title: A comparative study of the use of a transverse preputial island flap (the Duckett technique) to treat primary and secondary hypospadias in older Chinese patients with severe chordee.
abstract: OBJECTIVE
  To investigate the outcome between the primary and secondary hypospadias with severe chordee in older patients by the transverse preputial island flap (TPIF).
  
  
  METHODS
  We retrospectively analyzed 53 hypospadias patients who were performed with TPIF for urethroplasty, including 25 primary hypospadias (Group 1) and 28 secondary hypospadias (Group 2). The mean age in Group 1 was 12.12 ± 10.709 and 18.64 ± 8.727 in Group 2 (P = 0.0181). The mean follow-up time was 38.7 months (22-60 months).
  
  
  RESULTS
  All of the foreskin flaps survived after the operation without necrosis. The overall complication rate was 24 % in Group 1 and 53.57 % in Group 2 (P = 0.0280). All the patients were also divided into two cohorts according to their ages in surgery. In the 0-10-yr cohort, there was a significant difference in the overall complication rate between the primary and secondary groups (P = 0.0173). But in the cases who were over 11 year old, there was no significant difference in the overall complications between two groups (P = 0.1603). Also no significant difference was found in the mean length of the urethral defect between two groups (P = 0.8312).
  
  
  CONCLUSIONS
  The Duckett technique is an optional choice for some older Chinese patients undergoing primary operations, but it has a higher complication rate in those who have undergone previous failed urethroplasties. The unsatisfactory results found in the reoperative group were supposed to be linked to the older age, the lack of subcutaneous flap coverage and local scar tissue, but not to the length of the urethral defect.
authors.affiliation: Department of Urology, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200011, People's Republic of China.
authors.forename: Da-chao
authors.initials: DC
authors.lastname: Zheng
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.forename: Mu-jun
authors.initials: MJ
authors.lastname: Lu
authors.forename: Qi
authors.initials: Q
authors.lastname: Chen
authors.forename: Yan-bo
authors.initials: YB
authors.lastname: Chen
authors.forename: Xiao-min
authors.initials: XM
authors.lastname: Ren
authors.forename: Hai-jun
authors.initials: HJ
authors.lastname: Yao
authors.forename: Ming-xi
authors.initials: MX
authors.lastname: Xu
authors.forename: Ke
authors.initials: K
authors.lastname: Zhang
authors.forename: Zhi-kang
authors.initials: ZK
authors.lastname: Cai
authors.forename: Zhong
authors.initials: Z
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D044466:Asian People; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D052816:Foreskin / Q000601:surgery; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D015994:Incidence; D008297:Male; D010413:Penis / Q000002:abnormalities* / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013524:Surgical Flaps; D014521:Urethra / Q000601:surgery; D013519:Urogenital Surgical Procedures / Q000379:methods*; D055815:Young Adult