An-Najah Staff

Purpose: To introduce new technique for covering neourethra with dorsal dartos subcutaneous tissue in Snodgrass hypospadias repair.
Material & Methods: The study included twenty sex patients with primary hypospadias, aged 2 to 22 years (average 7.86), who were operated from June 2002 to August 2006. Of the patients, twenty one patients had distal, three had midshaft and two had penoscrotal hypospadias. The standard technique of tubularized incised plate (TIP) with double layers covering of neourethra by subcutaneous tissues was used in the reconstruction of all cases. A longitudinal dorsal dartos subcutaneous flap was harvested and dissected from the middle then both layers of flap were symmetrically transposed to the ventral side of the penis. Each layer was sutured to the glans wings and to the corpora covernosa thus the neourehtra became completely covered with double layers of well-vascularized tissue. The mean follow-up period was 4.5 months (range 3-12 months).
Results:Successful results of normally looking penis without fistula were achieved in all patients. Only one patient had meatal stenosis (3.84%) at early postoperative period which was corrected by urethral dilatation of external meatus at interval up to two months postoperatively.
Conclusion: Our technique represents a reasonable option for utilizing dorsal dartos subcutaneous tissue in TIP urethroplasty. The neourethra is symmetrically covered with double layer of well vascularized tissue and the penis is kept without rotation. Redundancy of the flap and its excellent vascularization depend on harvesting technique. Further follow up and larger number of patients are needed before a final conclusion could be made.