Dorsal dartos flap for preventing fistula in the Snodgrass hypospadias repair.
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.
Djordjevic
Miroslav L
ML
Department of Urology, University Children's Hospital, Belgrade, Serbia. uromiros@eunet.yu
Perovic
Sava V
SV
Vukadinovic
Vojkan M
VM
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*