Reinforced Distal Hypostadiac Urethroplasty with Nesbit’s and Byar’s Flaps

To evaluate the role of Nesbit’s and Byar’s type of soft tissues reinforcement interposition flaps (STRIFs) in prevention of urethro-cutaneous fistulas (UCFs) in distal Snodgrass TIP urethroplasties. Between 2003-2005, 28 distal hypospadiacs, ranging from 8 to 14 years of age, without chordee, underwent Snodgrass TIP urethroplasties. The reconstructed neo-urethras were reinforced with preputial dartos fascial flaps, harvested by way of de-epithelialization. The de-epithelialized dorsal prepuce was either button holed (n=14, Nesbit’ type of STRIFs) or divided in to two equals halves (n=14, Byar’s type of STRIFs) to be ventralized and tucked under the glans wings distally to provide a complete cover to the neo-urethras. Total of four patients, two from each group, developed single, micro-sized coronal urethro-cutaneous fistula three of which healed spontaneously within a period of 6 weeks, and one required purse string closure after 3 months. At one year follow up, all the patients were asymptomatic with good functional and cosmetic out come.