title: Comparison of tubularized incised plate urethroplasty combined with a meatus-based ventral dartos flap or dorsal dartos flap in hypospadias.
abstract: OBJECTIVE
  Tubularized incised plate urethroplasty (TIPU) is the preferred surgical option for distal and mid-shaft hypospadias repair. Neourethra dartos flap coverage is routinely used as a protective layer with good results. We modified meatus-based ventral dartos flap (MBVDF) to TIPU by dissecting the proximal mid-ventral dartos attached urethra and leaving the subcutaneous fascia connecting the meatus, and retrospectively compared the outcomes of using MBVDF with single dorsal dartos flap (DDF) on the complication rates of TIPU.
  
  
  METHODS
  We present 2 surgeons' experiences with 356 patients with distal and mid-shaft hypospadias between January 2010 and December 2014. Patients were divided into two groups. Group DDF included 185 patients (mean age 29 months) underwent TIPU with DDF rotated laterally covering the suture lines of the neourethra. Group MBVDF included 171 patients (mean age 26 months) underwent TIPU with MBVDF covering the suture lines of the neourethra. Statistical analysis of patient basic information and complications was performed by two independent sample t test and Chi square test or Fisher's exact test.
  
  
  RESULTS
  There were no statistical differences in age, type of hypospadias, and follow-up time between the two groups. The mean operative time in the group MBVDF (68.93 ± 8.32 min) was significantly shorter than in the group DDF (73.60 ± 9.06 min). Ventral skin necrosis (2.7%) and penile rotation (3.8%) in group DDF was significantly higher than group MBVDF which did not occur. The differences in other complication rates including fistula rate (2.7 vs 2.9%) between the groups were not statistically significant.
  
  
  CONCLUSIONS
  DDF and MBVDF with TIPU are similarly effective methods for decreasing fistula in hypospadias repair. MBVDF with TIPU may be an easier method and can avoid ventral skin necrosis and penile rotation.
authors.affiliation: Southern Medical University, Guangzhou, 510515, People's Republic of China.|Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Jia
authors.affiliation: Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, People's Republic of China.
authors.forename: Guo-chang
authors.initials: GC
authors.lastname: Liu
authors.affiliation: Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, People's Republic of China.
authors.forename: Li-yu
authors.initials: LY
authors.lastname: Zhang
authors.affiliation: Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, People's Republic of China.
authors.forename: Ying-quan
authors.initials: YQ
authors.lastname: Wen
authors.affiliation: Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, People's Republic of China.
authors.forename: Wen
authors.initials: W
authors.lastname: Fu
authors.affiliation: Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, People's Republic of China.
authors.forename: Jin-hua
authors.initials: JH
authors.lastname: Hu
authors.affiliation: Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, People's Republic of China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, People's Republic of China.
authors.forename: Qiu-ming
authors.initials: QM
authors.lastname: He
authors.affiliation: Southern Medical University, Guangzhou, 510515, People's Republic of China. xia-huimin@foxmail.com.|Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, People's Republic of China. xia-huimin@foxmail.com.
authors.forename: Hui-min
authors.identifier: http://orcid.org/0000-0002-0103-1672
authors.initials: HM
authors.lastname: Xia
mesh_terms: D002648:Child; D002675:Child, Preschool; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D008297:Male; D010413:Penis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D013524:Surgical Flaps; D014521:Urethra / Q000002:abnormalities / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000379:methods*
keywords: Dartos flap; Hypospadias; Tubularized incised plate; Urethroplasty