Dorsal Dartos Research Articles

Editorial Comment on "The effectiveness of double dorsal dartos flap for urethroplasty coverage in distal hypospadias repair: A single surgeon approach to preventing urethrocutaneous fistula".

Editorial Comment on "The effectiveness of double dorsal dartos flap for urethroplasty coverage in distal hypospadias repair: A single surgeon approach to preventing urethrocutaneous fistula".

Is The Dorsal Dartos Flap Rotation Technique Successful in Children with Isolated Penile Torsion?

Penile torsion is a counterclockwise rotational anomaly of the penile shaft or glans. We aimed to evaluate the results of dorsal dartos flap rotation technique in children with isolated penile torsion. 5470 boys who applied to our clinic between 2012 and 2022 for circumcision were evaluated for congenital isolated penile torsion. They were classified according to the degree and direction of torsion and clinical findings were analyzed. According to the degree of torsion, penile degloving or dorsal dartos flap rotation technique with circumcision was performed. Patients whose torsion corrected after penile degloving were excluded from the study. The results of dorsal dartos flap rotation technique were evaluated. Results: Congenital isolated penile torsion ≥60° was identified in 1.04 % (n=57) of the children. Eight patients whose torsion corrected after penile degloving were excluded from the study. 49 patients who underwent dorsal dartos flap rotation had a mean age of 4.94 years (1-9) and a mean operation time of 29.9 min (20-40). The mean degree of torsion was 77.6° (60-110). The mean operation times in the < 90° and ≥ 90° dorsal dartos flap groups were statistically significant (p<0.05). Residual torsion was statistically significant in the < 90° and ≥ 90° dorsal dartos flap groups (p<0.05). At the postoperative 1st and 6th month follow-ups, torsion less than 10 degrees was observed in 3 patients who underwent dorsal dartos flap rotation technique. No residual torsion was observed in other patients. Isolated penile torsion cases should not be overlooked during circumcision. It seems possible to obtain successful results with dorsal dartos flap rotation in moderate and severe torsions.

Result of simple versus layered repair of urethro-cutaneous fistula developing after hypospadias surgery

Background: Urethro-cutaneous fistula (UCF) after hypospadias surgery occurs regardless of the location of the meatus, procedure performed or experience of the surgeon. Hypospadias repair continues to be a singularly demanding form of surgical expression with considerable artistic latitude. The commonest complication of hypospadias surgery is fistula formation, which almost always requires repeat and similarly demanding surgery. Aims and Objectives: The aim of our study was to compare the result between simple and layered repair of UCF developing after hypospadias surgery. Materials and Methods: This comparative type of study was carried out in the Department of Paediatric Surgery, BSMMU, Dhaka from June 2015 to August 2016 for a period of 15 (fifteen) months. Forty (40) diagnosed cases of UCF were included in the study. All the participants were randomized into two groups named Group A &amp; Group B. Group A was assigned to the simple repair technique &amp; Group B was assigned to the layered repair technique. Relevant data were collected in a predesigned questionnaire. Results: The recurrent fistula formation rate was much higher in Group A (30%) than in Group B (05%), which was statistically significant in between the two groups. The majority of the fistulae recurred within a few days of the removal of the stent (from 7th to 10th POD). 6, out of 7 recurrent UCF were observed in this period. No recurrent fistula was observed beyond 4 weeks after operation. Conclusions: This study revealed that, the layered repair technique, with the addition of vascularized dorsal dartos fascia reduces the recurrent fistula formation rate in a significant number. Though more time consuming and technically difficult, we recommend wide application of layered repair technique in the management of post hypospadias UCF. Journal of Paediatric Surgeons of Bangladesh (2019) Vol. 10 (1 &amp; 2): 37-42

Evaluation of Tubularized Incised Plate Urethroplasty with Spongioplasty-Dartosoraphy Reinforcement in Pediatric Hypospadias: A Randomized Controlled Study.

