How to improve outcome in surgery for proximal hypospadias?

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. conclusion: the application of dartos facial flap waterproofing layer reduced fistula rate. © 2016,pakistan medical association. all rights reserved.