Comparison of dartos flap and dartos flap plus spongioplasty to prevent the formation of fistulae in the snodgrass technique

Bilici, Salim; Sekmenli, Tamer; Güneş, Mustafa; Geçit, İlhan; Bakan, Vedat; Isik, Daghan

doi:10.1007/s11255-011-9943-8

Cited by 28 publications

(18 citation statements)

References 25 publications

(52 reference statements)

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“…In the present study, postoperative fistulae were observed in 8.1% of group A cases in which an interpositional dartos flap was used and in 30.7% of group B cases with flapless coverage. Although that is comparable with recent reports, 27 however, in a larger series, 26% fistula rate was reported in single dartos coverage, whereas 29.4% fistula rate was reported in flapless repair, 10 denoting respective superior and similar outcomes of this study.…”

Section: Discussionsupporting

confidence: 91%

Inclusion and Exclusion Criteria to Overcome Bias and Reach a Valid Conclusion for Interpositional Flap Coverage in Primary Hypospadias Repair With Tubularized Incised Plate Urethroplasty

El-Shazly

2013

Annals of Plastic Surgery

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Flapless repair should not be tried as long as there is the needed experience to harvest a well-vascularized coverage. Interpositional flap coverage of the neourethra is crucial to decrease the rate of fistula in primary hypospadias TIPU repair. However, before designating a relative study, different forms of the anomaly, surgeon's experience, the potential harvesting complications, complexity degrees of different repairs, and the used surgical materials should be really considered.

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Section: Discussionsupporting

confidence: 91%

Inclusion and Exclusion Criteria to Overcome Bias and Reach a Valid Conclusion for Interpositional Flap Coverage in Primary Hypospadias Repair With Tubularized Incised Plate Urethroplasty

El-Shazly

2013

Annals of Plastic Surgery

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“…Bilici et al compared results of TIPU compared to the dartos flap alone and spongioplasty plus dorsal dartos flap and had (8%) higher fistula rate in the dorsal dartos alone group. They concluded that the use of the corpus spongiosum as an intermediate layer in urethral coverage, combined with the dartos flap, reduces the likelihood of fistula formation and can be applied easily and effectively [8]. In our series, results with spongioplasty alone were almost equivalent or better as compared to TIPU with spongioplasty plus a dartos cover.…”

Section: Discussionmentioning

confidence: 54%

“…Many methods have been described in the literature for the interposition of tissue to cover the neo-urethra beginning with transverse island dorsal subcutaneous flap, which was soon found to be unfavorable because of skin coverage problems and penile torsion [2]. Later various other methods included dorsal [3], lateral, single or double [4], dartos flaps, ventral based dartos flap [5] [6], scrotal dartos [7], de-epithelised local penile skin [2], preputial flap, paraurethral tissue [8], spongioplasty [9]- [17], or tunica vaginalis flaps [18] [19]. Out of all these, the dorsal dartos flap is used by most surgeons, but there is still no consensus over the ideal interposing tissue in TIPU.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Results of TIPU Repair for Hypospadias with “Spongioplasty Alone” and “Spongioplasty with Dorsal Dartos Flap”

