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

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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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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A Comparative Study to Evaluate the Outcome of Double Dartos Flap in Tubularized Incised Plate Urethroplasty for Distal Hypospadias Repair

Journal of Paediatric Surgeons of Bangladesh ◽

10.3329/jpsb.v3i2.23915 ◽

2015 ◽

Vol 3 (2) ◽

pp. 65-70

Author(s):

Abhi Kumar Chakraborty ◽

Sajal Kumar Majumdar ◽

Mirza Kamrul Zahid ◽

Sayed Mahmudur Rahman ◽

Dipankar Kumar Saha ◽

...

Keyword(s):

Double Layer ◽

Fistula Formation ◽

Hypospadias Repair ◽

Tubularized Incised Plate ◽

Superficial Skin ◽

Group A ◽

Dartos Flap ◽

Tubularized Incised Plate Urethroplasty ◽

Distal Hypospadias ◽

Group B

Background/purpose: The tubularized incised plate urethroplasty (Snodgrass technique) presents the procedure of choice for distal hypospadias repair. Fistula formation is the most common complication with various rates. Avoiding overlap of suture lines in the Snodgrass repair is critical to minimize fistula formation through second-layer coverage of the neourethra. We compared the outcome of double- layer dartos flaps to flapless procedure in the tubularized incised plate urethroplasty for distal hypospadias repair to assess the effectiveness of dartos flap in this method.Methods: Our study included 28 patients aged upto 12 years who were treated with tubularized incised plate urethroplasty for distal hypospadias in Shaheed Suhrawardy Medical College Hospital from April 2010 to December 2011. They were divided into two groups. Group A (14 patients) had double dartos flap coverings. Group B (14 patients) had no dartos flap covering. The dissected dorsal dartos flap was bisected vertically to form two pedicle wings. Each wing was rotated laterally from either side of the glans to cover the neourethra ventrally in a double-layer fashion.Result: Mean follow up period was 9 months. In Group A, one patient (7%) developed fistula and one (7%) superficial skin necrosis. On the other hand three (21%) patients developed fistula and one patient (7%) meatal stenosis in group B, who were treated with Snodgrass procedure without using dartos flap. All successful repaired hypospadias patients of both groups had a cosmetically normal looking circumcised penis with ventrally slit meatus.Conclusions : Double dartos flaps covering of the neourethra is a simple procedure and could be effective for the prevention of urethrocutaneous fistula after tubularized incised plate urethroplasty.J. Paediatr. Surg. Bangladesh 3(2): 65-70, 2012 (July)

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THE ROLE OF WATERPROOFING LAYER IN SINGLE STAGE HYPOSPADIAS REPAIR: A PROSPECTIVE STUDY

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2014/3129 ◽

2014 ◽

Vol 3 (32) ◽

pp. 8818-8824

Author(s):

Kedarnath Arya ◽

Rajni Gautam ◽

Surya Prakash ◽

Monika Trivedi

Keyword(s):

Prospective Study ◽

Single Stage ◽

Hypospadias Repair ◽

A Prospective Study

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A Prospective Study of Outcomes After Tubularized Incised Plate (TIP) Urethroplasty: a Multivariable Analysis of Prognostic Factors in Children

10.1101/2020.09.15.20193037 ◽

2020 ◽

Author(s):

M. Reza Roshandel ◽

Fahimeh Kazemi Rashed ◽

Tannaz Aghaei Badr ◽

Samantha Salomon ◽

Mohammad Seyyed Ghahestani ◽

...

