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

Elsayed ER, Zayed AM, El Sayed D, El Adl M - Arab J Urol (2011)

Bottom Line: 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.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).

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

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.

No MeSH data available.


Related in: MedlinePlus

(A and B) The dorsal dartos flap was divided in the midline into right and left halves.
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f0005: (A and B) The dorsal dartos flap was divided in the midline into right and left halves.

Mentions: For all patients, the dartos flap was harvested from the preputial and dorsal penile shaft. For group A the flap was transposed to the ventral aspect in a button-hole manner and fixed over the neourethra. For group B the neourethra was covered by double dartos flaps in an attempt to avoid fistula formation. The dorsal dartos flap was divided in the midline into right and left halves (Fig. 1). The right half was turned on the right side to the ventral aspect and the left half was turned on the left side to the ventral aspect. Both flap strips were overlapped and fanned out to reduce the bulk of the flap. Each flap strip was sutured to the contralateral recess of the raised glanular wing around the neomeatus, and to the corpora cavernosa over the neourethra. For all patients, the glanular wings were sutured over the flaps to create a conical glans with vertically orientated meatus. During surgery all patients received intravenous antibiotics (ampicillin and gentamicin), both then maintained for 3 days. A dressing was applied and changed 72 h after surgery, with subsequent dressings applied every other day. The urethral stent (6–8 F, according to the urethral diameter and patient age) was kept in place for 5–7 days after surgery.


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

Elsayed ER, Zayed AM, El Sayed D, El Adl M - Arab J Urol (2011)

(A and B) The dorsal dartos flap was divided in the midline into right and left halves.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150563&req=5

f0005: (A and B) The dorsal dartos flap was divided in the midline into right and left halves.
Mentions: For all patients, the dartos flap was harvested from the preputial and dorsal penile shaft. For group A the flap was transposed to the ventral aspect in a button-hole manner and fixed over the neourethra. For group B the neourethra was covered by double dartos flaps in an attempt to avoid fistula formation. The dorsal dartos flap was divided in the midline into right and left halves (Fig. 1). The right half was turned on the right side to the ventral aspect and the left half was turned on the left side to the ventral aspect. Both flap strips were overlapped and fanned out to reduce the bulk of the flap. Each flap strip was sutured to the contralateral recess of the raised glanular wing around the neomeatus, and to the corpora cavernosa over the neourethra. For all patients, the glanular wings were sutured over the flaps to create a conical glans with vertically orientated meatus. During surgery all patients received intravenous antibiotics (ampicillin and gentamicin), both then maintained for 3 days. A dressing was applied and changed 72 h after surgery, with subsequent dressings applied every other day. The urethral stent (6–8 F, according to the urethral diameter and patient age) was kept in place for 5–7 days after surgery.

Bottom Line: 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.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).

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

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.

No MeSH data available.


Related in: MedlinePlus