Re: Miroslav L. Djordjevic, Sava V. Perovic, Zoran Slavkovic and Nenad Djakovic. Longitudinal Dorsal Dartos Flap for Prevention of Fistula after a Snodgrass Hypospadias Procedure. Eur Urol 2006;50:53–57

November 3, 2017 | Autor: Ali Ayyıldız | Categoria: Urology, Hypospadias, Humans, Male, Clinical Sciences
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european urology 51 (2007) 856–864

available at www.sciencedirect.com journal homepage: www.europeanurology.com

Letters to the Editor Re: Miroslav L. Djordjevic, Sava V. Perovic, Zoran Slavkovic and Nenad Djakovic. Longitudinal Dorsal Dartos Flap for Prevention of Fistula after a Snodgrass Hypospadias Procedure. Eur Urol 2006;50:53–57 We read the article by Djordjevic et al. with great interest. The authors’ method and findings are so impressive and seem to meet an important need for the treatment of hypospadias. As we know, hypospadias is one of the most seen congenital anomalies in the urogenital system. To date, many surgical methods have been described for repair and investigations continue seeking the ‘‘golden repair.’’ However, the efforts for developing a new surgical method seem to be decelerated with the description of the tubularized incised plate urethroplasty (TIPU) procedure by Snodgrass. Although this technique is being performed as a standard procedure for distal hypospadias, it is now being performed also for proximal hypospadias in several centres. As we know from the literature, the TIPU procedure has a complication rate of 3–30%. We also observed a similar complication rate, 17%, in our previously published study [1]. Djordjevic et al. describe a new modification of the TIPU procedure in this multi-institutional study and report a perfect success rate, that is 100%, in 126 cases. The authors also reported a 100% success rate with same procedure in 67 cases previously [2]. This perfect rate has been stated to be a result of longitudinal dorsal flap modification added to conventional TIPU procedure by the authors. Snodgrass used a dartos flap with the TIPU procedure and reported a 13% complication rate [3]. A 100% success rate is a rare and an impressive finding for a large study such as this. Many modifications are being performed to decrease the complication rates seen after the TIPU procedure in several centres and while the most seen complication is urethrocutaneous fistula,

prevention of this complication is important for clinicians. Probably the most performed method in the prevention of fistula is covering the neourethra with a well-vascularised flap after TIPU. For this purpose, several flap methods have been described. As the authors stated, asymmetric flap harvesting from dorsal subcutaneous tissue can cause penil rotation. Besides, ventral dartos harvested flaps can sometimes have insufficient tissue for urethral covering. The longitudinal dorsal flap procedure seems more successful for not causing the problems mentioned above. However, in longitudinal dorsal flap use, problems such as the possible difficult coverage of neourethra in proximal cases, the risk of ischaemia due to compression formed after the buttonhole manoeuvre, and possible sociocultural problems that can be seen after circumcision should always kept in mind. References [1] Germiyanoglu C, Nuhoglu B, Ayyildiz A, Akgul KT. Investigation of factors affecting result of distal hypospadias repair: comparison of two techniques. Urology 2006;68: 182–5. [2] Djordjevic ML, Perovic SV, Vukadinovic VM. Dorsal dartos flap for preventing fistula in the Snodgrass hypospadias repair. BJU Int 2005;95:1303–9. [3] Sozubir S, Snodgrass W. A new algorithm for primary hypospadias repair based on tip urethroplasty. J Pediatr Surg 2003;38:1157–61. Barıs¸ Nuhog˘lu K. Turgay Akgu¨l* Ali Ayyıldız Ministry of Health Ankara Training and Research Hospital, Second Urology Clinic, Ankara, Turkey *Corresponding author E-mail address: [email protected] October 4, 2006 Published online ahead of print on October 19, 2006 doi:10.1016/j.eururo.2006.10.009

DOI of original article: 10.1016/j.eururo.2006.04.014 0302-2838/$ – see back matter # 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved.

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