Keyword(s):

Prognostic Factors ◽

Young Children ◽

Prospective Study ◽

Multivariable Analysis ◽

Fistula Formation ◽

Hypospadias Repair ◽

Urethral Plate ◽

Tubularized Incised Plate ◽

Study Population ◽

The Impact

SummaryBackgroundTubularized incised plate (TIP) urethroplasty as the most common hypospadias repair method, aims to achieve normal functioning of the penis along with cosmetic reconstruction. However, there are remaining questions toward anatomical prognostic factors affecting the results of surgery. Lack of age-matched controls or controlling for meatal location, employment of several surgical techniques or multiple surgeons, or age heterogeneity of the study population are the problems affected the results of the current body of literature.ObjectiveThis prospective study aimed to evaluate the preoperative factors to predict future complications associated with hypospadias repair outcomes in males aged between 1-3 years and performed by a single surgeon with employing multivariable analysis.Patients and methodsA prospective cohort of 101 males aging from 1 to 3 years with distal to mid-shaft hypospadias were consecutively selected for TIP repair. The urethral plate dimensions in erect and flaccid states, penile length, glans diameter, and chordee were evaluated individually before reconstruction. After surgery and during follow-up visits, the subsequent transient and persistent complications were recorded.ResultsPostoperatively, the acute transient events were observed in 42 cases (41.6%) and the persistent complications in 16 cases (15.8%). The uncomplicated group had a higher percentage of patients with distal meatal location than the complicated group (P=0.01%). Furthermore, fistula formation was notably higher in the group with acute surgical site infection (P<0.001). wedThe analysis also shothe width of the urethral plate to be associated with the development of complications (P=0.03).ConclusionBy performing TIP by a single surgeon on a homogenous study population and eliminating the impact of severe chordee as a potential cofounding variable, this study prospectively found that out of the anatomical specifications, pre- and postoperative factors, the urethral meatus location was the only significant and independent predictor of the development of complications in young children with midshaft to distal hypospadias. Moreover we found that in young children the wider the plate was, the more complications happened. Consequently, we hypostatized that in young children who their anatomical dimensions are almost in same range of values, a combination of urethral width and depth should be considered in the investigation of prognostic factors for hypospadias repair outcomes. (figure 1)

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To Evaluate the Role of Vascularised Dorsal Dartos Flap in Snodgras Urethroplasty

Journal of Paediatric Surgeons of Bangladesh ◽

10.3329/jpsb.v2i1.15161 ◽

2013 ◽

Vol 2 (1) ◽

pp. 31-35

Author(s):

M Anisuzzaman ◽

MAB Akan ◽

R Ara ◽

MM Hasan ◽

MN Zaman ◽

...

Keyword(s):

Fistula Formation ◽

Urethrocutaneous Fistula ◽

Pedicle Flap ◽

Number Of Patients ◽

Postoperative Fistula ◽

Group A ◽

Dartos Flap ◽

Group B ◽

Interventional Group

Background: Hypospadias is a common congenital anomaly of male urethra. Surgical repair is the only treatment of this defect, but there is no single, universally acceptable technique for its repair . Snodgrass technique is now popular for its low complication rate, shorter operative time, vertically oriented slit like meatus and better cosmetic outcome. Objective: To evaluate the role of vascularized dorsal dartos pedicle flap over the neourethra in terms of postoperative urethrocutaneous fistula formation between two groups of patients of distal penile hypospadias. Methodology: Thirty two patients were included in this study. They were divided in group A and group B on the basis of serial number of patients. Snodgrass urethroplasty was done in group A considered as control and in group B, Snodgrass urethroplasty was done with additional dorsal dartos flap by buttonhole technique considered as interventional group. The outcome of both groups in terms of post operative urethrocutaneous fistula were evaluated. Results: In this study in group A, urethrocutaneous fistula developed in 6 patients out of 16 patients. Among the fistulas, 5 were situated at the coronal level and 1 at the hypospadiac meatus level. In group B, urethrocutaneous fistula developed in 1 patient out of 16 patients and the fistula occurred at the coronal level. In either group, all the fistulas are developed after removal of the catheter. In terms of post operative urethrocutaneous fistula formation in between the two groups, the results were statistically significant. Conclusion: Snodgrass urethroplasty with additional dorsal dartos flap by buttonhole technique have better outcome than without additional dorsal dartos flap in terms of postoperative fistula formation. DOI: http://dx.doi.org/10.3329/jpsb.v2i1.15161 Journal of Paediatric Surgeons of Bangladesh (2011) Vol. 2 (1): 31-35

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