Both dorsal and ventral flaps can be used in previously circumcised hypospadic adults with comparable success rates

To compare dorsal and ventral dartos flap outcomes for tubularized incised-plate urethroplasty (TIPU) in terms of success, complication rates and cosmetic appearance in adult circumcised hypospadic men.

Forty-two circumcised adult men underwent primary distal or midpenile hypospadias repair for cosmetic reasons by a single surgeon in a prospective randomized trial. Twenty-two patients were randomly selected for TIPU repair with dorsal (Group1, mean age 22.3 years) dartos flap as second layer. Twenty patients were randomly selected for TIPU repair with ventral dartos flap (Group2, mean age 21.1 years). Satisfaction questionnaires were answered by patients before surgery and at postoperative 6 weeks. The operating surgeon also filled in the form blindly at the same postoperative period. The differences between pre and postoperative satisfaction scores for each group were also evaluated. Preoperatively, all cases were evaluated with uroflowmetry and compared with postoperative results measured at 6th week of surgery. P < 0.05 was considered as significant.

Mean follow-up was 24 months (4-28). Complications were encountered in 18 and 20% of the patients in groups 1 and 2, respectively. Complications were urethrocutaneous fistula, meatal stenosis, retrusive/proximal meatus and residual curvature. Success rates were 82 and 80%, respectively. No differences were seen in overall satisfaction between the two groups (P = 0.07).

Outcome of hypospadias repair in circumcised adults for cosmetic reasons is similar to uncircumcised hypospadics previously mentioned in the literature. Both dorsal and ventral flaps can be used in previously circumcised hypospadic adults with comparable satisfaction and complication rates and uroflow findings.