Single vs. double dartos interposition flaps in preventing urethrocutaneous fistula after tubularized incised plate urethroplasty in primary distal hypospadias: a prospective randomized study

Urol Int. 2009;83(3):354-8. doi: 10.1159/000241682. Epub 2009 Oct 13.


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.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Cutaneous Fistula / prevention & control*
  • Humans
  • Hypospadias / pathology
  • Hypospadias / surgery*
  • Male
  • Middle Aged
  • Prospective Studies
  • Surgical Flaps*
  • Urethra / surgery*
  • Urethral Diseases / prevention & control*
  • Urinary Fistula / prevention & control*
  • Urologic Surgical Procedures, Male / methods
  • Young Adult