The original description of tubularized incised plate urethroplasty (TIPU) was provided by Snodgrass in 1994. The results were significantly improved by several modifications. To decrease the incidence of complications, interposing a vascularized flap after tubularization of the neourethra is recommended. The extent to which the type of interposed tissue has a direct effect on the rate of complications and cosmetic outcomes after TIPU repair is considered the answer to the main hypothesis of this study. This prospective controlled randomized trial was conducted in the Department of Pediatric Surgery, Al-Azhar University, Cairo, Egypt, between May 2019 and May 2023. A total of 220 patients were included in this study. Patients were randomly assigned to either group A or group B. Group A included 110 patients who underwent TIPU with spongioplasty-dartosoraphy reinforcement. The other 110 patients (group B) underwent TIPU with dorsal dartos flap interposition, without spongioplasty. Complications developed in 34 of 220 patients (15.4%). In group A, complications developed in 11 of 110 patients (10.0%). In group B, complications occurred in 23 of 110 patients (20.9%). Although the fistula rate, glanular dehiscence, disruption, and meatal stenosis were not significantly different between the study groups, the skin necrosis rate was significantly lower in group A than in group B. The overall complication rate was significantly lower in group A than in group B. Also, the difference in the mean Hypospadias Objective Scoring Evaluation between the two groups was statistically significant. TIPU with spongioplasty-dartosoraphy reinforcement is an effective modification of conventional TIPU. This modification appears to reduce the rate of complications and yield better cosmetic outcomes.

PENILE TORSION OF A TWO-YEAR-OLD BOY: A CASE REPORT

Objective: This case report presented Penile Torsion in pediatrics. Case(s) Presentation: A two-year-old boy with a chief complaint of rotated penile to the right side since birth. There were 45º in clockwise torsion, slight chordee, and uncircumcised. Patient underwent penile reconstruction surgery, including penile degloving, urethral mobilization, and plication. After seven days follow-up, parents were satisfied with straight penile erection and no torsion at all. After 3 months follow-up, parents reported satisfaction with the surgical outcome such as cosmetic appearance, straight erection, and normal stream urine. Discussion: Surgical techniques ranging from simple penile degloving with foreskin repositioning to more complex surgical procedure involving corporeal tissue. Surgery by using degloving of penile skin and realignment could be suitable for penile torsion &lt;90°. For the cases of &gt;90°, other techniques should be considered such as corporopexy procedure, rotation flap of dorsal dartos, or diagonal suturing of corporeal folds away from and parallel to the neurovascular bundle. Conclusion: Penile reconstruction surgery using penile degloving, urethral mobilization, and plication for penile torsion showed satisfaction result including cosmetic appearance, penile erection, and normal urine flow.&#x0D; Keywords: Chordee, penile reconstruction, penile torsion.

Analysis of The Curative Effect of Tubularized Incised Plate Urethroplasty for Distal Hypospadias With The Dysplastic Corpus Spongiosum Covering Technique.

To investigate the use of tubularized incised plate (TIP) urethroplasty for distal second- and third-degree hypospadias to free the dysplastic forked corpus spongiosum and Buck's fascia, which are used as a covering material for the new urethra, thereby reducing the incidence of urinary fistula and other complications in the coronal sulcus. Clinical data of 113 patients with distal hypospadias treated with TIP urethroplasty from January 2017 to December 2020 were retrospectively analyzed. The study group comprised 58 patients (use of dysplastic corpus spongiosum and Buck's fascia to cover the new urethra), and the control group comprised 55 patients (use of dorsal Dartos fascia to cover the new urethra). All children were followed up for more than 12 months. In the study group, 4 patients developed urinary fistulas, 4 developed a urethral stricture, and no case developed glans fissure. In the control group, 11 patients developed urinary fistulas, 2 developed a urethral stricture, 3 developed a glans cracking. Using the dysplastic corpus spongiosum to cover the new urethra increases the amount of tissue in the coronal sulcus and reduces the incidence of urethral fistula, but it may increase the incidence of urethral stricture.

