Comparison of Tunica Vaginalis flap with Dartos flap in reducing post-operative fistula after TIP

Tabularised incised plate urethroplasty (TIP) or Snodgrass procedure is a well accepted technique for distal penile hypospadias repair. Its main complication is formation of urethrocutaneous fistula in the post operative period. Different investigators have tried different reinforcement over neo-urethra to prevent fistula formation. Snodgrass originally applied Dartos flap over neo-urethra. But some investigators reported better result with Tunica Vaginalis flap (TVF) in terms of post operative fistula formation. We have done a prospective study in our department comparing the effectiveness of these two flaps in reducing the post operative fistula rate. Total 30 patients of distal penile hypospadias undergone TIP repair in two years time. We assigned them in 2:1 ratio to receive a specific reinforcement after neourethra formation. Among them 21 patients were reinforced with Dartos flap and 9 patients were reinforced with TVF. Though it apparently seems that TVF has better outcome, difference between the two techniques is statistically nonsignificant in terms of post operative urethrocutaneous fistula formation. We compared the results in paediatric (<12yrs) as well as in adult (>12yrs) population. Again we found no statistically significant difference in the outcome. So we conclude that both the flaps are equally effective in all age groups in prevention of post operative fistula.