Single vs. Double Dartos Interposition Flaps in Preventing Urethrocutaneous Fistula after Tubularized Incised Plate Urethroplasty in Primary Distal Hypospadias: A Prospective Randomized Study

Introduction: This prospective study was designed to compare symmetrical overlapping double flaps with a single dartos flap in regard to fistula formation as an adjunct to tubularized incised plate urethroplasty (TIPU). Patients and Methods: 77 consecutive children with primary coronal or subcoronal hypospadias were randomized into 2 groups. A single layer dartos flap was used to cover the anastomotic site in the first group (37 patients). A wider dorsal dartos flap bisectioned in the midline was utilized in the second group of 40 patients. The complication rates were compared. Results: There was no difference between the 2 groups in terms of age, and meatal location. Postoperative median follow-up was 34 months. Urethrocutaneous fistula occurred in 3 patients (8.1%) of the monolayer group. No fistula developed in the second group with double flaps. Conclusions: The current study proposes that the use of double dorsal flaps, although statistically not significant, better prevents fistula formation compared to monolayer dartos flaps following TIPU operation.