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Outcome of Snodgrass urethroplasty by modifying tubularization and dartos layer in Erbil
نتائج جراحة الإحليل البولية Snodgrass عن طريق تعديل طبقة الأنابيب والبلات في أربيل

Authors: Nihad Pauls Al-Ibraheem --- Hawkar Abdulla Kakahmed --- Jalal Hamasalih Fattah
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2017 Volume: 21 Issue: 2 Pages: 1715-1721
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Snodgrass first described the tubularized, incised plate (TIP) urethroplasty for distal hypospadias repair in 1994. This study aimed to find out whether there is any difference in the fistula rate with single versus double layer tubularization, and the use of ventral versus dorsal dartos layer.Methods: Between May 2009 and July 2014, tubularized incised plate urethroplasty was performed for correction of hypospadias in Erbil for 112 patients with age ranging from 1-32 years. Five patients were excluded from the study because of lack of adequate follow up. Data were analyzed using the statistical package for the social sciences.Results: Urethral fistula occurred in seven cases (6.5%).The use of an additional reinforcing second layer for the tubularization had a significant effect on decreasing the fistula formation (P = 0.05). The fistula rate was slightly lower with dorsal dartos flap (5.4%) than ventral dartos flap (7.8%).Conclusion: The urethral plate, when dissected, should be thick enough to allow for tubularizationin two layers. Both dorsal and ventral dartos flaps are effective in preventing urethral fistula.

Keywords

Hypospadias --- Dartos flap --- Fistula


Article
EVALUATION OF THE USE OF DORSAL DARTOS FLAP FOR THE PREVENTION OF FISTULA AFTER SNODGRASS REPAIR OF HYPOSPADIAS

Author: Firas Shakir Attar
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2016 Volume: 22 Issue: 2 Pages: 52-56
Publisher: Basrah University جامعة البصرة

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Abstract

Abstract The Snodgrass technique or the tubularized incised plate (TIP) repair is considered as excellent option for treatment of distal and mid-shaft hypospadias. Urethro-cutaneous fistula remains the most frustrating complication of hypospadias repair. After performing a tubularized incised plate (TIP) repair, the incidence of fistulae is reported to be up to 17% of cases. This study aimed to evaluate the use of dorsal dartos flap for the prevention of fistula formation after Snodgrass repair for distal hypospadias. The current study included 35 patients aged 2-6 years during the period between February 2013 to January 2016. All the patients had distal hypospadias and underwent Snodgrass or TIP repair. The neo-urethra was covered by dorsal preputial interpositional flap transposed ventrally via a button hole maneuver as a method to prevent fistula formation. Patients were followed up and their complications were assessed based on the patients’ medical records. The procedure was completed successfully in all patients, with no intraoperative complications. All patients had good functional results with straight penis and vertical slit shaped meatus at the tip of the glans. Thirty four (97.14%) patients had no evidence of fistula development. One patient only (2.8%) developed fistula. Meatal stenosis occurred in 3 patients (8.5%). In conclusion, the neo-urethral covering with well-vascularized dartos flap, harvested dorsally and button holed at its base for ventral transposition, represents a good choice for fistula prevention after Snodgrass repair.


Article
Comparison between Single and Double Dartos Layers Snodgrass Technique for Hypospadius Repair : Results of Our Experience

Author: Ali Hadi Sabhan
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 2 Pages: 330 -336
Publisher: Babylon University جامعة بابل

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Abstract

To compare our results with single versus double dartous layers Snodgrass technique for hypospadius repair, a comparative study was done and the results were compared in term of : the overall success and complications rates, percentage of each complication (urethrocutaneous fistula, meatal stenosis, urethral diverticulum and glandular or complete neourethradehiscence) with final cosmetic appearance and straightening of urinary stream.The study was extended from January 2013 to June 2015; including a randomly selected fourty three children with median age of 29 months (range from 12 to 66 months) with a primary hypospadias. Patients were divided into 2 groups: Group 1 include 21 patients that were selected to be operated by a single layer TIP technique.Group 2 include 22 patients that were selected to be operated by a double layer TIP technique.All patients under went Snodgrass technique urethroplasty in the surgical theater of Al-Diwaniya teaching general hospital under general anesthesia.The results shows a higher overall success rate and cosmetic appearance with lower complications for patients in group 2in comparison to those in group 1with no statistically significant difference. The neourethral covering in TIP hypospadias repair(Snodgrass technique) with double-dartos flap yield a better cosmetic and functional results in comparison to single dartos flap cover in terms of increasing success rate and minimizing complications specially in decreasing the rate of urethrocutaneous fistula formation which is the most common complication following this type of surgery.

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