Longitudinal dorsal dartos flap for prevention of fistula after a snodgrass hypospadias procedure

The Snodgrass technique presents the procedure of choice for distal hypospadias. Fistula formation is the most common complication with various rates. We evaluated the importance of a urethral covering using vascularized dorsal subcutaneous tissue for fistula prevention. Our study included 126 patie...

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Bibliographic Details
Published in:	European urology Vol. 50; no. 1; pp. 53 - 57
Main Authors:	DJORDJEUIC, Miroslau L, PEROUIC, Saua V, SIAUKOUIC, Zoran, DJDKOVIC, Nenad
Format:	Journal Article
Language:	English
Published:	Oxford Elsevier 01-07-2006
Subjects:	Adolescent Biological and medical sciences Child Child, Preschool Fistula - prevention & control Follow-Up Studies Humans Hypospadias - surgery Infant Male Malformations of the urinary system Medical sciences Nephrology. Urinary tract diseases Surgical Flaps Urinary system involvement in other diseases. Miscellaneous Urinary tract. Prostate gland Urogenital Surgical Procedures - methods Nephrology Urinary system disease Urethral disease Methodology Hypospadias Fistula Urinary tract disease Urology Prevention Treatment Malformation Dartos Surgery Procedure Technique Flap (surgery)
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Summary:	The Snodgrass technique presents the procedure of choice for distal hypospadias. Fistula formation is the most common complication with various rates. We evaluated the importance of a urethral covering using vascularized dorsal subcutaneous tissue for fistula prevention. Our study included 126 patients, aged 10 months to 16 years, who underwent hypospadias repair from April 1998 through June 2005. Of the patients, 89 had distal, 30 had midshaft and 7 had penoscrotal hypospadias. All patients underwent standard tubularized incised plate urethroplasty, which was followed by reconstruction of new surrounding urethral tissue. A longitudinal dorsal dartos flap was harvested and transposed to the ventral side by the buttonhole manoeuvre. The flap was sutured to the glans and the corpora cavernosa to completely cover the neourethra with well-vascularized subcutaneous tissue. Mean follow-up was 32 (6-87) months. A successful result without fistula was achieved in all 126 patients. In six patients, temporary stenosis of the glandular urethra occurred and was solved by dilation. A urethral covering should be performed as part of the Snodgrass procedure. A dorsal well-vascularized dartos flap that is buttonholed ventrally represents a good choice for fistula prevention. Redundancy of the flap and its excellent vascularization depend on the harvesting technique.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0302-2838 1873-7560
DOI:	10.1016/j.eururo.2006.04.014