Comparison of the Surgical Results of Ventral and Dorsal Dartos Flaps in Tubularized Incised Plate Urethroplasty for Distal Hypospadias: A Randomized Clinical Trial

Objective: Hypospadias is one of the most common congenital anomalies of the urogenital system. Various surgical methods exist to repair this condition, all aiming to create a straight penis, ensure proper placement of the meatus, and achieve a sufficient diameter for the urethra with optimal flow. Despite following precise surgical techniques, many patients in reported studies still experience complications. The aim was to evaluate and compare the surgical outcomes of distal hypospadias repair utilizing ventral versus dorsal Dartos flaps. Methods: In this randomized clinical trial, patients who were candidates for surgical treatment were randomly assigned to 2 groups. Both groups underwent hypospadias repair using the tubularized incised plate (TIP) method. The first group received a ventral Dartos flap, while the second group received a dorsal Dartos flap for urethral recon struction. Patients were monitored for complications, and the Hypospadias Objective Scoring Evaluation (HOSE) questionnaire was used to assess the surgical outcomes. Results: The dorsal flap group had higher complication rates, including 3 fistulas (10%), 6 cases of mild necrosis (20%), 2 cases of severe necrosis (6.7%), and 4 instances of penile torsion (13.3%). The ventral flap group had 2 cases (6.7%) of postoperative bleeding and 2 fistulas (6.7%). At the 6-month follow-up, no significant difference was observed between the 2 groups in terms of HOSE score. The need for reoperation was higher in the dorsal flap group. Fateme Tahmasbi1,2 Javad Aliasgarzadeh3 Mohsen Mohammad-Rahimi4 Behzad Lotfi3 Conclusion: The findings suggest that the ventral Dartos flap provides better results and fewer complications than the dorsal Dartos flap in the repair of hypospadias.