title: Our Experience with a Double-Layer Surgical Technique for Preventing Fistula Development in Children and Young Adults with Hypospadias.
abstract: BACKGROUND
  In this study, we describe a new approach called the double-layer on and prepucial flap technique in order to prevent fistula or fissure development.
  
  
  METHODS
  Twenty-seven patients with subcoronal hypospadias were enrolled. The prepared prepucial flap was divided into two equal parts. A double-layer flap was formed and used for reinforcing of the neourethra. Uroflowmetric analysis was used for evaluating the urethral stricture at the end of the first year. A blinded urologist and the patients' themselves evaluated the aesthetic appearance.
  
  
  RESULTS
  The mean age was 12.17 ± 2.79. All cases were primary. All evaluated parameters were at the end of the first year. Only three (3/27, 11.1%) of the patients had minimal external mea stricture that managed with urethral dilatation. None of them had any fistula, fissure, or dehiscence as well as infection and hematoma. The mean Qmax value was 17 ml/s and the Qave value was 9 ml/s. The mean scores with standard deviations with regard to the appearance of the patients' penis before and after operations were 3.08 ± 0.77 and 8.25 ± 0.73, respectively and this difference was statistically significant (p < 0.001).
  
  
  CONCLUSIONS
  The double-layer dartos flap technique is a candidate to be the least risky technique to prevent complications as well as to increase the aesthetic appearance up to satisfactory levels.
authors.affiliation: Kafkas University, School of Medicine, Urology Department, Kars, Turkey.
authors.forename: Aslan
authors.initials: A
authors.lastname: Demir
authors.forename: Mert Ali
authors.initials: MA
authors.lastname: Karadağ
authors.forename: Kürşat
authors.initials: K
authors.lastname: Çeçen
authors.forename: Mehmet
authors.initials: M
authors.lastname: Uslu
authors.forename: Ömer Erkam
authors.initials: ÖE
authors.lastname: Arslan
mesh_terms: D000293:Adolescent; D002648:Child; D005402:Fistula / Q000517:prevention & control* / Q000601:surgery; D006406:Hematoma / Q000601:surgery; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D010413:Penis / Q000601:surgery; D011446:Prospective Studies; D012212:Rheology; D013524:Surgical Flaps; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery; D013521:Urologic Surgical Procedures, Male / Q000379:methods*; D014572:Urology / Q000379:methods; D055815:Young Adult