Interposition of dartos flaps to prevent fistula after tubularized incised-plate repair of hypospadias

Abstract

Objective: To evaluate the effect of urethral coverage by a single- or double-layered dorsal dartos flap after tubularized incised-plate (TIP) repair of hypospadias on fistula formation.Patients and methods: In this retrospective study we evaluated sequential patients with hypospadias who underwent TIP urethroplasty with a dorsal dartos interpositional flap between April 2008 and December 2009. We reviewed their medical records for the site of hypospadias, previous hypospadias repair, single- or double-layered dartos flap and postoperative complications. The patients were divided into two groups; in group A the urethra was covered by a single layer of dartos fascia, and in group B the urethra was covered by double layers of dartos flap.Results: Of 91 patients who opted for hypospadias repair during the time of the study, 62 had a TIP urethroplasty with a dorsal dartos flap; of these 62, three did not fulfil the requirement of the minimum follow-up, so 59 were eligible for the study (32 in group A and 27 in group B). Preoperative clinical data were comparable in both groups. At a mean of 12.2 months of follow-up, there was no reported fistula in group B, while two patients in group A developed a urethrocutaneous fistula (P = 0.19). Meatal stenosis occurred in two patients in group A and one in group B (P = 0.66).Conclusion: There was no significant difference in subsequent urethrocutaneous fistula between a double-layered dorsal dartos flap and single layer for covering the urethra as a part of TIP urethroplasty for repairing hypospadias.

Single vs. double layer suturing method repair of the urethral plate in the rabbit model of hypospadias

“…Djordjevic et al [25, 26] also reported no fistula formation with single-dartos flaps. However, other researchers did not get similar results and reported fistula rates of 13% [27] and 26% [22] using single-dartos flaps. As mentioned above, the most common complication of hypospadias repair is fistula, which can be prevented by placing a barrier layer between the neourethra and the overlying glans and shaft skin closures.…”

“…Appignani et al [20] reported that the double-dartos flaps had significantly lower rates of fistula formation. Most studies conducted on the issue, including those by Yigiter et al [21], Elsayed et al [22], and Erol et al [23], also indicated lower rates of fistula formation using double-dartos flaps, but the difference was not statistically significant. Bertozzi et al [24] performed a multicenter review of 394 cases of hypospadias repair covered with double-dartos flaps and reported fistulae in only four cases [1.01%].…”

Spongioplasty with Dartos Flap Coverage in the Snodgrass Technique of Hypospadias Repair

“…3,[14][15][16][17][18][19] On the other hand, Elsayed et al reported no significant difference in subsequent Urethrocutaneous Fistula (UCF) between a doublelayered dorsal dartos flap and single layer for covering the urethra as a part of TIP urethroplasty for repairing hypospadias. 20 Spongiosal tissue has been used by many surgeons to prevent fistula and other complications from its introduction in 2000 by Beaudoin 7 and Yerkes. 21 Yerkes et al noticed no fistula in any of the patients of spongioplasty in a different urethral repair technique.…”

Single vs. double dartos layers for preventing fistula in a tubularised incised-plate repair of distal hypospadias

“…Our results showed that the fistula rate was higher among urethroplasties covered with a single layer (8%) than with a double layer (none), although the difference was not statistically significant ( P = 0.1). Many other studies have compared a single and double dartos interposition flap after TIP urethroplasty ( Table 2 ) [15–21] .…”