Tubularized Incised Plate Urethroplasty with Unilateral Preputial Vascularized Dartos Flap Repair for Distal Hypospadias: A Comparative Study versus Tubularized Incised Plate Urethroplasty alone
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Objectives: To evaluate outcome of primary repair of distal hypospadias using tubularized incised plate urethroplasty (TIPU) with preputial dartos flap for neourethra coverage compared to TIPU alone Patients & Methods: Forty children with distal hypospadias were divided into two groups: Group (A) included - patients assigned for TIPU with preputial dartos pedicle flap or TIPU alone (Group B). In group A, the skin of prepuce was de-epithelialized and fully dissected from the mucosa to create a unilateral preputial flap of underlying dartos fascia/muscle. Vascular supply of the raised flap was based on the preputial vessel which is a branch of the dorsolateral branch of the inferior external pudendal vessels. The flap was rapped to envelop the neourethra and was secured. Postoperative (PO) complications were recorded. Parents' satisfaction concerning aesthetic appearance of the penis was inquired at one month PO using the Pediatric Penile Perception Score (PPPS). Results: Mean operative time was non-significantly longer in group A. All patients passed smooth intraoperative course. Eight patients developed PO complication with significantly lower frequency in group A compared to group B. Four patients developed urethrocutaneous fistula; 3 patients in group B and one in group A with significantly higher frequency in group B. Three patients developed meatal stenosis with nonsignificantly higher frequency in group B. PPPS scorings concerning the shape of glans and penile skin were significantly higher but those of other items of PPPS were non-significantly higher in group B compared to group A. There was non-significantly higher frequency of parents scored >15 with non-significantly higher total score in group A compared to group B. Conclusion: TIPU with de-epitheiialized vascularized dartos muscle/fascia flap for neourethra coverage is safe and effective procedure for management of distal hypospadias with acceptable aesthetic outcome.