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Multicentric experience on double dartos flap protection in tubularized incised plate urethroplasty for distal and midpenile hypospadias

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Abstract

Purpose

We report a multicenter experience using double dartos flap to protect the neourethra in TIP urethroplasty for distal and midpenile hypospadias.

Methods

A total of 394 patients underwent tubularized incised plate urethroplasty for primary distal and midpenile hypospadias using double dartos flap protection by ten pediatric surgeons and urologists at five different institutions.

Results

Tubularized incised plate urethroplasty protected by a double dartos flap was simple to perform and flaps were easy to obtain. Complications occurred in 23 patients (5.83%): fistulas 1.01% (4 cases), stenosis 0.25% (1 case), mild stenosis 2.53% (10 cases), dehiscence of ventral cutis 0.50% (2 cases) and penile torsion 1.26% (5 cases). All fistulae had a spontaneous resolution.

Conclusion

Double dartos flap to protect tubularized incised plate urethroplasty is safe with a low complication rate. The neourethra is covered entirely with a double layer of vascularized tissue and the double coverage appears a good choice for preventing urethrocutaneous fistula formation.

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References

  1. Snodgrass W (1994) Tubularized, incised plate urethroplasty for distal hypospadias. J Urol 151:464–465

    PubMed  CAS  Google Scholar 

  2. Retik AB, Mandell J, Bauer SB et al (1994) Meatal based hypospadias repair with the use of a dorsal subcutaneous flap to prevent urethrocutaneous fistula. J Urol 152:1229–1231

    PubMed  CAS  Google Scholar 

  3. Sozubir S, Snodgrass W (2003) A new algorithm for primary hypospadias repair based on tip urethroplasty. J Pediatr Surg 38:1157–1161

    Article  PubMed  Google Scholar 

  4. Snodgrass WT (2005) Snodgrass technique for hypospadias repair. BJU Int 95:683–693

    Article  PubMed  Google Scholar 

  5. Sugarman ID, Trevett J, Malone PS (1999) Tubularization of the incised urethral plate (Snodgrass procedure) for primary hypospadias surgery. BJU Int 83:88–90

    Article  PubMed  CAS  Google Scholar 

  6. Guralnick ML, al-Shammari A, Williot PE et al (2000) Outcome of hypospadias repair using the tubularized, incised plate urethroplasty. Can J Urol 7:986–991

    PubMed  CAS  Google Scholar 

  7. Kamal BA (2005) Double dartos flaps in tubularized incised plate hypospadias repair. Urology 66:1095–1098

    Article  PubMed  Google Scholar 

  8. Bakan V, Yildiz A (2007) Dorsal double-layer dartos flap for preventing fistulae formation in the Snodgrass technique. Urol Int 78:241–244

    Article  PubMed  Google Scholar 

  9. Mustafa M, Wadie BS, Abol-Enein H (2008) Standard Snodgrass technique in conjunction with double-layer covering of the neourethra with dorsal dartos flap is the therapy of first choice for hypospadias. Int Urol Nephrol 40:573–576

    Article  PubMed  Google Scholar 

  10. Appignani A, Prestipino M, Bertozzi M et al (2009) Double-cross flap protection: new technique for coverage of neourethra in hypospadias repair. J Urol 182:1521–1527

    Article  PubMed  Google Scholar 

  11. Erol A, Kayikci A, Memik O et al (2009) Single vs double dartos interposition flaps in preventing urethrocutaneous fistula after tubularized incised plate urethroplasty in primary distal hypospadias: a prospective randomized study. Urol Int 83:354–358

    Article  PubMed  Google Scholar 

  12. Abolyosr A (2010) Snodgrass hypospadias repair with onlay overlapping double layered dorsal dartos flap without urethrocutaneous fistula: experience of 156 cases. J Pediatr Urol 6:403–407

    Article  PubMed  Google Scholar 

  13. Yiğiter M, Yildiz A, Oral A et al (2010) A comparative study to evaluate the effect of double dartos flaps in primary hypospadias repair: no fistula anymore. Int Urol Nephrol 42:985–990

    Article  PubMed  Google Scholar 

  14. El-Sherbiny MT, Hafez AT, Dawaba MS et al (2004) Comprehensive analysis of tubularized incised-plate urethroplasty in primary and re-operative hypospadias. BJU Int 93:1057–1061

    Article  PubMed  CAS  Google Scholar 

  15. Djordjevic ML, Perovic SV, Slavkovic Z et al (2006) Longitudinal dorsal dartos flap for prevention of fistula after a Snodgrass hypospadias procedure. Eur Urol 50:53–57

