title: Urethroplasty by use of turnover flaps (modified mathieu procedure) for distal hypospadias repair in adolescents: comparison with the tubularized incised plate procedure.
abstract: OBJECTIVE
  The purpose of this study was to examine whether urethroplasty with a turnover flap, as an alternative method of distal hypospadias repair in adolescents, improves the outcome of surgery.
  
  
  METHODS
  Between January 2004 and December 2013, a total of 38 adolescents (aged 11-17 years) underwent distal hypospadias repair with either the tubularized incised plate (TIP) procedure (n=25) or the turnover flap procedure (n=13). The turnover flap procedure was performed with a proximal, ventral penile flap that was turned over to cover the urethral plate. Patient demographics, perioperative outcomes, complications, and postoperative uroflowmetry in each surgical group were analyzed retrospectively.
  
  
  RESULTS
  The patient demographics were similar in the two groups. There were no significant differences in perioperative outcomes between the groups, including mean operative time, duration of hospital stay, and urethral catheterization. The number of patients with at least one complication, including wound dehiscence, urethrocutaneous fistula, meatal stenosis, and urethral stricture, was lower in the turnover flap group (1/13, 7.7%) than in the TIP group (11/25, 44%, p=0.030). The incidence of meatal stenosis was lower in the turnover flap group (0/12, 0%) than in the TIP group (6/25, 24%). In postoperative uroflowmetry, the plateau-shaped curve rate was lower in the turnover flap group (1/12, 8.3%) than in the TIP group (5/19, 26.3%); the peak flow was higher (p=0.030).
  
  
  CONCLUSIONS
  The turnover flap procedure is clinically useful for repairing adolescent distal hypospadias because it offers lower complication rates and better functional outcomes than TIP.
authors.affiliation: Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Seong Ho
authors.initials: SH
authors.lastname: Bae
authors.affiliation: Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Jun Nyung
authors.initials: JN
authors.lastname: Lee
authors.affiliation: Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Hyun Tae
authors.initials: HT
authors.lastname: Kim
authors.affiliation: Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Sung Kwang
authors.initials: SK
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013536:Suture Techniques / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*; D014945:Wound Healing
keywords: Adolescent; Complications; Hypospadias