Basrah Journal of Surgery

THE OUTCOME OF DOUBLE DARTOS VERSUS SINGLE LAYER FLAP IN SNODGRASS URETHROPLASTY FOR DISTAL HYPOSPADIAS REPAIR IN BASRA TRAINING CENTER OF UROLOGY

Document Type : Original Article

Authors

1 department of surgery, college of medine, university of basrah

2 Urology department of Al-Sadder Teaching Hospital

3 Urology department of Al-Mawani’ Hospital

Abstract

Hypospadias, a nomination of medical term which was derived from the Greek terms: hypo (under) and spadon (rent, fissure). It is one of the congenital abnormalities of the genitourinary tract. There are about 400 different procedures described for correction of this type of anomaly, but Tubularized Incised Plate (TIP) Urethroplasty is considered the most popular one, and there are multiple variations in this procedure to get high success rate and decrease the complications. In this study, we compare between single layer dartos flap versus double layer dorsal flaps in TIP urethroplasty. This is to assess the outcomes of double dartos flaps versus single layer flap in TIP urethroplasty for primary distal hypospadias repair in Basrah Teaching Center regarding the success rate, and to investigate the importance of double flaps in preventing possible complications in particular, urethral fistula. A cross sectional prospective study was done in Basra Teaching Hospital, between January 2018 to March 2020. A total of 50 boys, 2 to 10 year- old with coronal and sub coronal primary Hypospadias were treated with TIP urethroplasty (Snodgrass procedure) by one surgical team, who were referred to Basrah Teaching Hospital from private and outpatient clinics. Patients were divided into 2 groups: (group I: 25 patients) single layer Dartos flap & (group II: 25 patients) double layers of Dartos flaps. Six patients were missing during follow up, coincidentally 3 patients in each group. The mean age was 4.55 and 4.86 year for groups I, II respectively, the mean operative time was 88.81 and 91.86 minutes for group I & group II respectively. The success rate was (81%) and (86%) for group I, II respectively, with exception of complications which need re-do surgery. Urethrocutaneous fistula (UF) was developed in (22.7%) in group I, and in (4.5%) in group II. Bleeding was happened in 2 cases (9.1%) in group I and 3 cases (13.6%) in group II. Meatal stenosis was diagnosed in (9.1%) in group I and (13.6%) in group II. Glans dehiscence was seen in 1 case (4.5%) for each group. There was a significant difference between the two groups in the occurrence of UF (P = 0.001). According to our evidence in this study, double dartos flaps is easy to be harvested, safe procedure, and represents very good choice for UF prevention. Although the number of complicated patients regarding bleeding and meatal stenosis are higher in group II than group I but they were statistically insignificant. Keywords: Hypospadias, Urethroplasty, Tubularized Incised Plate (TIP), urethral fistula, dartos flaps.

Keywords

Main Subjects

References
1. Schroder A, Stein R, Melchior S, Fisch M, Riedmiller H, Thuroff JW. Hypospadie. Urologe A 2006;45(Suppl 4):204–8. 2. Nuhoğlu B, Akgül KT, Ayyıldız A: Re: Mi- roslav L. Djordjevic, Sava V. Perovic, Zoran Slavkovic and Nenad Djakovic. Longitudi- nal dorsal dartos flap for prevention of fistula after a Snodgrass hypospadias procedure. Eur Urol 2006; 50:53–57. 3. Kamal BA: Double dartos flaps in tubularized incised hypospadias repair. Urology 2005; 66:1095–1098. 4. Holland A, Smith G. Effect of the depth and width of the urethral plate on tubularized incised plate urethroplasty. The Journal of urology. 2000;164(2):489-91. 5. Snodgrass WT: Tubularized incised plate (TIP) hypospadias repair. Urol Clin North Am 2002;29: 285–290. 6. Snodgrass WT, Bush N, Cost N. Tubularized incised plate hypospadias repair for distal hypospadias. Journal of pediatric urology. 2010;6(4):408-13. 7. Snodgrass WT: Tubularized incised plate urethroplasty for distal hypospadias. J Urol 1994; 151:464–465. 8. Erol A, Baskin LS, Li YW, Liu WH: Anatomical studies of the urethral plate: why preservation of the urethral plate is important in hypospadias repair. BJU Int 2000; 85:728– 734. 9. Retik AB, Mandell J, Bauer SB, Atala A: Meatal based hypospadias repair with the use of a dorsal subcutaneous flap to prevent urethrocutaneous fistula. J Urol 1994; 152:1229– 1231. 10. Nguyen MT, Snodgrass WT, Zaontz MR: Effect of urethral plate characteristics on tubularized incised plate urethroplasty. 2004; 171:1260–1262. 11. Kamal BA: Double dartos flaps in tubularized incised hypospadias repair. Urology 2005; 66:1095–1098. 12. Bakan V, Yıldız A: Dorsal double-layer dartos flap for preventing fistulae formation in the Snodgrass technique. Urol Int 2007;78: 241–244. 13 Savanelli A, Esposito C, Settimi A: A prospective randomized comparative study on the use of ventral subcutaneous flap to prevent fistulas in the Snodgrass repair for distal hypospadias. World J Urol 2007; 25:641–645 14. Erol A, Kayikci A, Memik O et al. 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 2009; 83:354–358. 15. Snodgrass WT, Nguyen MT. Current technique of tubularized incised plate hypospadias repair. Urology 2002; 60:157– 162. 16. Snodgrass WT. Snodgrass technique for hypospadias repair. BJU Int 2005; 95:683–69. 17. Djordjevic ML, Perovic SV, Slavkovic Z, Djakovic N: Longitudinal dorsal dartos flap for prevention of fistula after Snodgrass hypospadias procedure. Eur Urol 2006; 50:53–57. 18. Lorenzo AJ, Snodgrass W: Regular dilatation is unnecessary after tubularized incised plate hypospadias repair. BJU Int 2002;89: 94–97. 19. Elbakry A: Tubularized-incised urethral plate urethroplasty: is regular dilatation necessary for success? BJU Int 1999; 84:683– 688. 20. Elbakry A, Shamaa M, Al-Atrash G. An axially vascularized meatal based flap for the repair of hypospadias. Br J Urol. 1998; 82:698–703. 21. El‐Sherbiny M, Hafez A, Dawaba M, Shorrab A, Bazeed M. Comprehensive analysis of tubularized incised‐plate urethroplasty in primary and re‐operative hypospadias. BJU international. 2004;93(7):1057-61. 22. Van Savage JG, Palanca LG, Slaughenhoupt BLJTJou. A prospective randomized trial of dressings versus no dressings for hypospadias repair. 2000;164(3 Part 2):981-3. 23. Shenoy NS, Kumbhar VV, Shenoy YR, Sharma DB. Outcome of hypospadias repair-stentless versus stented repair. International Surgery Journal. 2016;3(4):2167-72. 24. El-Karamany TM, Al-Adl AM, Omar RG, Aal AMA, Eldakhakhny AS, Abdelbaki SAJU. A critical analysis of stented and unstented tubularized incised plate urethroplasty through a prospective randomized study and assessment of factors. 2017;107:202-8.
Basrah Journal of Surgery
Volume 27, Issue 2 - Issue Serial Number 2
December 2021
Page 2-8
Files
History
  • Receive Date: 21 October 2021
  • Revise Date: 20 November 2021
  • Accept Date: 15 December 2021
  • First Publish Date: 15 December 2021
Share
Export Citation
Statistics