To Compare the Outcomes of Dorsal Dartos Flap, Tunica Vaginalis Flap and Durham Smith De-Epithelialized Dartos Based Flap as Secondary Interposition Cover after Tubularized Incised Plate Urethroplasty in Reducing Post-Operative Complications

Interposition flaps are mainstay in the success of hypospadias surgery because they lead to decrease in complications of hypospadias repair significantly especially urethrocutaneous fistula by buttressing the neo urethral suture line. Many interposition flaps have been tried with varying outcome results. Most commonly used interposition flaps are Tunica vaginalis flap and dorsal dartos flap however, recently interest have also researched in Durham smith de-epithelialized dartos based overlay flap. Though there are many publications comparing outcome of dorsal dartos and tunica vaginalis flap but hardly any study that has compared all three interposition flaps. So, we aimed to compare the outcomes of dorsal dartos flap (DF), tunica vaginalis flap (TVF) and Durham smith de-epithelialized dartos based overlay flap as interposition layer in TIP urethroplasty. Aim: To compare the outcomes of dorsal dartos flap (DF), tunica vaginalis flap (TVF) and Durham smith de-epithelialized dartos based flap as secondary interposition cover after Tubularized incised plate urethroplastyin reducing post-operative complication. Materials and Methods: A retrospective study was conducted in which case records of 78 patients who had undergone repair for distal and midpenile hypospadias with minimal chordee and favorable anatomy by the Tubularized incised plate urethroplasty with interposition flap over 2 years (2017-2019) were reviewed. Patients were divided in three groups with 26 subjects in each group. Group A consisted of patients with dorsal dartos interposition flap, Group B comprised of patients with Tunica vaginalis interposition flap and Group C consisted of patients with Durham smith deepithelialized dartos based overlay cover. Outcome variables noted were the complications including wound dehiscence, Urethrocutaneous fistula, Meatal stenosis, Penile torsion, skin necrosis and preputial edema. Statistical methods were applied to compare these complications in all three groups.

To Compare the Outcomes of Dartos Flap and Tunica Vaginalis Flap as Secondary Cover after Second Stage Durham Smith Repair in Reducing Post-Operative Complications

Background: Interposition flaps are mainstay in the success of hypospadias surgery because they lead to decrease in complications of hypospadias repair significantly especially urethrocutaneous fistula by buttressing the neo urethral suture line. Many interposition flaps have been tried with varying outcome results. Most commonly used interposition flaps are Tunica vaginalis flap and dorsal dartos flap however, recently interest have also researched in Durham smith de-epithelialized dartos based overlay flap. Though there are many publications comparing outcome of dorsal dartos and tunica vaginalis flap but hardly any study that has compared all three interposition flaps. So, we aimed to compare the outcomes of dorsal dartos flap (DF), tunica vaginalis flap (TVF) and Durham smith de-epithelialized dartos based overlay flap as interposition layer in TIP urethroplasty. Aim: To compare the outcomes of dorsal dartos flap (DF), tunica vaginalis flap (TVF) and Durham smith de-epithelialized dartos based flap as secondary interposition cover after Tubularized incised plate urethroplastyin reducing post-operative complication. Materials and Methods: A retrospective study was conducted in which case records of 78 patients who had undergone repair for distal and midpenile hypospadias with minimal chordee and favorable anatomy by the Tubularized incised plate urethroplasty with interposition flap over 2 years (2017-2019) were reviewed. Patients were divided in three groups with 26 subjects in each group. Group A consisted of patients with dorsal dartos interposition flap, Group B comprised of patients with Tunica vaginalis interposition flap and Group C consisted of patients with Durham smith deepithelialized dartos based overlay cover. Outcome variables noted were the complications including wound dehiscence, Urethrocutaneous fistula, Meatal stenosis, Penile torsion, skin necrosis and preputial edema. Statistical methods were applied to compare these complications in all three groups. Results: Total number of complications in group A were 11(42.3%) and most common complications were skin necrosis (n=7, 26.9%) and urethrocutaneous fistula (n=6, 23.1%). Total number of complications in group B were 7(26.9%) while Chordee and preputial edema (n=6, 23.1% each) were among the most common complications. 9(34.6%) patients developed complications in group C and most common complications were penile torsion (n=6, 23.1%) and urethrocutaneous fistula (n=4, 15.4%). Conclusion: We have seen in our study that TV flap is a good option as second cover with lesser complications especially in terms of fistula related complications while Durham smith onlay cover found to be equally better option as it showed no skin complications and other complications were almost comparable to TV flap cover.

