VID-01.03: Scrotal Septal Dartos Flap for Neourethral Coverage in Proximal Hypospadias Repair: A Technique to Minimize Urethrocutaneous Fistula

Surgical technique for midshaft hypospadias has evolved since the time of Horton and Devine. The most common type of repair that is currently used is the tubularized incised plate urethroplasty, which is a modification of the Thiersch-Duplay hypospadias repair. The authors review the steps of this procedure in detail and discuss troubleshooting for issues that may arise during the repair. Alternatives for chordee correction and skin coverage are reviewed. The authors briefly discuss outcomes and possible complications. In addition, there is a step-by-step video of a midshaft hypospadias repair that highlights the surgical technique. This review contains 9 figures, and 23 references. Key Words: chordee, dartos flap, hypospadias, midshaft hypospadias, surgical technique, tubularized incised plate (TIP), urethrocutaneous fistula, ventral curvature

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Dartos flap coverage of the neourethra following repair for primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas: it is a safe approach

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502010000200012 ◽

2010 ◽

Vol 25 (2) ◽

pp. 190-193 ◽

Cited By ~ 3

Author(s):

Hayrettin Ozturk

Keyword(s):

Redo Surgery ◽

Hypospadias Repair ◽

Urethrocutaneous Fistula ◽

Operative Results ◽

Flap Coverage ◽

Distal Shaft ◽

Dartos Flap ◽

Hypospadias Surgery ◽

Safe Approach ◽

Mathieu Procedure

PURPOSE: Urethrocutaneous fistula and neourethral dehiscence are frequently seen complications of hypospadias surgery requiring reoperation. In this study we report the experience of one surgeon with dartos flap coverage in primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas repair. METHODS: A total of 23 patients underwent hypospadias and urethrocutaneous fistulas repair from January 2006 to May 2009. Fourteen patients were operated on for primary hypospadias repair at our institution and 9 patients were admitted for hypospadias complications such as failed hypospadias repair and urethrocutaneous fistula. In all the patients, the dartos flap was dissected and transposed to cover the neourethra. Operative results were recorded. RESULTS: The primary surgical procedure was a one-stage repair in 61% (n = 14); tubularised incised plate (TIP) urethroplasty in 43% (n = 6) and a Mathieu procedure in 57% (n = 8). Urethrocutaneous fistulas complicating the previous initial hypospadias repair were anterior in 33% (n = 2), middle in 33% (n = 2) and proximal in 33% (n = 2). Repair of the fistula was successful on the first attempt in all patients. The reason for redo surgery in 3 patients was complete dehiscence and the patients had distal shaft hypospadias. CONCLUSION: Dartos flap coverage of the neourethra seems to be an effective method of reducing the fistulous complication rate following primary and secondary hypospadias repair.

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Spongioplasty with Dartos Flap Coverage in the Snodgrass Technique of Hypospadias Repair

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v38i2.45629 ◽

2020 ◽

Vol 38 (2) ◽

pp. 64-67

Author(s):

Sahadeb Kumar Das ◽

Kaniz Hasina ◽

Md Ashraf Ul Huq ◽

Syed Abdul Adil ◽

Md Mahbubul Alam ◽

...

Keyword(s):

Prospective Study ◽

Fistula Formation ◽

Hypospadias Repair ◽

Urethrocutaneous Fistula ◽

Urethral Plate ◽

Flap Coverage ◽

Dartos Flap ◽

Distal Hypospadias ◽

A Prospective Study

Objective: The aim of the study is to evaluate the role of spongiosal tissue with dartos flap coverage for preventing Urethrocutaneous Fistula (UCF) formation in the Snodgrass technique. Materials and Methods: It is a prospective study, performed on 35 patients of mid penile and distal hypospadias aged 15 months to 144 months who underwent urethroplasty in the Snodgrass technique using spongiosal tissue and dartos flap for neourethral coverage. Results: Among 35 patients, Age ranged from 15 months to 144 months (mean 85.94 months). Chordee was corrected by penile degloving alone in 11 patients, partial mobilization of urethral plate with spongiosum in 20 patients and 4 patients required dorsal plication. Glans groove was deep in 19 patients, shallow in 13 patients and no groove noticed in 3 patients. Sixteen patients had narrow urethral plate (<8mm) and 19 patients had adequate urethral plate (>8mm). Urethrocutaneous Fistula (UCF) was encountered in five patients (14.28%), meatal stenosis in two patients (5.71%), and partial glanular dehiscence in one patient. Conclusions: Approximation of spongiosal tissue along with dartos flap as the intermediate layer for neourethral coverage reduces fistula formation. J Bangladesh Coll Phys Surg 2020; 38(2): 64-67

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