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Study of Variations in Axial Pattern Vessels of Penile Dartos in Hypospadias and Implied Surgical Significance

      Abstract

      Objectives

      To report the anatomical variations in axial pattern vessels of penile dartos in hypospadias.

      Methods

      Eighty hypospadias undergoing repair with tubularized incised plate urethroplasty were studied with preoperative examination of visible vein through penile skin. Course of vein proximal to root of penis was studied with vein viewer. Modified penile degloving beginning at preputial edge, splitting inner preputial urothelium off the preputial dartos and proceeding to penile shaft in subdartos plane was performed. Axial pattern veins visible on penile dartos were studied. Axial pattern penile dartos arteries were studied by recording arterial pulsations. If arterial pulsations were not seen, arterial mapping on penile dartos completed with use of Doppler and images recorded. Variations in axial pattern dartos vessels were analyzed.

      Results

      In 32 hyposapadias of 1 group, median superficial vein along the dorsal midline of penile dartos drained into left saphenous vein. In this group, dorsolateral vessels were not seen on either side in 20 cases. Unilateral dorsolateral vessel in 7 and bilateral dorsolateral vessels in five were seen. In 48 hypospadias of other group, median superficial vein was not seen. Bilateral dorsolateral vessels in 11, unilateral dorsolateral vessels in 27 and no definite pattern in 10 were seen. In both groups, superficial median artery was not discovered. Vessels were longitudinally oriented. Penile dartos was equally distributed.

      Conclusion

      In hypospadias, penile dartos vessels have axial pattern course longitudinally but not identical to normal. Eight patterns can be identified which can be diagnosed on careful clinical examination of penis.
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