    Article  PubMed  Google Scholar 

  16. Baccala AA Jr, Ross J, Detore N et al (2005) Modified tubularized incised plate urethroplasty (Snodgrass) procedure for hypospadias repair. Urology 66:1305–1306

    Article  PubMed  Google Scholar 

  17. Hayashi Y, Kojima Y, Kurokawa S et al (2005) Scrotal dartos flap for the prevention of the urethrocutaneous fistula on hypospadias urethroplasty. Int J Urol 12:280–283

    Article  PubMed  Google Scholar 

  18. Holland AJA, Smith GHH (2000) Effect of the depth and width of the urethral plate on tubularized incised plate urethroplasty. J Urol 164:489–491

    Article  PubMed  CAS  Google Scholar 

  19. Elbakry A (1999) Tubularized-incised urethral plate urethroplasty: is regular dilatation necessary for success? BJU Int 84:683–688

    Article  PubMed  CAS  Google Scholar 

  20. Chatterjee US, Mandal MK, Basu S et al (2004) Comparative study of dartos fascia and tunica vaginalis pedicle wrap for the tubularized incised plate in primary hypospadias repair. BJU Int 94:1102–1104

    Article  PubMed  Google Scholar 

  21. Soygur T, Arikan N, Zumrutbas AE et al (2005) Snodgrass hypospadias repair with ventral based dartos flap in combination with mucosal collars. Eur Urol 47:879–884

    Article  PubMed  Google Scholar 

  22. Yamataka A, Ando K, Lane GJ et al (1998) Pedicled external spermatic fascia flap for urethroplasty in hypospadias and closure of urethrocutaneous fistula. J Pediatr Surg 33:1788–1789

    Article  PubMed  CAS  Google Scholar 

  23. Snodgrass WT (2002) Tubularized incised plate (TIP) hypospadias repair. Urol Clin North Am 29:285–290

    Article  PubMed  Google Scholar 

  24. Djordjevic ML, Perovic SV, Vukadinovic VM (2005) Dorsal dartos flap for preventing fistula in the Snodgrass hypospadias repair. BJU Int 95:1303–1309

    Article  PubMed  Google Scholar 

  25. Baskin LS, Duckett JW (1994) Dorsal tunica albuginea plication for hypospadias curvature. J Urol 151:1668–1671

    PubMed  CAS  Google Scholar 

  26. Snodgrass W, Yucel S (2007) Tubularized incised plate for mid shaft and proximal hypospadias repair. J Urol 177:698–702

    Article  PubMed  Google Scholar 

  27. Lorenzo AJ, Snodgrass WT (2002) Regular dilatation is unnecessary after tubularized incised-plate hypospadias repair. BJU Int 89:94–97

    Article  PubMed  CAS  Google Scholar 

  28. Stehr M, Lehner M, Schuster T et al (2005) Tubularized incised plate (TIP) urethroplasty (Snodgrass) in primary hypospadias repair. Eur J Pediatr Surg 15:420–424

    Article  PubMed  CAS  Google Scholar 

  29. Snodgrass W (1999) Does tubularized incised plate hypospadias repair create neourethral strictures? J Urol 162:1159–1161

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

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Authors and Affiliations

  1. S. C. di Clinica Chirurgica Pediatrica, Ospedale S. Maria della Misericordia, Università degli Studi di Perugia, 06100 S. Andrea delle Fratte, Perugia, Italy

    M. Bertozzi, M. Prestipino, N. Nardi & A. Appignani

  2. Paediatric Surgery Department, Şişli Etfal Training and Research Hospital, Istanbul, Turkey

    A. Yıldız

  3. Department of Urology, Dammam University, Dammam, Saudi Arabia

    B. Kamal & H. Al-Darawany

  4. Urology Department, Rafidia Teaching Hospital, An-najah University School of Medicine, Nablus, West-Bank, Palestine

    M. Mustafa

  5. Department of Pediatric Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey

    M. Yiğiter & A. Oral

Authors
  1. M. Bertozzi
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  2. A. Yıldız
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  3. B. Kamal
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  4. M. Mustafa
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  5. M. Prestipino
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  6. M. Yiğiter
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  7. H. Al-Darawany
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  8. A. Oral
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  9. N. Nardi
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  10. A. Appignani
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Corresponding author

Correspondence to M. Bertozzi.

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Bertozzi, M., Yıldız, A., Kamal, B. et al. Multicentric experience on double dartos flap protection in tubularized incised plate urethroplasty for distal and midpenile hypospadias. Pediatr Surg Int 27, 1331–1336 (2011). https://doi.org/10.1007/s00383-011-2978-1

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  • DOI: https://doi.org/10.1007/s00383-011-2978-1

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