Fistula Prevention In Hypospadias Repair

The following material demonstrates a dartos flap for fistula prevention in the Snodgrass hypospadias repair. The Snodgrass technique is the procedure of choice for distal/midshaft hypospadias, as it is versatile, easy to do and has a good cosmetic outcome, with a vertically orientated meatus, as in a normal circumcised penis. Fistula formation is the most common complication, and several procedures have been described for preventing it. A longitudinal dartos flap was harvested from excessive dorsal preputial and penile hypospadiac skin, and transposed to the ventral side by a buttonhole manoeuvre; it was sutured to the glans wings around the neomeatus, and to the corpora cavernosa over the neourethra. Thus the neourethra was completely covered with well-vascularized subcutaneous tissue.