Dorsal Versus Ventral Dartos Flap to Prevent Fistula Formation in Tubularized Incised Plate Urethroplasty for Hypospadias.

The purpose of this study is to evaluate the results of two different flap procedures for prevention of urethrocutaneous fistula in hypospadias patients undergoing tubularized incised plate urethroplasty . We retrospectively reviewed 89 patients who underwent hypospadias repair. The standard technique of tubularized incised plate urethroplasty was used. There were 45 patients in Group 1 and 44 patients in Group 2, in which ventral and dorsal dartos flaps were used to cover the neourethra respectively. Surgical complications were assessed as the main outcomes. The results were analyzed with Chi-square and Mann-whitney u tests. There was no significiant difference between the groups in terms of age and meatus location. We observed postoperative surgical complications in 15 (33.3 %) patients in Group 1 and in 4 (9.1 %) patients in Group 2. The complications noted in the Group 1 were urethrocutaneous fistula in 10 patients ( 22.2 %) and meatal stenosis in 5 patients ( 11.1 %). In Group 2, fistula was observed in 2 patients (4.6 %) and stenosis in again 2 patients (4.6 %). Urethrocutaneous fistulas occurred statistically more frequently when ventral based dartos flaps were used (P < .05). Several flap procedures and their modifications have been suggested to avoid fistula formation. Within these procedures, dartos flaps are reported to be very useful for primary distal or proximal hypospadias repair and reoperations. In this study, we concluded that ; vascularized dorsal preputial dartos flap procedure is safe and more effective than ventral based flap in prevention of fistula formation.

Dorsal Dartos Flap Prepared Before Urethroplasty, Less Bleeding of Operation: A New Perspective on Hypospadias.

The benefits of preparing the dorsal dartos flap before urethroplasty were investigated. Patients with coronal, subcoronal, and distal penile hypopadias without severe cordee who underwent surgical repair between October 2016 and September 2020 were included in the study. Tubularized incised plate urethroplasty technique was applied to all patients. The patients were divided into two groups: In Group 1, the dorsal dartos flap was prepared after urethroplasty, which is the commonly used technique today, and sutured on the neourethra. In Group 2, the dorsal dartos flap was prepared before the post-degloving urethroplasty. The amount of bleeding, the duration of the surgery, and the complications between the two groups were recorded and compared. Twenty-two patients who could be followed up for at least 3 months were examined. There were 10 patients in Group 1 and 12 patients in Group 2. A statistically significant difference was found between the amount of bleeding of the operation in the two groups. Duration of operation, hematoma, infection, skin necrosis, or glanular dehiscence were not observed in any patient. Preparing the dorsal dartos flap, before urethroplasty significantly reduces the amount of bleeding. This may be a new modification alternative in hypospadias surgery.

Tubularized incised plate repair in 473 primary distal hypospadias cases: An evaluation of outcomes according to coverages and stent types

AimWe have previously employed the tubularized incised plate (TIP) repair technique in distal hypospadias cases with a few modifications because of its excellent cosmetic results. In this study, we aimed to evaluate the effects of spongioplasty and dorsal dartos flaps, in addition to short urethral stents on the outcomes of TIP repair. Materials and MethodsOnly distal hypospadias cases were involved in this study. Eligible patients were divided into two groups: group A included patients repaired with both spongioplasty and dorsal dartos flap placement, while group B included patients repaired with dorsal dartos flap placement alone. Group A was further divided into two subgroups according to the type of catheter used (bladder catheter or short urethral stent). ResultsA total of 473 patients were included in this study. There was no statistically significant difference observed in the complication rates between the two groups. In Group A, a bladder catheter was used in 107 patients and a short urethral stent was used in 135 patients. When the results of the two groups were compared, there was no statistically significant difference. ConclusionsSpongioplasty could be combined with dorsal dartos flap placement to reduce the need for dorsal plication rather than to reduce the fistula rate. Short urethral stents can be used safely with no postoperative effects in children who have completed toilet training.

