Preputial dartos reinforced Snodgrass tubularized incised plate urethroplasties in distal hypospadias

摘要

Purpose: The present study was carried out to evaluate the role of preputial dartos soft tissue reinforcement interposition flaps in prevention of persistent urethro-cutaneous fistulas (UCFs) in distal Snodgrass tubularised incised plate urethroplasties (STIPUs). Materials and Methods: During 2005 – 2007, 20 distal hypospadiacs (coronal n= 12, sub coronal n= 8) aged 12-20 years were subjected to STIPUs. After de-epithelialization of both sides of redundant dorsal preputial hoods, the resultant preputial dartos soft tissue flaps were ventralized (similar to Byars, n= 8; Nesbit, n= 8; and, double - breasting, n=4) to be interposed between the underlying neo – urethral tubes and the overlying skin covers. Results : All the three modifications of preputial dartos STRIFs functioned highly effectively and only two cases developed micro UCFs both of which healed spontaneously. Conclusion : Prepucial dartos reinforced flaps are ideal for distal hypospadiacs. Micro UCFs developing after routine use of STRIFs, tend to heal spontaneously. Introduction Urethro-cutaneous fistulas (UCFs) formation is the commonest complication of hypospadiac urethroplasties. Different soft tissue reinforcement interposition flaps (STRIFs) have been used to provide mechanical and biological support to neo-urethral tubes against fistulizations. 1,2,3,4 Patients and Technique During 2005-2007, 20 distal hypospadiacs (coronal n=12, sub coronal n=8) aged 15-20 years, were subjected to Snodgrass tubularized incised plate urethroplasties (STIPUs) and their repairs were reinforced using preputial dartos soft tissue reinforcement interposition flaps (STRIFs). The distal hypospadiacs were assessed for the presence of redundant dorsal preputial hood and the availability of enough mobile penile shaft skin to enable tension free circum - coronal closure after degloving of the penile shaft. The redundant preputial hood (Fig. 1) was de-epithelialized on both sides (inner skin and outer skin) up to the level of coronal sulcus to harvest preputial dartos soft tissue flap (Fig. 2).