Dorsal dartos flap for preventing fistula in the Snodgrass hypospadias repair

BJU Int. 2005 Jun;95(9):1303-9. doi: 10.1111/j.1464-410X.2005.05500.x.


Objective: To evaluate the importance of urethral covering using vascularized dorsal subcutaneous tissue for preventing fistula in the Snodgrass hypospadias repair.

Patients and methods: The study included 67 children (aged 1-11 years) who had hypospadias repaired between April 1998 and May 2003, including 51 with distal and 16 with midshaft hypospadias. In all children, a standard tubularized 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 the ventral side by a buttonhole manoeuvre; it was sutured to the glans wings around the neomeatus, and to the corpora cavernosa over the neourethra. Thus the neourethra was completely covered with well-vascularized subcutaneous tissue.

Results: At a mean (range) follow-up of 21 (6-65) months, the result was successful, with no fistula or urethral stenosis, in all 67 children.

Conclusion: We suggest that urethral covering should be part of the Snodgrass procedure. A dorsal well-vascularized dartos flap, buttonholed ventrally, is a good choice for preventing fistula. Redundancy of the flap and its excellent vascularization depends on the harvesting technique.

Publication types

  • Evaluation Study

MeSH terms

  • Child
  • Child, Preschool
  • Cutaneous Fistula / prevention & control*
  • Humans
  • Hypospadias / surgery*
  • Infant
  • Male
  • Surgical Flaps* / blood supply
  • Suture Techniques
  • Urethra / surgery
  • Urethral Diseases / prevention & control*
  • Urinary Fistula / prevention & control*