A One Year Randomized Controlled Trial To Compare The Outcome Of Primary Repair Of Hypospadias With Vascular Cover Using Tunica Vaginalis Flap With Those Using Preputial Dartos Fascia

Abstract

Background and Objectives Tubularized incised plate (TIP) urethroplasty, also called as Snodgrass Urethroplasty is the most common technique noted to correct hypospadias. But, urethrocutaneous fistula is still the most common complication of this technique which usually requires reoperation. Several techniques of providing vascularized flaps to the neourethra have been recommended to decrease this complication rate. The objective of this study was to assess the complication rate and outcome in patients undergoing primary hypospadias repair using tunica vaginalis flap with those using preputial dartos fascia. Methodology The present one year randomized controlled trial was conducted in the Department of General Surgery, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi from January 2016 to December 2016. A total of 40 children who came for primary hypospadias repair were randomized into two groups of 20 each based on the type of vascular cover as group PD (Preputial dartos cover) and group TV (Tunica Vaginalis flap cover). Results In the present study, the mean age of the children was 4.8yrs, youngest child being 1yr old and oldest being 16yrs old. The mean of the children in preputial dartos group was 4.17yrs and in that of tunica vaginalis group was 5.25yrs. After intra-operative correction of chordee, there were 20 cases of distal hypospadias, 8 cases of middle hypospadias and 12 cases of proximal hypospadias. Chordee was absent in 26 children. In 14 children, chordee was present, out of which it was <30 degree in 6 children and >30 degree among the rest. All the patients were followed up for minimum of 6 months. Two (10%) patient developed meatal stenosis and one (5%) patient developed mild torsion of testis in preputial dartos group. Two (10%) patient in tunica vaginalis group developed meatal stenosis. In the present study, two (10%) patients in preputial dartos group developed urethrocutaneous fistula and one (5%) patient developed stricture urethra in the follow up period. None of the patients developed urethrocutaneous fistula in the tunica vaginalis group. One (5%) patient had stricture urethra in tunica vaginalis group. However, no significant difference was noted between the two groups for major complications (P value – 0.442). Conclusion and interpretation Use of tunica vaginalis flap is associated with acceptable results, cosmesis and less complications compared to those occurring with preputial dartos cover. However, further long term studies are required for concluding.