title: Double-cross flap protection: new technique for coverage of neourethra in hypospadias repair.
abstract: OBJECTIVE
  We analyzed a new urethra preserving approach, double-cross flap protection, during tubularized incised plate urethroplasty. We compared the results of 57 patients treated with this new procedure and 80 patients treated with 2 different techniques.
  
  
  METHODS
  We studied 137 patients with hypospadias between October 2002 and March 2008. Patients were divided into 3 groups. Group 1 consisted of 40 patients (mean age 50 months) undergoing tubularized incised plate urethroplasty. Group 2 included 40 patients (mean age 48 months) undergoing tubularized incised plate urethroplasty with dorsal subcutaneous flap. Group 3 consisted of 57 patients (mean age 39 months) undergoing tubularized incised plate urethroplasty with 2 de-epithelialized preputial flaps twisted ventrally and sutured individually over the neourethra. All patients were operated on by the same surgeons. Statistical analysis of postoperative complications was performed by ANOVA and chi-square test.
  
  
  RESULTS
  In Group 1 fistula developed in 6 patients (15%) and was associated with stenosis of the neourethra in 4 (10%). In Group 2 fistula developed in 4 patients (10%). In Group 3 no fistula was observed, but mild stenosis of the neomeatus developed in 3 patients (5.3%), which was treated with dilation. Thus, the incidence of fistula in group 3 was significantly less (p = 0.015).
  
  
  CONCLUSIONS
  Double-cross flap protection is safe and significantly reduces the incidence of postoperative fistula.
authors.affiliation: Department of Pediatric Surgery, University of Perugia, Perugia, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Appignani
authors.forename: Marco
authors.initials: M
authors.lastname: Prestipino
authors.forename: Mirko
authors.initials: M
authors.lastname: Bertozzi
authors.forename: Niccolò
authors.initials: N
authors.lastname: Nardi
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Falcone
mesh_terms: D002648:Child; D002675:Child, Preschool; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D013524:Surgical Flaps; D014521:Urethra / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods