EVALUATION OF THE USE OF DORSAL DARTOS FLAP FOR THE PREVENTION OF FISTULA AFTER SNODGRASS REPAIR OF HYPOSPADIAS

Abstract

The Snodgrass technique or the tubularized incised plate (TIP) repair is considered as excellent option for treatment of distal and mid-shaft hypospadias. Urethro-cutaneous fistula remains the most frustrating complication of hypospadias repair. After performing a tubularized incised plate (TIP) repair, the incidence of fistulae is reported to be up to 17% of cases. This study aimed to evaluate the use of dorsal dartos flap for the prevention of fistula formation after Snodgrass repair for distal hypospadias. The current study included 35 patients aged 2-6 years during the period between February 2013 to January 2016. All the patients had distal hypospadias and underwent Snodgrass or TIP repair. The neo-urethra was covered by dorsal preputial interpositional flap transposed ventrally via a button hole maneuver as a method to prevent fistula formation. Patients were followed up and their complications were assessed based on the patients’ medical records. The procedure was completed successfully in all patients, with no intraoperative complications. All patients had good functional results with straight penis and vertical slit shaped meatus at the tip of the glans. Thirty four (97.14%) patients had no evidence of fistula development. One patient only (2.8%) developed fistula. Meatal stenosis occurred in 3 patients (8.5%). In conclusion, the neo-urethral covering with well-vascularized dartos flap, harvested dorsally and button holed at its base for ventral transposition, represents a good choice for fistula prevention after Snodgrass repair.