Bhat¹,

Singla²,

Bhat³

et al. 2014

OJU

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Objective: The aim of our study was to compare the results of tubularized plate urethroplasty with interposing healthy tissue spongioplasty alone and spongioplasty with dorsal dartos flap to assess the role of dartos flap in prevention of fistulae. Patients and Methods: A retrospective study was performed on 80 patients, aged 4 months to 27 years who underwent hypospadias repair using the Snodgrass technique. The patients were assigned to two groups. In group I (40 patients) the neourethra was covered with spongioplasty only, and in group II (40 patients) the neourethra was covered with spongioplasty plus dartos flap. Integrity of the urethral plate was maintained in all the cases. The ventral curvature & torsion was corrected by penile de-gloving, mobilization of the urethral plate and spongiosum and mobilization of the proximal urethra if needed. The results were analysed in view of complication rates. The average period of hospital stay was 7 days & follow-up varied from 8 months to 28 months with a mean of 14 months. Results: In group I, hypospadias were distal penile in 31 (77.5%), mid-penile in 4 (10%) and proximal/peno-scrotal in 5 (12.5%) patients. In group II, hypospadias were distal penile in 17 (42.5%), mid penile in 9 (22.5%) and proximal/peno-scrotal in 14 (35%) patients. Sixty five percent in group I and 80% in group II had ventral curvature but the difference was not statistically significant. Good functional results were achieved in 97.5% patients in group I and in 95% patients in group II which were statistically similar (p value-0.585). Urethral fistula was encountered in 2.5% in group I & in 2 cases (5%) in group II. Meatal stenosis was noted in 7.5% each in both groups, which responded to urethral dilatation. One patient in group II had complete disruption. There was no statistically significant difference in early and late complications in both groups (p value-0.812). Conclusions: Spongioplasty with healthy spongiosal tissue is strong enough and is effective waterproofing as an * Corresponding author. A. Bhat et al. 42 interposition layer. However, more prospective studies in different hands are needed to omit the step of dorsal dartos interposition.

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“…23 In a series of 500 patients, Sarhan et al performed urethroplasty in Snodgrass technique using dartos flap, spongioplasty or a combination of both for neourethral coverage and observed a statistically significant decrease in fistula formation in patients in which spongioplasty was done in comparison with patients in which it was not done. 24 By using the spongiosal tissue in addition to dartos flap wrapping, Almodhen et al 25 and Bilici et al 26 did not observe fistula in any of the cases of 32 patients and 86 patients respectively. Bhat et al reported 2 fistulae in a series of 40 patients of TIP urethroplasty using spongioplasty in addition to dartos flap coverage.…”

Section: Discussionmentioning

confidence: 95%

Spongioplasty with Dartos Flap Coverage in the Snodgrass Technique of Hypospadias Repair

Das

Hasina

Huq

et al. 2020

J. Bangladesh Coll. Phys.

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Objective: The aim of the study is to evaluate the role of spongiosal tissue with dartos flap coverage for preventing Urethrocutaneous Fistula (UCF) formation in the Snodgrass technique. 19 patients, shallow in 13 patients and no groove noticed in 3 patients. Sixteen patients had narrow urethral plate (<8mm) and 19 patients had adequate urethral plate (>8mm). patients (14.28%), meatal stenosis in two patients (5.71%), and partial glanular dehiscence in one patient. Materials and Methods: It is a prospective study, performed on 35 patients of mid penile and distal hypospadias aged 15 months to 144 months who underwent urethroplasty in the Snodgrass technique using spongiosal tissue and dartos flap for neourethral coverage. Results: Among 35 patients, Age ranged from 15 months to 144 months (mean 85.94 months). Chordee was corrected by penile degloving alone in 11 patients, partial mobilization of urethral plate with spongiosum in 20 patients and 4 patients required dorsal plication. Glans groove was deep in Urethrocutaneous Fistula (UCF) was encountered in five Conclusions: Approximation of spongiosal tissue along with dartos flap as the intermediate layer for neourethral coverage reduces fistula formation.

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Comparison of dartos flap and dartos flap plus spongioplasty to prevent the formation of fistulae in the snodgrass technique

Abstract: The use of corpus spongiosum as an intermediate layer in urethral coverage, combined with the dartos flap, reduces the likelihood of fistula formation. This procedure can be applied easily and effectively to prevent the formation of fistulae.

Cited by 28 publications

References 25 publications

Inclusion and Exclusion Criteria to Overcome Bias and Reach a Valid Conclusion for Interpositional Flap Coverage in Primary Hypospadias Repair With Tubularized Incised Plate Urethroplasty

Inclusion and Exclusion Criteria to Overcome Bias and Reach a Valid Conclusion for Interpositional Flap Coverage in Primary Hypospadias Repair With Tubularized Incised Plate Urethroplasty

Comparison of Results of TIPU Repair for Hypospadias with “Spongioplasty Alone” and “Spongioplasty with Dorsal Dartos Flap”

Spongioplasty with Dartos Flap Coverage in the Snodgrass Technique of Hypospadias Repair

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