A de-epithelialised 'turnover dartos flap' in the repair of urethral fistula

J Plast Reconstr Aesthet Surg. 2009 Mar;62(3):374-9. doi: 10.1016/j.bjps.2008.03.031. Epub 2008 Jul 21.

Abstract

We report our experience in the management of urethrocutaneous fistulae following hypospadias repair by using a turnover, de-epithelialiszed dartos flap. From May 2003 to June 2007 we operated on 10 patients with urethral fistulae following hypospadias repair. Their ages ranged from 4 to 25 years (mean: 7 years). Four of these patients had their urethroplasty done elsewhere and reported for fistula repair alone. These four patients had no record of the urethroplasty procedure that was used. A solitary fistula was located at the corona in two patients, on the mid-shaft in three patients, and proximal penile in one patient. Two patients had multiple fistulae on the shaft, one patient had two fistulae on the shaft, and one patient had a long fistula from the proximal penile to peno-scrotal region. The technique involves using a circumscribing incision around the fistula and closing the inner skin edges by an inverting subcuticular stitch to form the urethral layer. A flap is marked on the skin adjacent to the circumscribing incision and de-epithelialised. It is raised with underlying dartos fascia/muscle and turned over the first layer of closure and secured. The vascular supply to the flap is based on a hinge of tissue around the defect. A long skin flap developed from shaft or the scrotum is approximated over this layer to complete the repair. Alternatively, the skin is closed in a 'pants over vest' technique. An indwelling catheter is placed for 3-4 days. Nine patients healed without complications, and one patient with multiple fistulae on the shaft had a residual tiny pin-point fistula which closed spontaneously. Thus, the success rate with this technique was 100%. Although dartos flaps have been used for many years as a waterproofing layer in urethroplasties or while repairing urethrocutaneous fistulae, their use as a 'de-epithelialised turnover flap' provides another reliable tool in the surgical repertoire.

MeSH terms

  • Adolescent
  • Adult
  • Catheters, Indwelling
  • Child
  • Child, Preschool
  • Cutaneous Fistula / etiology
  • Cutaneous Fistula / surgery*
  • Humans
  • Hypospadias / complications
  • Hypospadias / surgery*
  • Male
  • Penis / surgery
  • Plastic Surgery Procedures / methods*
  • Scrotum / surgery
  • Surgical Flaps / blood supply
  • Treatment Outcome
  • Urethra / surgery
  • Urethral Diseases / etiology
  • Urethral Diseases / surgery*
  • Urinary Fistula / etiology
  • Urinary Fistula / surgery*
  • Young Adult