Split Dorsal Dartos Flap Transposed Ventrally as a Bed for Preputial Skin Graft in Primary Staged Hypospadias Repair

Objective To describe a modification of the 2-stage repair using a dorsal split dartos fascia flap, as a well vascularized bed for the graft in the first stage.The 2-stage repair is a commonly used technique in proximal hypospadias or in hypospadias with severe chordee, or in cases with urethral plate of poor or dubious quality. Methods Between 2006 and 2009, 32 patients underwent a staged hypospadias repair: 8 (25.0%) midshaft with chordee and/or poor urethral plate, 14 (43.8%) proximal penile, 7 (21.9%) peno-scrotal, and 3 (9.4%) perineal hypospadias. Plication was necessary in 27 (84.4%). All cases received a preputial skin graft. Median age at the first stage was 21 months (range 15-26); median follow-up was 35 months (range 20-55) and the median time between the 2 stages was 8 months (range 6-12). Results Graft take was 100% after the first stage. Follow-up after second-stage repair showed 31 of 32 (96.8%) had a successful functional outcome (straight erection; good, single urine stream; voiding in a standing position) and cosmetic outcome (slitlike meatus positioned at the tip of the glans, “normal looking circumcised penis”); one fistula occurred. One patient has mild residual ventral curvature. Conclusion Using a vascularized dorsal split dartos flap ventrally underneath and laterally of the skin graft in the first stage offers the advantages of an excellent graft take and the provision of versatile dartos tissue for a waterproofed and secured urethroplasty.