Histopathological Comparison and Expression Analysis of COL1A1, COL3A1, and ELN in the Proximal and Distal Ventral Dartos of Patients With Hypospadias: Protocol for Prospective Case-Control Study

Abstract

Background: The exact cause of penile curvature in hypospadias remains unknown. Resection of the dartos fascia has been observed to straighten the penis, indicating the involvement of the dartos fascia in the superficial chordee. However, the characteristics of dartos tissue in the distal territory of the ventral penile shaft may differ from those in the proximal aspect of the penile shaft. Objective: This study aims to investigate the distinct histopathological profiles and expression of COL1A1 (collagen type 1), COL3A1 (collagen type 3), and ELN (elastin) in proximal and distal ventral dartos of patients with hypospadias compared to those without hypospadias. Methods: This prospective case-control study compares the ventral dartos tissue of patients with hypospadias at different locations with that of patients without hypospadias. Dartos samples will be taken during surgery, with age matching. Histopathology examination uses hematoxylin and eosin and Masson's trichrome stain. The mRNA expression of COL1A1, COL3A1, and ELN will be quantified using a 2-step reverse transcription-polymerase chain reaction analysis. Results: Previous studies have documented different characteristics of dartos tissue between patients with hypospadias and those without hypospadias. Some studies even suggest resection of the dartos tissue during hypospadias repair. However, this is the first study to compare the characteristics of ventral dartos tissue in patients with hypospadias based on its location along the penile shaft, suggesting potential differences between the distal and proximal locations. We have obtained ethical approval to conduct a prospective case-control study aimed at elucidating these differences in dartos tissue characteristics. The findings of the study are anticipated to be available by 2025. Conclusions: Differences in the characteristics of dartos fascia based on its location may require tailored surgical strategies. If the properties of distal dartos tissue closely mirror those of typical dartos tissue, the possibility of avoiding its excision during hypospadias surgery could be considered.