Buried penis surgical treatment in children: Dorsal dartos flap VS. Fascia fixation. A retrospective cohort study

Several surgical techniques for buried penis (BP) treatment have been described, although there is not a reference pattern for it. In our institution, we have traditionally performed penis fixation to Buck's fascia at 3 points. In 2014 we introduced a dorsal dartos flap technique, fixed at both sides of the penis base. To compare both techniques and their long-term outcomes. A retrospective cohort study was conducted on consecutive patients with BP who underwent surgery between 2010 and 2018. They were divided according to surgical technique performed: group A (fascia fixation) and B (dorsal dartos flap). Demographic variables, surgical time and postoperative complications were analyzed. Long-term cosmetic outcomes were evaluated through a telephone survey to patients parents. Thirty-five patients were included (16 group A; 19 group B). Median age at intervention was 9.7 years in group A, with no statistical differences with group B (7.3 years; p=0.071). No statistically significant differences were observed in mean surgical time or postoperative complications between both groups. Cosmetic outcomes (Table 2) were significantly better in group B, which presented higher percentages of satisfaction with the outcomes (95% vs. 64%; p=0.02) and age at intervention (89% vs. 59%; p=0.032), higher perception of the procedure as "minimally invasive" (100% vs. 71%; p=0.013) and higher recommendation rate of the intervention (95% vs. 57%; p=0.029). Dorsal dartos flap is a reproducible, minimally invasive technique with minimal adverse effects and satisfactory long-term results. It has fewer postoperative complications and more satisfactory cosmetic results compared to fascia fixation.

Tubularización e incisión de la placa uretral para reparación de hipospadias distal primario en 473 casos: evaluación de los resultados según la cobertura y el tipo de sonda

AimWe have previously employed the tubularized incised plate (TIP) repair technique in distal hypospadias cases with a few modifications because of its excellent cosmetic results. In this study, we aimed to evaluate the effects of spongioplasty and dorsal dartos flaps, in addition to short urethral stents on the outcomes of TIP repair. Materials and methodsOnly distal hypospadias cases were involved in this study. Eligible patients were divided into two groups: group A included patients repaired with both spongioplasty and dorsal dartos flap placement, while group B included patients repaired with dorsal dartos flap placement alone. Group A was further divided into two subgroups according to the type of catheter used (bladder catheter or short urethral stent). ResultsA total of 473 patients were included in this study. There was no statistically significant difference observed in the complication rates between the two groups. In Group A, a bladder catheter was used in 107 patients and a short urethral stent was used in 135 patients. When the results of the two groups were compared, there was no statistically significant difference. ConclusionsSpongioplasty could be combined with dorsal dartos flap placement to reduce the need for dorsal plication rather than to reduce the fistula rate. Short urethral stents can be used safely with no postoperative effects in children who have completed toilet training.

