CU 14. The application of different dartos tissues for covering new urethra in tubularized incised plate (TIP) urethroplasty

Objective: To compare the anti-urinary fistula effect of different dartos tissues used in Snodgrass urethroplasty to cover the new urethra.

Methods: From January 2010 to October 2011, 44 cases of hypospadias patients underwent Snodgrass urethroplasty, aged from 2.5 to 31 years old, including 7 cases of coronal, 35 cases of distal penile shaft, and 2 cases of penoscrotal hypospadias. There were the first operations of all the patients. Correction of chordee penis was performed during operation, after the urethral plate had been tubularized to construct a new urethra, different vascularized dartos tissues were used to cover the new urethra. There were 16 cases in group A, the new urethra was covered by either preputial or scrotal dartos on one side. And there were 14 patients were in group B, dorsal preputial dartos flap was graft to ventral penis with hole opening in centre at the proximal end to cover urethra. Group C included 22 cases, dorsal preputial dartos flap was graft with an incision was made in the middle of the flap. And then the flap wound behind the ventral penis from two sides respectively to cover the new urethra in two layers. Urethral silicone stent was used in all patients for 12-14 days.

Results: Follow up lasted for 2 to 22 months, the appearance of the penis was fine, the external urethral orifice presents as a vertical slit, was circular cone-shaped, urinary stream was normal, and no significant penile curvature and urethral stricture was observed. There were 7 cases of urinary fistula that 3 cases (18.75%) in group A, 3 cases (21.43%) in group B, and 1 cases (4.54%) in group C.

Conclusions: Dorsal preputial dartos flap used for two-layer covering in Snodgrass urethroplasty method can significantly reduce the incidence of urinary fistula.