Extended dartos fascial flaps in distal Snodgrass TIP urethroplasties

Purpose: To evaluate the role of extended dartos fascial flaps in prevention of urethro-cutaneous fistulas (UCFs) in distal Snodgrass TIP urethroplasties. Patients and methods: Between 2004-2006, 18 distal hypospadiacs without chordee, aged 10-14 years with well-developed phallus and urethral plate, underwent distal Snodgrass TIP urethroplasties. Extended dartos fascial flaps were harvested by deepithelialization of 5 mm strip of penile skin pedicled on one side of the urethral plate. The pedicled dartos fascial flaps were turned over to the other side across the mid line of the seam of the re-constructed neo-urethral tubes (tubularization of the median incised and grafted urethral plate) to provide them an in continuity re-enforcement against fistulization. Results: Two of the 18 distal hypospadiacs had developed eccentrically placed micro UCFs, which healed spontaneously within 3 weeks of follow up due to their oblique fistulous tracts which were unfavorable for epithelialization. Conclusions: The extended dartos fascial flaps provide mechanical and biological support to the under lying neo-urethral tubes, and prevent fistula-associated morbidities by avoiding suture line superimpositions.