title: Coverage of urethroplasty in pediatric hypospadias: randomized comparison between different flaps.
abstract: OBJECTIVE
  The use of covering urethroplasty with flaps in hypospadias surgery has been well recommended. Various techniques have been described for flap harvesting. The aim of the present study was to compare the outcome and complication rate of dorsal preputial flaps and ventral dartos flaps.
  
  
  METHODS
  A total of 130 patients were prospectively evaluated from January 2008 to December 2011. Using the tubularized incised plate urethroplasty procedure, urethroplasty was carried out by a single surgeon. Patients were randomly divided in two groups: group A (57 patients), in which a preputial flap was carried out using three different techniques; and group B (73 patients), in which a single or a double ventral dartos flap was used.
  
  
  RESULTS
  A total of 41 complications occurred in 24 patients. Urethrocutaneous fistulas were observed in 14.9%, quite equally distributed between groups A and B. There was only one urethrocutaneous fistula in a patient treated with the double ventral dartos flaps. Five cases (3.8%) of glans dehiscence were observed: four after single ventral dartos flap and one after dorsal preputial flap. Six patients in group A and seven in group B experienced meatal stenosis. In three cases of iatrogenic torsion of the penis, a dorsal preputial flap was laterally transposed. Finally, a lower complication rate was observed for double ventral dartos flap versus the other techniques.
  
  
  CONCLUSIONS
  The use of a double ventral dartos flap should represent the first-line technique for coverage of distal urethroplasty.
authors: Section of Pediatric Urology, Pediatric Surgical Unit, Department of Mother and Child Care, University of Palermo, Palermo, Italy.
authors: Marcello
authors: M
authors: Cimador
authors: Marco
authors: M
authors: Pensabene
authors: Maria
authors: M
authors: Sergio
authors: Pieralba
authors: P
authors: Catalano
authors: Enrico
authors: E
authors: de Grazia
mesh_terms: D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000209:etiology; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D008297:Male; D010413:Penis / Q000601:surgery*; D011446:Prospective Studies; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000209:etiology; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014548:Urinary Fistula / Q000209:etiology; D013521:Urologic Surgical Procedures, Male / Q000379:methods*
keywords: coverage flap; hypospadias; pediatrics