Comparing the results of distal hypospadias surgery using ventral and dorsal dartos flaps

Abstract

Hypospadias is one of the most common congenital abnormalities of the genitourinary system. There are various surgical methods to repair this abnormality, the goal of all of them is to create a straight penis, the correct placement of the meateus duct at the end of the glans, the sufficient diameter of the new duct with normal urinary flow, and achieving normal sexual function during puberty. A number of complications have been reported in different hypospadias repair techniques. To prevent these complications, it is necessary to choose a suitable surgical method with a precise technique. In the reported studies, despite following the strict technique, a significant number of patients still face problems. Therefore, in this review, we tried to compare the results of distal hypospadias surgery using ventral and dorsal dartus flaps.

Method: This study was conducted on children with hypospadias referred to Tabriz Children's Hospital from July 2022 to June 2023. Patients referred to the clinic who were candidates for hypospadias surgery were randomly divided into two groups. Both groups underwent hypospadias surgical treatment by Tubularized incised plate (TIP) method. In the first group, the ventral dartos flap was used for the patients, and in the second group, the dorsal dartos flap was used to cover the duct. After surgery, the patients were followed up for complications. Also, using the HOSE questionnaire, the result of hypospadias surgery was determined and recorded in the visit.

Results: The results of our study showed that in the investigation of the complications of hypospadias surgery, in the ventral dartos flap group, two cases of bleeding (6.7%) and two fistulas (6.7%), and in dorsal dartos flaps group, 3 cases of fistulas (10%), 1 case of diverticulum (3.3 %) and 6 cases of mild necrosis (20%), 2 cases of severe necrosis (6.7%) and 4 cases of penis torsion (13.3%) were observed. After six months, no significant difference between the two groups was observed in the follow-up of the patients with HOSE evaluation of urine flow, erection, and fistula after the operation. The need for reoperation was higher in the dorsal dartos flaps group.