Dorsal dartos flap for preventing fistula in the Snodgrass hypospadias repair

Abstract

There are three different topics covered in the paediatric urology section in this issue. Authors from Belgrade describe how a dorsal dartos flap can be used to prevent fistula in the Snodgrass hypospadias repair. The use of extracorporeal pelvic floor magnetic stimulation in children with voiding dysfunction is described by authors from Seoul. And finally, authors from Antalya write about the impact of the location of the ureteric orifice on the efficacy of endoscopic injection to correct VUR. OBJECTIVE To evaluate the importance of urethral covering using vascularized dorsal subcutaneous tissue for preventing fistula in the Snodgrass hypospadias repair. PATIENTS AND 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. CONCLUSION 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.