title: Multiple failed urethroplasties: definitive repair with the Duckett island-flap technique.
abstract: OBJECTIVE
  The correction of postoperative complications after hypospadias repair presents frequently serious problems, and the results are not always satisfactory. The aim of this study is to present our experience with the tubularized island flap technique (Duckett procedure) in patients who had been submitted to repeated unsuccessful attempts for the repair of hypospadias and its complications.
  
  
  METHODS
  During an 8-year period (1994 through 2001), 21 patients, aged 4 to 18 years, presented with severe recurrent hypospadias (3 to 13 times). In all patients, the urethral orifice was quite proximal because of disruption of the neourethra and was associated with severe penile ventriflexion. In addition, there were diverticula with hair ingrowth in 5 boys and lack of the prepuce in 4. All patients underwent the Duckett island-flap technique. The inner layer of the prepuce was used in 17. The dorsal penile skin was used for the island flap formation in the remaining 4 patients in whom the prepuce had been resected during the previous operations.
  
  
  RESULTS
  After repair, the meatus was located at the top of the glans in all patients. There were 5 complications (24%): distal fistula near the glans (n = 1), meatal stenosis (n = 1), diverticula at the proximal anastomosis (n = 2), and anastomotic stenosis (n = 1). All of them were treated successfully by meatotomy, fistula closure, diverticula tapering, and dilatations, respectively.
  
  
  CONCLUSIONS
  The island-flap technique gives satisfactory results in patients with multiple failed urethroplasties; it is applicable even in boys with resected prepuce and has an acceptable complication rate.
authors: Second Department of Pediatric Surgery, Aghia Sophia Children's Hospital, Athens, Greece.
authors: Michael
authors: M
authors: Soutis
authors: Evangelos
authors: E
authors: Papandreou
authors: George
authors: G
authors: Mavridis
authors: Dimitris
authors: D
authors: Keramidas
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D010413:Penis / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery; D019651:Plastic Surgery Procedures; D012086:Reoperation; D013524:Surgical Flaps; D017211:Treatment Failure; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*