Dorsal dartos flap in Snodgrass hypospadias repair: how to use it?

To introduce new technique for covering neourethra with dorsal dartos subcutaneous tissue in Snodgrass hypospadias repair.

The study included 26 patients with primary hypospadias, aged 2-22 years (average 7.86), operated from June 2002 to August 2006. Of the patients, 21 had distal, 3 midshaft and 2 penoscrotal hypospadias. The standard technique of tubularized incised plate (TIP) with double-layer covering of the neourethra by subcutaneous tissue was used in all cases of reconstruction. The mean follow-up period was 4.5 months (range 3-12 months).

Successful result of a normal-looking penis without fistula was achieved in all patients. One patient had meatal stenosis (3.84%) at the early postoperative period which was corrected by urethral dilatation of the external meatus at an interval of up to 2 months postoperatively.

Our technique represents a reasonable option for utilizing dorsal dartos subcutaneous tissue in TIP urethroplasty. The neourethra is covered symmetrically with a double layer of well-vascularized tissue and the penis is kept without rotation. Redundancy of the flap and its excellent vascularization depend on the harvesting technique. Further follow-up and a larger number of patients are needed before a final conclusion can be made.