A modified method of dartos flap coverage of neourethra in the repair of hypospadias and urethrocutaneous fistula

Abstract

Background: Hypospadias is a common congenital anomaly and its repair has been characterised by constant evolution. Urethrocutaneous fistula (UCF) formation remained the most common complication of hypospadias repair the occurrence of which precludes one of the goals of hypospadias surgery. Aim: To assess the modification of interposing layer of dartos flap coverage in hypospadias and UCF repairs in the prevention of UCF. Materials and Methods: In this retrospective review, 11 cases of hypospadias and UCF were repaired with our modification of dartos flap interposition from January 2010 to December 2013. The medical records were retrospectively reviewed to determine the clinical presentation, the age at surgery, the position of meatus and UCF, history of previous repair and the surgical outcomes. Results: The ages range from 1 to 25 years with a mean age of 8.36 years. Eight patients had repair of hypospadias, two patients had repair of post-circumcision UCF and a patient had repair of congenital UCF (CUCF). All the patients with hypospadias had tabularised incised plate urethroplasty except two of them who had staged repair with buccal mucosa graft reconstruction. Those with post-circumcision UCF and CUCF had incised plate plus simple closure. All the patients had our modified interposing layer of dartos flap incorporated. The outcomes were satisfactory in nine patients, one patient had glanular dehiscence and another one had complete dehiscence of the wound. Conclusion: This modification of dartos flap interposition can be added to the various surgical armamentariums in the management of these patients.