Abstract
Urethrocutaneous fistula and neourethral dehiscence are frequently seen complications of hypospadias surgery requiring reoperation. In this study we report the experience of one surgeon with dartos flap coverage in primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas repair. A total of 23 patients underwent hypospadias and urethrocutaneous fistulas repair from January 2006 to May 2009. Fourteen patients were operated on for primary hypospadias repair at our institution and 9 patients were admitted for hypospadias complications such as failed hypospadias repair and urethrocutaneous fistula. In all the patients, the dartos flap was dissected and transposed to cover the neourethra. Operative results were recorded. The primary surgical procedure was a one-stage repair in 61% (n = 14); tubularised incised plate (TIP) urethroplasty in 43% (n = 6) and a Mathieu procedure in 57% (n = 8). Urethrocutaneous fistulas complicating the previous initial hypospadias repair were anterior in 33% (n = 2), middle in 33% (n = 2) and proximal in 33% (n = 2). Repair of the fistula was successful on the first attempt in all patients. The reason for redo surgery in 3 patients was complete dehiscence and the patients had distal shaft hypospadias. Dartos flap coverage of the neourethra seems to be an effective method of reducing the fistulous complication rate following primary and secondary hypospadias repair.
Highlights
With an incidence of 1:300, hypospadias is one of the most common genital anomalies in male newborns[1,2]
In this study we report the experience of one surgeon on dartos flap coverage in primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas repair
Fourteen patients were operated on for primary hypospadias repair at our institution and 9 patients were admitted for hypospadias complications such as failed hypospadias repair and urethrocutaneous fistula (Figure 1)
Summary
With an incidence of 1:300, hypospadias is one of the most common genital anomalies in male newborns[1,2]. Hypospadias is defined as an anomaly (hypo- or dysplasia) involving the ventral aspect of the penis[2,3]. Despite the use of optical magnification, fine suture material and modern techniques, urethrocutaneous fistula or neourethral dehiscence was the most troublesome complication. These problems are the main difficulty in re-operations, because in these cases urethral reconstruction is required, but only a small amount of penile foreskin is available. In this study we report the experience of one surgeon on dartos flap coverage in primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas repair
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