Outcome analysis of tubularized incised urethral plate using dorsal dartos flap for proximal penile hypospadias repair

Purpose: To assess the outcome of tubularized incised plate (TIP) urethroplasty in conjunction with a dorsal dartos flap for primary proximal penile hypospadias. Materials and methods: Forty-nine patients with proximal penile hypospadias underwent a one-stage TIP urethroplasty with single-layer closure using polyglactin suture. A dorsal dartos (subcutaneous) flap, harvested from the dorsal penile shaft was used to cover the neourethra ventrally. Glanuloplasty was also performed in all cases. All patients had a well preserved urethral plate after straightening of the penis. Complications and cosmetic appearance were documented during follow-up. Results: Mean patient age at surgery was 23 months (16-72 months). Mean operative time was 180 min (154-240 min). At the mean follow-up of 36 months, the overall complication rate was 12% (4 fistulae, 1 meatal stenosis). Glandular dehiscence occurred in one patient, and 38 patients (78%) required dorsal Nesbit plication. No patient had residual chordee, neourethral stricture or a urethral diverticulum, and the neomeatus with a slit-like appearance was positioned at the glans tip. Conclusions: TIP urethroplasty with dorsal dartos layer covering the neourethra is an effective treatment for primary proximal penile hypospadias with a preserved urethral plate and without severe curvature. There is a good cosmetic outcome with low risk of complications. (C) 2009 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.