Risk of Glans Dehiscence Associated with Vascular Flap Coverage of the Glanular Neourethra during Primary Urethroplasty: A Randomised Controlled Trial

Abstract

Background: Hypospadias is one of the common congenital anomalies of male genitalia. Although over 300 different operative techniques have been described, post-operative complications are still common, of which glans dehiscence (GD) is the most severe complication requiring redo urethroplasty. Some surgeons use the vascular flap to cover the glanular part of the neourethra to prevent GD, but there are controversies regarding its usefulness. There is a paucity in the literature, about articles evaluating the risk of GD associated with vascular flap coverage of the glanular neourethra during primary urethroplasty. Materials and Methods: We planned a single-blinded, parallel-design, randomised controlled trial involving 56 cases of hypospadias treated with single-stage urethroplasty amongst the admitted cases of hypospadias for primary urethroplasty in the Department of Paediatric Surgery, AIIMS, Bhubaneswar, from November 2017 to December 2019 as an M.Ch. thesis project. This was approved by the Institutional Ethics Committee and enrolled in the national registry of clinical trial. 28 patients were randomised into Group A (without flap coverage of the glanular part of the neourethra) and 28 patients were randomised into Group B (with flap coverage of the glanular neourethra). Results: Only 2 (7.1%) cases amongst the Group A patients developed GD, while 9 (32.1%) cases of Group B had GD (P = 0.013). Conclusions: Extending the vascular flap coverage up to the glanular part of the neourethra till the neo-meatus during primary urethroplasty is significantly associated with GD.

Keywords

• glans dehiscence
• hypospadias
• single-stage urethroplasty
• snodgrass urethroplasty
• vascular flap