Hayashi et al. (2005) Scrotal dartos flap for the prevention of the urethrocutaneous fistula on hypospadias urethroplasty. Int J Urol 12: 280–283

Hayashi and co-workers report the application of a scrotal dartos flap wrapping surgical technique to prevent the occurrence of urethrocutaneous fistula in 14 patients with hypospadias.

Urethrocutaneous fistula is a frequent complication after surgery to repair hypospadias, particularly in severe cases where the neourethra is long. Hayashi et al. applied a scrotal dartos tunic wrap to the neourethra during one-stage urethroplasty. The dartos fascia and the tunica vaginalis containing a testis were separated using Churchill's technique for obtaining dartos tissue, but without opening the tunica vaginalis. This modified technique avoids exposure of the testis, and the abundant blood supply in the well-vascularized dartos flap improves the vascular supply to the neourethra.

Hypospadias was successfully repaired without fistula formation in all but one patient who developed a tiny fistula, and this was successfully closed by a simple procedure. No other complications occurred in the neourethra, scrotum or testis of patients who underwent surgery. Limitations included the requirement for a penoscrotal incision, unsuitability for treatment of distal urethoplasty and a longer surgery time (45 min) compared with alternative procedures.

Hayashi et al. conclude that the scrotal dartos flap wrapping technique has fewer complications than other surgical procedures and they recommend its application for prevention of urethocutaneous fistula on hypospadias.