title: Dorsal dartos flap for preventing fistula in the Snodgrass hypospadias repair.
abstract: OBJECTIVE
  To evaluate the importance of urethral covering using vascularized dorsal subcutaneous tissue for preventing fistula in the Snodgrass hypospadias repair.
  
  
  METHODS
  The study included 67 children (aged 1-11 years) who had hypospadias repaired between April 1998 and May 2003, including 51 with distal and 16 with midshaft hypospadias. In all children, a standard tubularized incised-plate urethroplasty was followed by reconstruction of new surrounding urethral tissue. A longitudinal dartos flap was harvested from excessive dorsal preputial and penile hypospadiac skin, and transposed to the ventral side by a buttonhole manoeuvre; it was sutured to the glans wings around the neomeatus, and to the corpora cavernosa over the neourethra. Thus the neourethra was completely covered with well-vascularized subcutaneous tissue.
  
  
  RESULTS
  At a mean (range) follow-up of 21 (6-65) months, the result was successful, with no fistula or urethral stenosis, in all 67 children.
  
  
  CONCLUSIONS
  We suggest that urethral covering should be part of the Snodgrass procedure. A dorsal well-vascularized dartos flap, buttonholed ventrally, is a good choice for preventing fistula. Redundancy of the flap and its excellent vascularization depends on the harvesting technique.
authors.affiliation: Department of Urology, University Children's Hospital, Belgrade, Serbia. uromiros@eunet.yu
authors.forename: Miroslav L
authors.initials: ML
authors.lastname: Djordjevic
authors.forename: Sava V
authors.initials: SV
authors.lastname: Perovic
authors.forename: Vojkan M
authors.initials: VM
authors.lastname: Vukadinovic
mesh_terms: D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000517:prevention & control*; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D008297:Male; D013524:Surgical Flaps / Q000098:blood supply; D013536:Suture Techniques; D014521:Urethra / Q000601:surgery; D014522:Urethral Diseases / Q000517:prevention & control*; D014548:Urinary Fistula / Q000517:prevention & control*