title: Feasibility of a tubularised incised-plate urethroplasty with double de-epithelised dartos flaps in a failed hypospadias repair: a preliminary report.
abstract: BACKGROUND
  Reoperation for failed hypospadias has been considered to be seriously problematic. The dense fibrotic tissue causes difficulties in wound healing and increases the rate of complications. The tubularised incised-plate urethroplasty (TIPU) method has become a preferred method for all varieties of hypospadias in the past decade. However, fistulas are still one of the most common complications of this technique. The aim of this paper was to present the preliminary results of TIPU procedure with double de-epithelised dartos flaps in failed hypospadias repair.
  
  
  METHODS
  All patients were treated between January 2009 and August 2010 by the same procedure, utilising TIPU with double de-epithelised dartos flaps. Vascularised ventral dartos flaps harvested from each side of the penis with their vascular supply were transposed to cover the suture line by wrapping them from either side of the penis.
  
  
  RESULTS
  There were 21 boys with failed hypospadias: 20 had previously undergone TIPU, and one Koyanagi repair. Patients presented with very large fistulas in four and dehiscence in 17. Repair of the failed hypospadias using TIPU with double de-epithelised dartos flaps was quite successful, with no fistula recurrence or dehiscence observed.
  
  
  CONCLUSIONS
  The preliminary results showed that TIPU with double de-epithelised dartos flaps is a useful method of successfully repairing failed hypospadias.
authors.affiliation: Department of Paediatric Surgery, SisliEtfal Training and Research Hospital, Istanbul, Turkey. nihon@superonline.com
authors.forename: Abdullah
authors.initials: A
authors.lastname: Yildiz
authors.forename: Mirko
authors.initials: M
authors.lastname: Bertozzi
authors.forename: Melih
authors.initials: M
authors.lastname: Akin
authors.forename: Antonino
authors.initials: A
authors.lastname: Appignani
authors.forename: Marco
authors.initials: M
authors.lastname: Prestipino
authors.forename: Ali Ihsan
authors.initials: AI
authors.lastname: Dokucu
mesh_terms: D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000517:prevention & control; D005240:Feasibility Studies; D006801:Humans; D007021:Hypospadias / Q000150:complications / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D012086:Reoperation / Q000379:methods; D013524:Surgical Flaps; D017211:Treatment Failure; D014521:Urethra / Q000601:surgery*; D014522:Urethral Diseases / Q000517:prevention & control; D014548:Urinary Fistula / Q000517:prevention & control; D013521:Urologic Surgical Procedures, Male / Q000379:methods*