Comparative Efficacy of Tunica Vaginalis Flap Versus Preputial Dartos Flap in Tubularized Incised Plate (TIP) Urethroplasty for Hypospadias: A Randomized Controlled Trial

Brief Summary

Hypospadias is a common congenital anomaly in males characterized by an abnormal location of the urethral meatus on the ventral surface of the penis. Surgical repair is required to restore normal urinary function, penile appearance, and long-term functional outcomes. Tubularized Incised Plate (TIP) urethroplasty is currently the most widely accepted surgical technique for distal and mid-penile hypospadias repair.

A key step in TIP urethroplasty is the placement of a vascularized tissue flap over the neourethra to reduce postoperative complications such as urethrocutaneous fistula, meatal stenosis, wound dehiscence, and poor cosmetic outcomes. Traditionally, the Preputial Dartos Flap (PDF) has been used for this purpose due to its easy availability and straightforward harvesting from the dorsal preputial tissue. However, limitations such as inadequate tissue in some cases, compromised vascularity, and higher risk of complications including fistula formation and meatal stenosis have been reported.

The Tunica Vaginalis Flap (TVF), harvested from the parietal layer of the tunica vaginalis of the testis, is a well-vascularized tissue that may provide superior coverage and improved healing of the neourethra. Although TVF has been increasingly used in hypospadias surgery, its routine use in primary TIP urethroplasty remains controversial because it requires additional surgical dissection and may be associated with scrotal morbidity.

This study aims to compare the efficacy and safety of tunica vaginalis flap versus preputial dartos flap as an intermediate layer in TIP urethroplasty through a randomized controlled trial. The primary objective is to compare postoperative complication rates, particularly urethrocutaneous fistula formation. Secondary outcomes include cosmetic appearance, functional urinary outcomes, and operative time.

This prospective randomized study will help generate evidence regarding the optimal tissue flap for neourethral coverage in hypospadias repair. The findings may contribute to improved surgical decision-making and better postoperative outcomes in children undergoing TIP urethroplasty.