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

  • A. K. M. Zahid Hossain Department of Pediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Kazi Nazrul Islam Avenue, Shahbag, Dhaka
  • Gazi Zahirul Hasan Department of Pediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Kazi Nazrul Islam Avenue, Shahbag, Dhaka
  • Susankar Kumar Mondal Department of Pediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Kazi Nazrul Islam Avenue, Shahbag, Dhaka
  • A. M. Shahinoor Department of Pediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Kazi Nazrul Islam Avenue, Shahbag, Dhaka
  • Md. Nooruzzaman Department of Pediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Kazi Nazrul Islam Avenue, Shahbag, Dhaka
  • Dinesh Prasad Koirala Department of Pediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Kazi Nazrul Islam Avenue, Shahbag, Dhaka
Keywords: Dorsal dartos, Fistula, Hypospadias, Tabularized incised plate urethroplasty, Vascular

Abstract

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.

 

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Published
2016-08-17
How to Cite
Hossain, A. K. M. Z., Hasan, G., Mondal, S., Shahinoor, A. M., Nooruzzaman, M., & Koirala, D. (2016). Vascularized dorsal dartos flap to prevent fistula in tubularized incised plate urethroplasty for primary distal and mid shaft hypospadias. Bangabandhu Sheikh Mujib Medical University Journal, 9(2), 88-91. https://doi.org/10.3329/bsmmuj.v9i2.29047
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Original Articles