Double neourethral covering with platelet-rich fibrin and Dartos flap versus double Dartos flaps in Tubularized Incised Plate repair of primary distal hypospadias

Mansour, Abdullah M; Abdelhalim, Khaled Mahmoud; Abdalla, Mohamed Osama; Ismail, Iman Yehia; Alnashar, Ahmed M

doi:10.21608/eju.2025.356588.1024

Double neourethral covering with platelet-rich fibrin and Dartos flap versus double Dartos flaps in Tubularized Incised Plate repair of primary distal hypospadias

Articles in Press

Document Type : Original Article

Authors

¹ faculty of medicine, suez canal university.

² Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.

³ Department of Clinical Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.

10.21608/eju.2025.356588.1024

Abstract

Background: Two-layer coverage with double Dartos flaps (DDF) was reported to give better protection against urethrocutaneous fistula (UCF) than single flap in Tubularized Incised Plate (TIP) urethroplasty. Platelet-rich fibrin (PRF) is a healing promotor and can be used as an autologous bioactive alternative to traditional tissue flaps.

Objectives: To compare the effect of double covering of the neourethra with a single Dartos flap in addition to a PRF membrane versus DDF on rate of postoperative complications of TIP repair of primary distal hypospadias.

Methods: A total of 44 patients with primary distal hypospadias were prospectively randomized into two groups according to the method of neourethral coverage. DDF technique was used in group A (included 22 patients with a mean age of 36±29 months). A single Dartos flap in addition to a PRF membrane were applied for group B (included 22 patients with a mean age of 30±21 months). PRF was intraoperatively prepared by simple centrifugation of a patientʼs blood sample.

Results: After a minimum follow up for 6 months, group B showed better outcome and lower rate of UCF (4.5% compared to 13.6% in group A), although not statistically significant. Additionally, group B did not show any cases of wound infection versus 3 cases in group A.

Conclusions: Two-layer neourethral coverage by a PRF membrane and a Dartos flap in TIP urethroplasty seems to decrease rates of postoperative UCF and wound infection compared to application of DDF. The technique is simple and safe.

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