title: Correction of problematic hypospadias with dartos fascia-reinforced flap and slanted incision of fistula.
abstract: BACKGROUND
  Hypospadias is the most common congenital malformation of the male urinary tract, wherein the urethral opening is located proximal to the normal site. Tubularized incised-plate urethroplasty reconstruction, and its efficacy, remains controversial due to the high recurrence rate. This study aimed to evaluate the results of dartos fascia-reinforced flap surgery in hypospadias patients with previous operative complications.
  
  
  METHODS
  Nine patients (mean age, 12 years) who had previous one- or two-stage repair with TIP urethroplasty and suffered from urethrocutaneous fistulas or fissures as complications, underwent dartos fascia-reinforced flap surgery in our clinic between January 2010 and December 2012. The mean postoperative follow-up period was 6 months.
  
  
  RESULTS
  Among the 9 patients, 7 had complete correction. In all the patients, the maximum uroflow angle was >45°. No patient complained of an unnatural urinating position. The patients and parents gave very high satisfaction scores (4.7 points) with regard to the appearance of the outer genitalia.
  
  
  CONCLUSIONS
  The dartos fascia-reinforced flap could be a useful and reliable option for complications of hypospadias repair or fissure with the prepuce preserved, given that histological aspects vary and that the possibility of recurrence in the glanular region is high.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyungpook National University, Daegu, Korea.
authors.forename: Dong Sik
authors.initials: DS
authors.lastname: Choi
authors.forename: Jeong Woo
authors.initials: JW
authors.lastname: Lee
authors.forename: Jung Dug
authors.initials: JD
authors.lastname: Yang
authors.forename: Ho Yun
authors.initials: HY
authors.lastname: Chung
authors.forename: Byung Chae
authors.initials: BC
authors.lastname: Cho
authors.forename: Jin Suk
authors.initials: JS
authors.lastname: Byun
authors.forename: Kang Young
authors.initials: KY
authors.lastname: Choi
keywords: Fistula; Hypospadias; Surgical flaps; Urethra