Outcome of Tubularized Incised Plate Urethroplasty by Single Layer Urethral Closure with Flap and Double Layer Urethral Closure without Flap

Background: Hypospadias is one of the common genitourinary anomalies, has been treated with a variety of operative procedures, but tubularized incised plate urethroplasty (TIPU) has proven to be the most effective because of its simplicity and positive outcomes. The postoperative complications are thought to be reduced by a flap during the TIPU. It is still up for debate whether utilizing a flap is risk-worthy given the hazards involved in doing so as well as the issue of single or double layer urethral closure.
Objective: To compare the outcomes of TIPU by single layer urethral closure with flap and double layer urethral closure without flap in mid and distal hypospadias.
Methods: This prospective comparative study was conducted in the Paediatric Surgery Department, Mymensingh Medical College Hospital, Bangladesh, from January, 2022 to June, 2023. Patients aged up to 12 years with mid and distal hypospadias, according to inclusion and exclusion criteria was included in this study. Patients were divided alternatively in Group A(single layer with flap) and Group B(double layer without flap). Data of follow up schedule was recorded at 2nd, 4th, 8th and 12th week from the day of surgery. Data were processed both manually and by computer using computer software Statistical package for social sciences (SPSS) version 29.0.1.0.
Results: 47 patients were enrolled, 24 were in group A and 23 were in group B with a mean age 6.16 ± 3.345 years. Mid penile, Distal penile and coronal hypospadias were 21%, 75% and 4% respectively. Postoperative complications were 41.7% in group A and 39.1% in group B (ρ = 0.849) with urethrocutaneous fistula (UCF) rate 33.3% and 30.4% respectively, less in 4-8 years age group. There were statistically significant differences (ρ < 0.05) between two groups in terms of operative time (94.46 ± 6.661 vs. 75.26 ± 2.800 min) and cosmetic outcome. Conclusion: Flap does not seem to reduce overall complications of TIPU, rather has its own hazards. Double layer urethral closure without flap is beneficial considering operative time and cosmetic outcome. Researching with a multivariable comparison group throughout a broad study population could a concrete conclusion be drawn.