title: Evaluation of distally folded onlay flap in repair of distal penile hypospadias.
abstract: OBJECTIVE
  To evaluate the results of using a distally folded onlay flap in the repair of distal penile hypospadias, with regard to meatal stenosis, urethrocutaneous fistula and esthetic outcome.
  
  
  METHODS
  This prospective study involved 36 patients with mean age 3.2 years (range 1-4); 18 had a shallow urethral plate, 10 a small glans, and 8 had undergone a previous operation but still had available preputial skin. All underwent the elective technique of distally folded onlay flap, which was carried out under general anesthesia using a 4× magnifying loupe. Starting with penile degloving and then harvesting the transverse island preputial flap provides a flap about 1 cm longer than the urethral plate. Two lateral incisions are made along the urethral plate with no need for dissection deep into the glanular wings. The flap is sutured to the urethral plate, leaving 1 cm distal to the tip of the glans, which is folded back to be sutured to the edges of the glanular wings.
  
  
  RESULTS
  There were no cases of meatal stenosis or requirement for urethral dilatation. Two patients had a urethrocutaneous fistula; one closed spontaneously while the other needed surgical repair 6 months later. Regarding esthetic appearance, 32 were scored good and 4 satisfactory.
  
  
  CONCLUSIONS
  This versatile technique offers satisfactory results regarding meatal stenosis, urethrocutaneous fistula and esthetic outcome.
authors.affiliation: Urology Department, Zagazig University Hospitals, Egypt. Dr_ihabraafat@yahoo.com
authors.forename: Ehab R
authors.initials: ER
authors.lastname: Elsayed
authors.forename: Salem
authors.initials: S
authors.lastname: Khalil
authors.forename: Khalid
authors.initials: K
authors.lastname: Abd Samad
authors.forename: Mohamed M H
authors.initials: MM
authors.lastname: Abdalla
mesh_terms: D002675:Child, Preschool; D015331:Cohort Studies; D004954:Esthetics; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000175:diagnosis / Q000601:surgery*; D007223:Infant; D008297:Male; D010413:Penis / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps; D013536:Suture Techniques; D020858:Tissue and Organ Harvesting; D016896:Treatment Outcome; D014554:Urination / Q000502:physiology; D014945:Wound Healing / Q000502:physiology*