Dartos flap coverage of the neourethra following repair for primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas: it is a safe approach

Abstract

Dartos flap coverage of the neourethra following repair for primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas. It is a safe approach 1Emprego de um retalho pediculado do músculo dartos para cobertura da neouretra na cirurgia primária de hipospádias, reoperações de hipospádias e correção de fístulas uretrocutâneas ABSTRACT 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. Key words: Hypospadias. Fistula. Surgical Flaps. Scrotum. RESUMO Objetivo:Fístulas uretrocutâneas e deiscências são complicações frequentes na cirurgia das hipospádias necessitando reoperações. Este estudo é baseado na experiência pessoal de um cirurgião utilizando um retalho pediculado do músculo dartos para cobertura da neouretra na correção primária de hipospádias, reoperações de hipospádias e correção de fístulas uretrocutâneas. Métodos: Vinte e três pacientes foram operados sendo 14 submetidos a cirurgia primária de hipospádia e 9 a reoperações por insucesso da correção primária ou por fístulas uretrocutâneas. Em todos os pacientes, um retalho pediculado do músculo dartos foi mobilizado e utilizado para recobrir a neouretra. Resultados: Para a cirurgia primária da hipospádia foi utilizada técnica de correção em um só tempo (n=14): uretroplastia tubularizada com incisão da placa (TIP) em 43% (n=6) e técnica de Mathieu em 57% (n=8). As fístulas uretrocutâneas resultantes de correções primárias anteriores eram de localização anterior em 33% (n=2), média em 33% (n=2) e proximal em 33% (n=2). A correção das fístulas uretrocutâneas resultou em sucesso em todos os pacientes. Três pacientes necessitaram de reoperação por deiscência ...

Outcome of Hypospadias Surgery in Children;

“…1,13 Through our learning curve, it was learnt that coverage of neo urethral tube with vascularised prepucial flap or dartos facial tissues or periurethral tissues in second layer covering the neo urethra after adequate mobilization of corpus spongiosum decrease the chances of fistula. 14,15 Though there is an increasing trend of operating posterior hypospadias in one stage but at our center we do staged repair in all proximal hypospadias with associated chordee considering that 2 staged is reliable and refined. Literature showed that there is not much difference in terms of outcome in expert hands but we experienced that it is a difficult task to release the ventral curvature and simultaneous urethroplasty along with coverage of skin.…”

Use of dCELL (Decellularized Human Dermis) in Repair of Urethrocutaneous Fistulas or Glans Dehiscence

“…1 ). 6 Therefore, use of a dartos flap follows the principle of a “belt and braces” approach to hypospadias surgery. 7 …”

Surgical Repair of Mid-shaft Hypospadias Using a Transverse Preputial Island Flap and Pedicled Dartos Flap Around Urethral Orifice

“…Most researchers agree that the protective cover layer on the neourethra is critical for reducing the risk of postoperative fistula [4]. Nominally, a dartos flap, a tunica vaginalis flap, or subcutaneous preputial tissue is used to cover the reconstructed urethra to reduce the incidence of postoperative fistula [5][6][7][8][9][10]. Seo et al reported that dartos flaps created from the ventral and basal surface of the penis are effective for covering and strengthening the reconstructed urethra and reduce the incidence of postoperative fistulae to 4.1 % [11].…”