Correction of Problematic Hypospadias with Dartos Fascia-Reinforced Flap and Slanted Incision of Fistula

Abstract

BackgroundHypospadias is the most common congenital malformation of the male urinary tract, wherein the urethral opening is located proximal to the normal site. Tubularized incised-plate urethroplasty reconstruction, and its efficacy, remains controversial due to the high recurrence rate. This study aimed to evaluate the results of dartos fascia-reinforced flap surgery in hypospadias patients with previous operative complications.MethodsNine patients (mean age, 12 years) who had previous one- or two-stage repair with TIP urethroplasty and suffered from urethrocutaneous fistulas or fissures as complications, underwent dartos fascia-reinforced flap surgery in our clinic between January 2010 and December 2012. The mean postoperative follow-up period was 6 months.ResultsAmong the 9 patients, 7 had complete correction. In all the patients, the maximum uroflow angle was >45°. No patient complained of an unnatural urinating position. The patients and parents gave very high satisfaction scores (4.7 points) with regard to the appearance of the outer genitalia.ConclusionThe dartos fascia-reinforced flap could be a useful and reliable option for complications of hypospadias repair or fissure with the prepuce preserved, given that histological aspects vary and that the possibility of recurrence in the glanular region is high.

Urethroplasty of extensive penile urethral strictures with a longitudinal ventral tubed flap of penile skin (modified Orandi urethroplasty): 20 years of follow-up of two cases

“…In strictures longer than 5 cm, corresponding to more than half of the total length of the penis [16], a fasciocutaneous flap using the dartos fascia [17,18] as a pedicle is most suitable.…”

Urethroplasty wıth the Use of a Turnover Flap for Correctıon of Problematıc Urethrocutaneous Fıstula: Report of a Case and Revıew of the Lıterature

“… 9 Choi et al tried to correct 9 cases with UF who had previous one- or two-stage repair with tubularized incised-plate urethroplasty (TIPU) and used dartos fascia-reinforced flaps. 10 They tubularized the plate and covered by dartos and prepuce. However, another group of plastic surgeons preferred to use scrotal septal flaps.…”

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

“… 13 To avoid this problem, others have suggested taking the dartos flap from both sides of the penis and double-breasting the flaps. 14 However, this has the potential to make an already complex and lengthy procedure even longer and may further compromise the blood supply to the overlying skin. 15 , 16 Although torsion can be avoided by transferring a dorsal dartos flap ventrally, using a button-hole technique, 17 it is impossible to reconstruct the prepuce once this has been done.…”