Hypospadias repair- Buccal Mucosal Graft Supported with Double Dartos Flap or Tunica Vaginalis Flap

Hypospadiasis is a common congenital genitourinary malformation which has various surgical procedures for its reconstruction. Tabularized incised plate (TIP) is the most common technique and this study compares the use of buccal mucosal graft combined to double dartos flap with tunica vaginalis flap as second layers in TIP procedure. In a prospective study 43 patients with hypospadiasis underwent TIP. Patients were randomly assigned into two groups. In the first group, 21 patients undergo buccal mucosal graft combined to double dartos flap and in the a second group, tunica vaginalis flap were used as second layer in 22 patients. Patients were followed and development of complications such as wound infections, meatal stenosis, and urethrocutaneous fistula formation were recorded. Failure was defined as need for repeated surgery. The overall success rate was 87.5% (100% in first group and 60% in the second). 12 patients had complications (3 in the first group and 9 in the other group) which half of them needed surgical operation. In 5 patients of tunica vaginalis flap group developed urethrocutaneus fistula; nevertheless, no fistula was recorded in buccal mucosal graft combined to double dartos flap (P=0.048). Other complications were not significantly different in the 2 groups. The surgical success rate of patients undergoing buccal mucosal graft combined to double dartos flap was significantly higher than tunica vaginalis flap(P=0.021). Buccal mucosal graft combined to double dartos flap as a second layer is a good technique with reasonable results in hypospadiasis surgery.