title: [Treatment of complications in hypospadias surgery: modern advancement].
abstract: BACKGROUND
  With today's improved surgical techniques, complications in hypospadias surgery are seen less often, especially in distal form (1-5%). However, in proximal or complex hypospadias complications rate varied between 15 and 57%. Corrective surgery is mandatory in maior complications (urethrocutaneous fistulas, persistent chorde, urethral strictures, superficial skin separation). The search for the innovative surgical procedures and the optimal urethral substitute continues because each tissue has its particular shortcomings and disadvantages.
  
  
  METHODS
  At our hospital complications occurred in 25 ( 15%) of 177 patients who underwent primary hypospadias repair between 1994 and 1998. 9 patients required further surgery to repair the complications of previous hypospadias operations performed at other institutions. When local epithelial tissue was not available, different surgical procedures were performed, using bladder or buccal mucosa graft and free or vascularized tunica vaginalis flaps.
  
  
  RESULTS
  Follow up ranged from 3 to 6 years: the cosmetic and functional results were excellent. Small fistulas occurred in 3 patients and were corrected successfully in a subsequent surgical procedure using a tunica vaginalis wrap.
  
  
  CONCLUSIONS
  The concept of using tunica vaginalis in urethral reconstruction represent a recent innovation. This tissue is a valid alternative in cases of multiple failed repairs.
authors.affiliation: Istituto Materno-Infantile, Clinica Chirurgica Pediatrica, Università degli Studi, Palermo, Italy.
authors.forename: R M
authors.initials: RM
authors.lastname: Cigna
authors.forename: C
authors.initials: C
authors.lastname: Chiaramonte
authors.forename: F
authors.initials: F
authors.lastname: Italiano
authors.forename: F
authors.initials: F
authors.lastname: Cataliotti
mesh_terms: D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D009092:Mucous Membrane / Q000637:transplantation; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures; D016038:Skin Transplantation; D013524:Surgical Flaps; D013737:Testis / Q000601:surgery; D016896:Treatment Outcome; D014521:Urethra / Q000293:injuries / Q000601:surgery; D014524:Urethral Obstruction / Q000209:etiology / Q000601:surgery; D014548:Urinary Fistula / Q000209:etiology / Q000601:surgery
vernacular_title: Il trattamento delle complicanze nella chirurgia dell'ipospadia: nuove prospettive.