title: Marzouk skin tag two-stage urethroplasty for the repair of complex cases of hypospadias.
abstract: BACKGROUND
  Cases of hypospadias with severe chordee and deficient skin, as well as those for re-do hypospadias or fistula repair, are considered complex cases. Depending on the degree of complexity of the defect, a two-stage procedure may still be advisable. The present paper describes the so-called Marzouk skin tag urethroplasty as a new two-stage procedure advisable for use in such difficult cases.
  
  
  METHODS
  The Marzouk skin tag urethroplasty procedure was performed on 16 complex cases. The first stage consists of urethral mobilization plus the double-buttonhole procedure (designed by the author) to form a midline ventral skin tag proximal to an advanced hypospadiac orifice. This skin tag is fashioned, 6 months later, by the author's special techniques (type I in 12 patients and type II in four patients) to form the neourethral tube and its coverage with minimal dissection.
  
  
  RESULTS
  The operation resulted in a straight penis with neomeatus at the glans top in all 16 cases without significant complications. Both type I and II procedures give good functional results. The type I procedure has a superior cosmetic result. The follow-up period ranged from 4 to 8 months.
  
  
  CONCLUSIONS
  The double-buttonhole modification can solve the problem of deficient skin and simplify a safe second-stage procedure. The Marzouk skin tag operation (types I and II) can be an additional option to be used when indicated.
authors.affiliation: Urology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt. e_marzouk@hotmail.com
authors.forename: Essam
authors.initials: E
authors.lastname: Marzouk
mesh_terms: D000328:Adult; D002648:Child; D062109:Dermatologic Surgical Procedures; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D013524:Surgical Flaps; D014521:Urethra / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*