Ramez Mohamed, Hashem Abdelwahab, Bazeed Mahmoud, Dawaba Mohamed S, Helmy Tamer E
Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Urology Department, 30, June Urology and Nephrology Centre, Ismailia, Egypt.
World J Urol. 2025 Jan 18;43(1):78. doi: 10.1007/s00345-024-05419-x.
To compare between the dartos and tunica vaginalis flaps as covering layers in denovo distal or mid-shaft penile hypospadias underwent tubularized incised plate (TIP) repair.
This is a single-center, randomized trial was for denovo distal or mid-shaft penile hypospadias. Children with history of orchiectomy, orchiopexy and inguinal hernia repair were excluded. Eighty-eight patients were divided into two groups: the first used dartos flap (DF), while the second used tunica vaginalis flap (TVF). The primary outcome was to assess the incidence of urethrocutaneous fistula. The secondary outcome was to assess cosmetic outcome using paediatric penile perception score (PPPS) and hypospadias objective scoring evaluation (HOSE).
Baseline demographic and clinical characteristics showed no statistically significant. Median operative time (IQR) was 100 (90, 120) and 145 (140, 150) minutes in in DF and TVF Groups, respectively (p < 0.001). Urethrocutaneous Fistula was detected in 9 (20.9%) in DF group and 2 (4.9%) in TVF group (p 0.029). Meatal stenosis occurred in 3 (7%) in DF group and 2 (4.9%) in TVF group. Penile torque was diagnosed in one (2.4%) in TVF group. There was no significant difference in total PPPS score (p = 0.076), however, there was a significant difference in total HOSE score in the favour to TVF group (p = 0.024). At 12 months, testicular ascent occurred in 0% and 3 (7.3%) in DF and TVF groups, respectively (p = 0.071).
Compared to dartos flap, tunica vaginalis flap significantly helps in reduction of fistula rate. However, it has significant more operative time.
比较肉膜瓣和睾丸鞘膜瓣作为覆盖层在初次行远端或阴茎中段尿道下裂管状切开板（TIP）修复术中的应用效果。
这是一项针对初次远端或阴茎中段尿道下裂的单中心随机试验。排除有睾丸切除术、睾丸固定术和腹股沟疝修补术病史的儿童。88例患者分为两组：第一组使用肉膜瓣（DF），第二组使用睾丸鞘膜瓣（TVF）。主要结局是评估尿道皮肤瘘的发生率。次要结局是使用小儿阴茎感知评分（PPPS）和尿道下裂客观评分评估（HOSE）来评估外观效果。
基线人口统计学和临床特征无统计学显著差异。DF组和TVF组的中位手术时间（IQR）分别为100（90，120）分钟和145（140，150）分钟（p<0.001）。DF组有9例（20.9%）发生尿道皮肤瘘，TVF组有2例（4.9%）发生尿道皮肤瘘（p=0.029）。DF组有3例（7%）发生尿道口狭窄，TVF组有2例（4.9%）发生尿道口狭窄。TVF组有1例（2.4%）诊断为阴茎扭转。PPPS总分无显著差异（p=0.076），然而，HOSE总分有显著差异，TVF组更具优势（p=0.024）。12个月时，DF组和TVF组的睾丸下降率分别为0%和3例（7.3%）（p=0.071）。
与肉膜瓣相比，睾丸鞘膜瓣显著有助于降低瘘管发生率。然而，其手术时间明显更长。
