Buck s Fascia Continuous With Dartos Fascia
Summary
Background
Hypospadias is a common problem encountered in surgical practice and its repair is challenging because of various complications. Urethro-cutaneous fistula is the most common postoperative complication (incidence of 0–33%). Different types of intermediate protective layers have been used in attempts to decrease UCF formation; however, no single surgical technique is ideal.
Objective
The aim of this study was to compare use of dartos fascia and Buck's fascia as intermediate layers in prevention of the formation of UCF.
Study design
This was a prospective, comparative study conducted over a period of 2 years from January 2014 to December 2015. Patients with primary hypospadias without or with mild ventral penile curvature were included in the study. Patients were categorised into two groups, A and B, with alternate patients assigned to each group. Patients in group A underwent Snodgrass repair with urethroplasty by two-layer subepithelial closure and dartos tissue as an intermediate layer. Patients in group B underwent a urethral repair followed by Buck's fascia repair as intermediate layer and glanuloplasty after excision of a triangular skin strip on either side of the urethral plate. Patients were followed at regular intervals for a minimum of 6 months and complications were noted.
Results
Over a period of 2 years, 160 patients were included in the study: 80 patients in group A and 80 patients in group B. The age of patients ranged from 1 year to 4.6 years, with a mean age of 1.8 years. Postoperative complications are listed in the summary table.
Discussion
A protective intermediate layer between the neourethra and the skin can be used to reduce fistula formation. We describe a technique of urethroplasty using Buck's fascia as intermediate layer and glanuloplasty, with excellent results. Buck's fascia over the corpora spongiosum which is deficient ventrally in hypospadias is not completely absent, and can be easily used to cover the neourethra, needs minimal dissection and hence vascularity of tissues is preserved (summary Fig.). We used this Buck's fascia as a second protective layer over the neourethra in an attempt to decrease UCF formation, and compared it with use of dartos fascia. In our study, UCF occurred in 2.5% of patients in the Buck's fascia group and 12.5% of patients in the dartos group, a statistically significant difference. We believe that the native Buck's fascia lateral to spongiosum is a more appropriate, natural, and strong layer to cover the neourethra.
Conclusion
Table Complications.
| Complication | Group A (n = 80) | Group B (n = 80) | p-value | ||
|---|---|---|---|---|---|
| Number | Percentage (%) | Number | Percentage (%) | ||
| UCF | 10 | 12.5 | 2 | 2.5 | 0.036 |
| Meatal stenosis | 3 | 3.7 | 1 | 1.2 | 0.620 |
| Glans dehiscence (partial) | 2 | 2.5 | Nil | – | – |
| Total | 15 | 18.7 | 3 | 3.7 | |
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Graphical Abstract Buck's fascia used for neourethral coverage.
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Keywords
- Hypospadias
- Dartos fascia
- Buck's fascia
- Urethro-cutaneous fistula
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Article Info
Publication History
Published online: July 15, 2017
Accepted: June 22, 2017
Received: January 10, 2017
Identification
DOI: https://doi.org/10.1016/j.jpurol.2017.06.015
Copyright
© 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
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Source: https://www.jpurol.com/article/S1477-5131(17)30285-1/pdf
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