Snodgrass Hypospadias Repair with Ventral Based Dartos Flap in Combination with Mucosal Collars

Soygür, Tarkan; Arıkan, Nihat; Zümrütbaş, Ali Ersin; Gülpınar, Ömer

doi:10.1016/j.eururo.2005.02.022

Cited by 36 publications

(33 citation statements)

References 15 publications

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“…In case of fistula formation, this vascular tissue promotes healing and majority of fistulae heal without requiring a redo surgery. Dartos flap can also be raised from the prepuce but it has poor blood supply and it and the associated skin can get necrosed [15,16]. Dartos flap to protect tubularized incised plate urethroplasty is safe with a low complication rate.…”

Section: Discussionmentioning

confidence: 99%

Ten Commandments of Hypospadias Surgery

Jawale¹

2017

JPNC

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Submit Manuscript | http://medcraveonline.com penile in 77(30%) and proximal Hypospadias in 46(18%) patients. Tubularized incised plate urethroplasty (TIP) by Dr. Warren Snodgrass and Byar's two stage urethroplasty were the only two basic methods applied. Only 13 patients (5%) of total required two stage repairs. Subsequent 10 years, I operated 512 cases of hypospadias with the Ten Commandments. Tubularized incised plate urethroplasty (TIP) Warren Snodgrass repair and Byar's two stage urethroplasty were the only two basic methods applied. Distal Hypospadias was found in 230(45%), Mid penile in 180(35%) and proximal Hypospadias in 102(20%) patients. Only 23 patients (4.5%) of total required two stage repair. Results:The results of Tubularized incised plate urethroplasty (TIP) Warren Snodgrass repair are as follows: fistula rate of 10 % and 21% respectively for distal and proximal hypospadias. Meatal Stenosis in 3% cases. No patient had urethral stricture and glanular dehiscence. No patient had a residual chordee. Complication of two staged urethroplasty are fistula rate 24%, meatal stenosis 3%, no patients had residual chordee and complete disruption. The two staged urethroplasties done with buccal mucosa as an onlay graft are very bad with 50-100 % failure, many centers have discontinued these repairs. Hence I did not perform any of these repairs in my series. The results of my series with 257 cases before the protocol(group A) were as follows: 33 patients (12.8%) developed meatal stenosis for which only one urethral dilatation under GA was required. 78 patients(30.35%) developed fistula and 18 of them closed spontaneously with conservative treatment and 60(23.34%) required fistula repair. Total complication rate was 66.5 % .The results of my series with 512 cases done with Ten Commandments (group B) were as follows: 17 patients (3%) developed meatal stenosis for which only one urethral dilatation under GA was required. Although 9 patients developed fistula 6 of them closed spontaneously with conservative treatment and only three required fistula repair (0.6%). Total complication rate was 3.6 %.No patient developed a urethral stricture. Incidance of meatal stenosis, fistula formation, fistula closure operation and total complication rate of group A was compared to group B and all the complications were found to be far less frequent in group B compared to group A and the difference was found to be statistically significant. The results of group B were compared to the series of Warren Snodgrass and Aseem Shukla who are the international authorities on the subject and have written a chapter on Hypospadias in paediatric urology text book Kelalis and King. They have a fistula rate of 10 % and 21% respectively for distal and proximal hypospadias which is 17 and 35 times higher than my series. Other international series on Hypospadias have more or less similar outcomes. III. Suprapubic diversion for three weeks. Healing takes about 3-4 weeks and removing urethral stent in one week time is too early. Urine flows in forc...

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Section: Discussionmentioning

confidence: 99%

Ten Commandments of Hypospadias Surgery

Jawale¹

2017

JPNC

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“…Ventral based dartos flaps also have used for the urethral covering. 11 Ventral skin can be poorly developed, so it is not available for creating sufficient ventral dartos flap always. Tunica vaginalis flap has been reported as a reinforcing layer of the neo-urethra, 17 although the fistula rate was zero.…”

Section: Discussionmentioning

confidence: 99%

“…Also, excessive back pressure due to distal obstruction can disrupt and reinforce repairs of good integrity for disruption. To decrease fistula rate, an additional tissue cover after neo-urethra, reconstruction have been described by many surgeons using transverse onlay dorsal subcutaneous flap, de-epithelialized skin flaps, 9 dorsal dartos flap, 10 ventral based dartos flap, 11,12 scrotal dartos, 13 spongioplasty, 14 or tunica vaginalis flap There is still no consensus over the ideal interposition tissue in TIPU. In the present study, the experience using a vascularized dartos flap after TIPU for distal and mid shaft hypospadias repair has been presented.…”

Section: Introductionmentioning

confidence: 99%

Vascularized dorsal dartos flap to prevent fistula in tubularized incised plate urethroplasty for primary distal and mid shaft hypospadias

Hossain

Hasan

Mondal

et al. 2016

Bangabandhu Sheikh Mujib Medical University Journal

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<p>The aim of the present study was to evaluate the importance of neourethral covering using vascularized dorsal flap for preventing fistula in Tabularized incised plate (TIP) urethroplasty. The study included 52 children (aged 2-10 years) who had hypospadias repaired including 44 with distal and 8 with mid shaft hypospadias. In all children, a standard tabularized incised plate urethroplasty was followed by reconstruction of new surrounding urethral tissue. A longitudinal dartos flap was harvested from excessive dorsal preputial and penile hypospadiac skin and transposed to ventral side by a buttonhole maneuver. It was sutured to the glans wings and the neomeatus and to the corpora covernosa over the neo-urethra. Thus the new urethra was completely covered with well-vascularzed subcutaneous tissue. At a mean follow-up of 18 months, the result was successful with no fistula or urethral stenosis, except 2 of the mid penile hypospadias. All patients had good functional and cosmetic results with straight penis and vertical slit shaped meatus at the tip of the penis. The 2 patients developed tiny fistula, which were closed spontaneously after meatal dilatation. In conclusion, urethral covering should be part of TIP urethroplasty. A dorsal well-vascularized dartos flap, button holed ventrally is a good choice for preventing fistula for distal and mid shaft hypospadias.</p><p> </p>

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“…Snodgrass hypospadias repair has been applied to virtually all forms of hypospadias, since 1994 [3]. Despite outstanding surgical outcome with this technique, there still exist some complications.…”

Section: Introductionmentioning

confidence: 99%