Vol. 6, Issue 1, Part C (2024)

Hypospadias, a congenital anomaly of the male external genitalia, is commonly repaired using the tubularized incised plate (TIP) urethroplasty technique, recognized for its simplicity and effectiveness. However, postoperative complications like urethrocutaneous fistula (UCF), meatal stenosis, and urethral stricture are frequent concerns. This quasi-experimental study was carried out at the Department of Urology, Dhaka Medical College Hospital, over one year from July 2021 to June 2022 and compared the outcomes of double-layer dorsal dartos flap (Group A) and single-layer dorsal dartos flap (Group B) in TIP urethroplasty for distal and midpenile hypospadias. It included 54 uncircumcised patients with distal or midpenile hypospadias, mild or no chordee, and no history of previous hypospadias surgery. The participants were divided into two groups through alternate assignment: Group A (27 patients) underwent tubularized incised plate urethroplasty (TIPU) with a dorsal double dartos flap, while Group B (27 patients) received TIPU with a single dartos flap. Detailed clinical evaluations and history were conducted for all patients. Postoperative follow-ups were performed on the 5th and 14th days, as well as at 1, 3, and 6 months. Data collected during the study were analyzed using SPSS version 24. In this study, the majority of participants in both groups were aged 6-9 years, with 75% having distal penile hypospadias. The mean operative time was significantly longer for Group A (113.04 ± 8.2 minutes) compared to Group B (93.8 ± 5.82 minutes). Complications were observed in 16% of patients in Group A and 48% in Group B, reflecting a significantly higher success rate in Group A (84% vs. 52%; p<0.05). Although wound infection, penile skin necrosis, and wound dehiscence rates were slightly lower in Group A (4.2%, 0%, and 4.2%, respectively) compared to Group B (12%, 8%, and 4%), the differences were not statistically significant. Meatal stenosis occurred in 8.3% of Group A and 4% of Group B. Glanular torsion was present in 40% of Group B but absent in Group A, a statistically significant finding. No cases of urethral stricture were recorded. While 20% of Group B developed urethrocutaneous fistula (UCF), no UCF cases were observed in Group A, though this difference was not statistically significant. Both groups achieved an 88% rate of satisfactory cosmetic and functional outcomes. The study concluded that the dorsal double dartos flap technique is safe, effectively minimizes the risk of postoperative UCF and glanular torsion, and offers improved cosmetic results, although it requires more operative time. Overall, its advantages outweigh the associated drawbacks.