title: How to improve outcome in surgery for Proximal Hypospadias?
abstract: OBJECTIVE
  To evaluate the role of subdartos fascial tissue as watertight layer in improving outcome for 2-stage proximal hypospadias surgery.
  
  
  METHODS
  The experimental study was conducted at the Department of Urology, Indus Hospital, Karachi, and comprised an audit of patients with proximal hypospadias who underwent surgery from July 1, 2007, to December 31, 2011. The initial two-stage repair of proximal hypospadias led to a high rate of urethrocutanous fistula formation (Group A), and, thus, a modification was introduced and subdartos facial double layer was applied over the urethral suture line (Group B). The results were compared regarding age, type of hypospadias, graft failure and urethrocutanous fistula in these patients.
  
  
  RESULTS
  There were 27 patients in Group A and 16(59.3%) of them ended up having urethrocutanous fistula. Group B had 25 patients and only 2(8%) had fistula formation.
  
  
  CONCLUSIONS
  The application of dartos facial flap waterproofing layer reduced fistula rate.
authors.affiliation: Department of Urology, Indus Hospital Karachi, Pakistan.
authors.forename: Abdul Hafeez
authors.initials: AH
authors.lastname: Qureshi
authors.affiliation: Department of Urology, Indus Hospital Karachi, Pakistan.
authors.forename: Syed Zafar
authors.initials: SZ
authors.lastname: Zaidi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007021:Hypospadias / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D016038:Skin Transplantation / Q000009:adverse effects / Q000379:methods; D013524:Surgical Flaps / Q000009:adverse effects; D014521:Urethra / Q000002:abnormalities / Q000000981:diagnostic imaging; D014548:Urinary Fistula / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods
keywords: Severe hypospadias, Dartos fascial flap, Urethrocutanous fistula.