Introduction and Objectives
Since Fistula formation is the most common complication with various rates, we evaluated the importance of a urethral covering using long vascularized dorsal subcutaneous tissue for fistula prevention, Snodgrass technique, for correction of proximal hypospadias.
Material and Methods
During the period from April 2004 through November 2008 we evaluated 16 patients aged 9 months to 11 years who underwent proximal hypospadias surgery. Fourteen patients had penoscrotal and two had scrotal hypospadias. Chordee occurred in all patients and was corrected by dorsal plication. All patients underwent standard tubularized incised plate urethroplasty, which was followed by reconstruction of new surrounding urethral tissue. A very long, longitudinal dorsal dartos flap was harvested and transposed to the ventral side by the buttonhole maneuver. The flap was sutured to the glans and the corpora cavernosa to completely cover the neourethra with well-vascularized subcutaneous tissue. Penile body was covered using remaining penile skin.
Mean follow-up was 24 (6–40) months. A successful result without fistula was achieved in 14 patients. There were one fistula and one stenosis of the glandular urethra, all solved by minor revision.
Snodgrass technique with urethral covering with long dorsal well-vascularized dartos flap represents a good choice for fistula prevention. Redundancy of the flap and its excellent vascularization are promising for good outcome in proximal hypospadias repair.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.