title: Double unfurled dartos flap technique in the surgical treatment of recurrent urethrocutaneous fistulas.
abstract: BACKGROUND
  The management of recurrent urethrocutaneous fistula (RUCF) is a challenging problem that poses a serious difficulty for the hypospadias surgeon. We report here a novel technique in which a double unfurled dartos subcutaneous flap is utilized in the treatment of patients with RUCF.
  
  
  METHODS
  We retrospectively reviewed the records of all our patients who underwent surgical treatment of urethrocutaneous fistula with this new operative method after previously failed fistula repair. The main novelty of this technique is the use of two opposite medium thickness flaps, unfurled from the inner surface of the dartos fascia and spread over the fistula and each other so as to cover the urethral suture line completely, and fixed to the surrounding corporal tissue.
  
  
  RESULTS
  Eight patients with 11 RUCFs (with localizations varying from subcoronal to penoscrotal fistula opening) underwent surgical correction with the new method. There had previously been at least 3 recurrences in 6 of these patients, and different closure techniques had been used. RUCF diameter was <4 mm in all patients. Surgery was performed at the earliest following a 6-month healing period since the last fistula repair attempt. All of the RUCFs were repaired successfully with the technique. After a follow-up of at least 6 months, none of the 8 patients had developed recurrence of the fistula, and there were no postoperative complications.
  
  
  CONCLUSIONS
  The double unfurled dartos subcutaneous flap method appears to be a simple and appropriate procedure with which to repair recurrent mid-shaft and proximal urethral fistulas after failed hypospadias repair.
authors.affiliation: Institute of Pediatrics, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary. jozsa_tamas @ freemail.hu
authors.forename: Tamás
authors.initials: T
authors.lastname: Józsa
authors.forename: István
authors.initials: I
authors.lastname: Csízy
authors.forename: Adrienn
authors.initials: A
authors.lastname: Csiszkó
authors.forename: Miklós
authors.initials: M
authors.lastname: Boros
authors.forename: Tamás
authors.initials: T
authors.lastname: Roszer
authors.forename: Péter
authors.initials: P
authors.lastname: Nyirády
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006814:Hungary; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D040521:Subcutaneous Tissue / Q000601:surgery*; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000209:etiology / Q000601:surgery*; D014548:Urinary Fistula / Q000209:etiology / Q000601:surgery*; D013519:Urogenital Surgical Procedures / Q000009:adverse effects*; D055815:Young Adult