Modified Snodgrass Repair for Hypospadias: Outcome at a General Surgical Unit

Background: Hypospadias occurs in around one in 200-300 male live births and is the most common congenital abnormality of the urethra. There are three characteristic features; Firstly the external meatus opens on the underside of the penis or the perineum, secondly the ventral aspect of the prepuce is poorly developed ('hooded prepuce') and thirdly there is usually a ventral deformity of the erect penis (chordee). Many methods have been used to repair hypospadias. We worked on Modified Snodgrass repair for mid-shaft and distal hypospadias in a General Surgical Unit. Objective: To study the outcome of Modified Snodgrass Repair with respect to outcome and post operative complications like fistulas, disruption, meatal stenosis, residual chordae ,penile torsion and infections.Material and Methods: All patients with hypospadias according to exclusion and inclusion criteria admitted to Surgical B unit of Saidu Teaching Hospital from 1st January 2015 to 21st December, 2019 were entered in the study. U shape incision was made around the urethral plate. Urethral incisions were extended to the mid-glans. Urethral plate was incised in center upto midglans. After tubularization of urethral plate and circumferential incision proximal to coronal sulcus from each edge of urethral plate, the penile skin was degloved upto or near to penoscrotal junction depending upon extent of chordee. Neourethra was formed and covered by Dorsal Dartos facial flap which was slit in the centre and brought out to ventral surface by passing the glans through the slit. The child was followed after a week to change dressing and after 10 days to remove catheter and then after one month and three months for checking complications and outcome.Results: Total of 100 subjects were included in study,(67%) having anterior and (43%) having middle hypospadias. Mean age was 3.7 years. Complications were recorded in 21% of patients. Urethro cutaneous fistula in 9%, Total disruption in 1%, Infections in 5%, Meatal stenosis in 2% ,Catheter blockage in 2% and penile torsion occurred in 2% of patients. 97% cases had good cosmetic shape. The fistulas were repaired after 6 months in two layers and had satisfactory results.Conclusion: A properly performed Modified Snodgross repair can be performed in General Surgical Unit with reasonable efficacy if expertise is available

Comparison Between Dorsal and Ventral Dartos Flap Interposition in A Tubularized Incised Plate Repair of Distal Hypospadias

Comparison Between Dorsal and Ventral Dartos Flap Interposition in A Tubularized Incised Plate Repair of Distal Hypospadias

Edges-On-Dartos: An Easy Way to Improve Graft Performance in Staged Hypospadias Repair

ObjectivesTo present a technical tip to be incorporated in the first stage of a 2-stage graft repair of proximal hypospadias associated with curvature, aiming at widening the graft bed and enhancing mobility of the lateral portions of the graft for subsequent urethroplasty. MethodsAfter penile straightening, the dorsal dartos layer, carefully preserved attached to the dorsal penile skin used for penile coverage, is anchored to the lateral edges of the denuded corpora cavernosa with 3 to 4 interrupted 6-0 resorbable stiches on each side. The dartos creates a sort of hammock in-between the corpora, on which the central portion of the graft is quilted as in standard staged graft repair, and the skin margins laterally. Therefore, it widens the graft bed by 3-4 mm on each side. The lateral portions of the graft, laying on dartos, also remain supple for subsequent tabularization. ResultsBetween 2017 and 2019, the technique was used in 16 cases (range 10-19 months). None of these patients required re-grafting because of severe longitudinal graft shrinkage. ConclusionThe described modification seems a simple tip to be incorporate in staged graft urethroplasty. Putative advantages include that a wider graft can compensate for some graft shrinkage occurring in-between stages; during the second stage, it can facilitate dissection and improve mobility of the lateral graft portions for tubularization, and make retrieval of a dartos flap for urethroplasty coverage easier. Prospective evaluation and comparative data are needed.

Application of Buck's fascia to restore the complete wrapping of the neourethra with corpus spongiosum in tubularized incised plate urethroplasty in hypospadias

The aim of this study was to evaluate the outcome and complication rate of Buck's fascia used as the third coverage layer of the neourethra to restore the complete wrapping of the neourethra with corpus spongiosum in TIP surgery. 140 patients with hypospadias in our hospital from March 2016 to March 2018 were prospectively studied. Age range 9-48 months. All patients underwent TIP surgery to repair hypospadias. In the surgery corpus spongiosum tissues were sutured as the second coverage layer of the neourethra. Patients were randomly divided into two groups: group A (with dorsal dartos flap as the third coverage layer) and group B (with Buck's fascia as the third coverage layer). Complication rates were compared between two groups. There was no significant difference in the composition ratio of hypospadias between groups A and B (P > 0.05). All patients were followed up for 1 year. The incidence of complications in group A: urethrocutaneous fistula (11%), meatal stenosis (1.4%), partial glans dehiscence (5%) and wound infection (1.4%). The incidence of complications in group B: urethrocutaneous fistula (2%), meatal stenosis (2%), partial glans dehiscence (0%) and wound infection (0%). The occurrence rates of urethrocutaneous fistula and partial glans dehiscence of two groups were statistically significant (P < 0.05). Buck's fascia is easily available, needs minimal dissection. It is well vascularized, thick and has good tensile strength. Buck's fascia used as the third coverage layer of the neourethra in TIP can restore the complete wrapping of the neourethra with corpus spongiosum and regain normal anatomical structure of corpus spongiosum and corpora cavernosa. It is simple and very effective to prevent urethrocutaneous fistula and partial glans dehiscence.

