional covering of neo-urethra by a double dartos layer significantly reduces fistula rate after tubularized incised plate urethroplasty in both primary distal and mid penile hypospadias.

Single dartos flap versus double dartos flap in hypospadias repair: A systematic review and meta-analysis with trial sequential analysis and fragility index

“…Study selection -Total 319 studies selected from the various database, but only six [15][16][17][18][19][20] studies met our inclusion criteria. PRIMSA flow diagram shows the detailed flow of study screening and selection process.…”

Use of Validated Questionnaires to Predict Cosmetic Outcomes of Hypospadias Repair

“…Studies have reported a range of fistula rates after hypospadias repair, which can be influenced by factors such as the severity of hypospadias, the age of the patient at the time of surgery, and the presence of associated conditions. Reported rates vary from 5% to 30-40% [25,26].…”

Effect of Haematological Parameters in the Development of Urethrocutaneous Fistula After Hypospadias Surgery

“…The use of intraoperative tissue adhesives has been shown to reduce the risk of UCF [22,23]. In another study, it was reported that additional coating of the neo-urethra with a double layer of dartos significantly reduced the rate of fistula after hypospadias [24]. On the other hand, there are studies reporting that the use of inlay grafts reduces the development of UCF and the risk of meatal/neourethral stenosis [25,26].…”