The dartos flap as an adjunct in preventing urethrocutaneous fistulas in repeat hypospadias surgery.
OBJECTIVE
Vascularized flaps for repeat hypospadias repair are often limited. We report our experience with the dartos flap in children undergoing secondary hypospadias and complex urethral repair.


METHODS
The dartos flap is fibroadipose tissue between the scrotal skin and tunica vaginalis layers with its vascular pedicle based at the penoscrotal angle. The flap reaches the distal penile shaft without tension. Eight patients 1 to 17 years old (mean age 6) underwent urethral surgery and an interposed dartos flap procedure in 1994 to 1995.


RESULTS
Of 6 patients cosmesis was excellent in 84%, erections were straight in 100%, and urinary streams were of good quality and without fistula in 100% after repeat hypospadias surgery. Following staged repair for anterior urethral valves a urethrocutaneous fistula developed in 1 patient and following urethral duplication repair results were excellent in 1. Mean followup was 1 year.


CONCLUSIONS
The dartos flap is easy to mobilize and it provides excellent coverage for repeat proximal hypospadias surgery, since the dartos remains undisturbed. We endorse its use for complex urethral surgery and believe that the extra layer of closure helps to prevent urethrocutaneous fistulas.
Division of Urology, Hospital for Sick Children, Toronto, Ontario, Canada.
B M
BM
Churchill
J G
JG
van Savage
A E
AE
Khoury
G A
GA
McLorie
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000517:prevention & control*; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D012086:Reoperation; D013524:Surgical Flaps / Q000379:methods*; D014522:Urethral Diseases / Q000517:prevention & control*; D014548:Urinary Fistula / Q000517:prevention & control*