Snodgrass Hypospadias Repair with Vascularized Dartos Flap: The Perfect Repair for Virgin Cases of Hypospadias?

Abstract

This series represents the largest reported multi-institutional experience with the Snodgrass technique. When used in conjunction with vascularized dartos flap coverage, 2-layer closure of the neourethra and special attention to preservation of the periurethral vascular supply, this repair can be performed with a near 0 complication rate. We believe that this is the optimal repair for routine cases of hypospadias.

Interposition of dartos flaps to prevent fistula after tubularized incised-plate repair of hypospadias

“…To minimize the fistula rate, several procedures have been described, i.e. tunica vaginalis used as a blanket to wrap the urethra [1], or spongial tissue as an intermediate layer in urethral coverage [2], and a two-layer closure of the neourethra in conjunction with a vascularized dartos flap [3]. Retik et al [4] used a dorsal dartos flap to wrap the neourethra after a meatal-based flap hypospadias repair.…”

Feasibility of a tubularised incised-plate urethroplasty with double de-epithelised dartos flaps in a failed hypospadias repair: A preliminary report

“…[12][13][14] A well-vascularised adjacent tissue, such as a dartos flap, significantly decreases fistula formation. [2,3,6,[8][9][10][11][12][13][14] Several operative procedures have been reported in literature to decrease the incidence of the complications. [9][10][11][12][13][14][15][16][17][18][19] Authors have reported the use of dorsal subcutaneous preputial flaps, ventral subcutaneous flaps, dartos flaps, external spermatic fascia flaps, spongioplasty, tunica vaginalis and scrotal dartos flaps.…”

“…[2,3,6,[8][9][10][11][12][13][14] Several operative procedures have been reported in literature to decrease the incidence of the complications. [9][10][11][12][13][14][15][16][17][18][19] Authors have reported the use of dorsal subcutaneous preputial flaps, ventral subcutaneous flaps, dartos flaps, external spermatic fascia flaps, spongioplasty, tunica vaginalis and scrotal dartos flaps. [9][10][11][12][13][14][15][16][17][18] Although Telfer et al and Borer et al reported that using a protective intermediate layer reduced the fistula rate from 63% to 4.5%, [19] some researchers reported high fistula rates despite the use of a single dartos flap as a barrier layer.…”

“…[9][10][11][12][13][14][15][16][17][18][19] Authors have reported the use of dorsal subcutaneous preputial flaps, ventral subcutaneous flaps, dartos flaps, external spermatic fascia flaps, spongioplasty, tunica vaginalis and scrotal dartos flaps. [9][10][11][12][13][14][15][16][17][18] Although Telfer et al and Borer et al reported that using a protective intermediate layer reduced the fistula rate from 63% to 4.5%, [19] some researchers reported high fistula rates despite the use of a single dartos flap as a barrier layer. [3,7,10] Recently, in a study done by Yigiter et al, the authors compared the complication rates of the flapless, single flap, double flaps and procedures in TIPU, and reported a 29.4%, 26% and 0.1% incidence of fistulas, respectively.…”

“…[7] The dartos flap placement over the neourethra in a TIPU procedure reduces the incidence of postoperative urethrocutaneous fistulas even when using a single dartos flap However, the urethrocutaneous fistula rate could not quite be reduced to zero, and varying degrees of glanular torsion was often observed. [9][10][11][12][13][14][15] Authors previously described TIPU with double de-epithelised dartos flaps, in order to prevent fistula formation in primary cases. [13,14] We have been able to decrease high fistula rate to almost zero in primary hypospadias repairs using double dartos flaps.…”