INTRODUCTION– Hypospadias is one of the most common malformations of male genitalia, with a traditionally quoted incidence of 1 in 300 male births. However, epidemiological evidence suggests that in developed Western countries the incidence is increasing and may be as high as 8 in 1000 male births. Both genetic and environmental factors are implicated in the cause and numerous theories have been proposed about both the cause and the changing prevalence^2–4, but discussion of these falls outside the remit of this review. There is no single satisfactory way of classifying hypospadias. Both dartos fascia and tunica vaginalis provide robust cover to the urethra and act as a barrier between the sutures lines. The purpose of our study was to compare outcomes of standard tubularised incised plate urethroplasty (TIP) repair using dartos flap and TVF  in different type of hypospadias cases.            

MATERIAL AND METHODS– This study was carried out in the Department of Surgery (Paediatric Surgery Division) of Pt. J. N. M. Medical College and associated Dr. B. R. A. M. Hospital, Raipur (C.G.) in patients diagnosed to had distal, mid penile and proximal penile type of hypospadias. The study was carried out during the period from February 2016 to September 2017. Total no of cases studied was 55. All admitted patients for primary Snodgrass repair were randomized into two groups by Simple Random method to avoid selection bias.Group A of 27 patients were prospectively selected for repair using TVF for soft tissue cover. Group B of 28 Patients, comparable in age and type of hypospadias, who underwent TIP repair using dartos flap as soft tissue cover. Descriptive statistics were employed to characterize the data. Fischer exact test was used for categorical data. A P value of <0.05 was considered statistically significant.

RESULTS– Maximum number of patients belongs to age group 2 years – 4 years (i.e., 14.5 %). Next common group being 4 –<6 years (11%). Out of 55 patients, 21 patients (31.18 %) had no chordee, 32 patients (58.18%) have superficial chordee and 2 patients (3.64%) had deep chordee. In mid penile hypospadias group, dartos flap had 55.55% rate of urethrocutaneous fistula formation and TVF flap had 22.2% rate of urethrocutaneous fistula formation. In distal hypospadias group, dartos flap had 0% rate of neourethral diverticula/ acquired megalourethra formation and TVF flap had 0% rate of neourethral diverticula/ acquired megalourethra stricture formation.

CONCLUSION– Tunica vaginalis flap reduces the fistula rate and is superior to dartos flap as a waterproofing layer for TIP repair in midshaft and proximal penile hypospadias.