Editorial Comment on “The effectiveness of double dorsal dartos flap for urethroplasty coverage in distal hypospadias repair: A <scp>single surgeon</scp> approach to preventing urethrocutaneous fistula”
Bibliographic record
Abstract
Urethro-cutaneous fistula (UCF) remains the most common complication following hypospadias repair. The group of investigators in this study showed favorable outcomes for the use of double dartos flap (DDF) during Thiersch-Duplay hypospadias repair, which prevented postoperative UCF formation without significantly higher meatal stenosis, glans dehiscence, or penile torsion.1 The technique of DDF was originally described by Kamal BA in 2005 and it proved efficacy in preventing UCF and penile torsion following tubularized incised plate (TIP) hypospadias repair.2 These findings were supported by a randomized controlled trial (RCT) confirming the effectiveness of DDF in preventing UCF formation following TIP repair of distal penile hypospadias.3 In a recent meta-analysis, DDF was associated with nine times decrease in the risk of UCF, without a statistically significant risk for higher incidence of meatal stenosis and glans dehiscence.4 The current study highlighted the importance of urethroplasty closure to the middle of the glans. However, one randomized study showed that extended TIP could potentially provide better cosmoses objectively assessed by HOPE score, without affecting the functional outcomes, and without significantly higher UCF or meatal stenosis.5 The authors acknowledged the retrospective nature as a major drawback. Nonetheless, the fact that all surgeries were consecutively performed by one surgeon between 2010 and 2021 gives consistency to the data collected and credibility to the results obtained. Parental satisfaction and HOPE score were used as a surrogate for cosmetic outcomes, but the authors did not elaborate on how this was assessed as HOPE score was introduced in 2013. The current study and the literature support the use of DDF to prevent UCF. Nevertheless, there are other topographic, intraoperative, and postoperative factors that potentially contribute to the development of postoperative UCF. Therefore, UCF should be considered a “multifactorial” complication, and the use of DDF should be presented as one of the intraoperative technical approaches to significantly decrease or prevent UCF formation. I do believe that the use of DDF should be considered a standard practice in hypospadias repair. However, this needs more multicenter RCTs and a consensus among pediatric surgeons and pediatric urologists. None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.025 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.021 | 0.022 |
| Insufficient payload (model declined to judge) | 0.009 | 0.010 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".