Dorsal double layer dartos flap in the Snodgrass technique of hypospadias repair: An experience in Dhaka Medical College Hospital

Introduction: Hypospadias is one of the most common congenital anomalies and more than 300 operation techniques have been described for primary hypospadias. The Snodgrass technique and its modification have become a preferred for all varieties of hypospadias in the past decade. However fistula is the most common of this technique. The aim of the study is to investigate the importance of double layer dartos flap to prevent fistula formation in the Snodgrass technique. Materials and Methods: It’s a retrospective study, among 52 patients aged 11 months to 144 months who underwent mid penile and distal hypospadias repair in the Snodgrass technique using dorsal dartos flap for neo-urethral coverage. This study was done in the Department of Pediatric Surgery in Dhaka Medical College &amp; Hospital from November 2014 to December 2016. Results: Urethrocutaneous (UC) fistula were encountered in 10 patients (19.23%), meatal stenosis in 3 patients (5.76%), partial glanular dehiscence in 1 patient and residual chordee in 1 patient. Conclusions: For preventing fistula formation, urethral covering by a well vascularized dorsal double layer dartos flap should be the important part of the Snodgrass technique. Journal of Paediatric Surgeons of Bangladesh (2017) Vol. 8 (2): 47-51

Median raphe deviation, association with hypospadias and clinical significance: A case report and literature review

Here, we present a case of hypospadias and median raphe deviation with literature review. A 4-yearold patient presented with subcoronal hypospadias and treated by using tubularized incised plate urethroplasty technique. Additionally, a longitudinal dorsal dartos flap was harvested and transposed to the ventral side by the buttonhole maneuver. The ventral view of the patient penis showed a 15 degree deviation to the right side of the center.

ONE STAGE CORRECTION OF CONGENITAL COMPLEX PENILE CURVATURE BY COMBINED MODIFIED NESBIT'S PROCEDURE WITH DORSAL DARTOS FLAP

Background: Congenital complex penile curvature (CCPC) is a rare deformity that arises from asymmetry of the corpora cavernosa. Congenital complex penile curvature has two abnormality components: torsion and curvature of the penis either ventral or dorsal. Objectives: Evaluation of one stage correction of CCPC by combination of modified Nesbit's procedure with dorsal dartos flap. Patients and Methods: This prospective study was conducted at Al-Azhar University Hospital in Damietta. Twenty eight patients with CCPC were evaluated and corrected during the period from October 2014 to September 2017. Their mean age was 5.5±2.1years (range 2–9.5 y). The direction of mal-rotation was anticlockwise in 23 patients and clockwise in 5 patients. Fifteen cases have ventral curvature; 8cases have dorsal curvature, while 5 cases have lateral curvature. All cases were treated firstly by modified Nesbit's procedure for correction of chordee, and then dorsal dartos flap was used for correction of penile mal-rotation in one stage. Results: All patients were corrected with high success rate. There were no more than 10° of residual mal-rotation or binding in all patients. One patient (3.57%) had penile hematoma that treated conservatively. All patients and their parents were satisfied with wonderful cosmetic and functional outcomes with no recurrent mal-rotation or binding. All cases were followed up for a mean follow up period of 9 ± 1.7 months (range 6 - 12 m.). Conclusion: Congenital complex penile curvature can be treated in one-stage surgery with excellent cosmetic and functional outcomes by combination of modified Nesbit's procedure with dorsal dartos flap.