Introduction: 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. Material and Method: 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 Q_max value was 17 ml/s and the Q_ave 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). Conclusion: 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.

Malignant melanoma caused by malignant transformation of melanocytes is associated with high mortality and is difficult to manage. Metastasis is not uncommon (up to 31% of all cases) and is closely associated with a poor prognosis. Although rare (4-5%), extracutaneous melanoma has been reported; however, primary malignant melanoma of the sacrum is extremely rare (only three case reports to date). Here, we present a 51-year-old patient who underwent surgical treatment for a lesion of the spinal canal and associated bony structures; extensive aggressive resection was required. She underwent partial sacrectomy and lumbo-iliac fixation (to maintain spinal stability). Pathology revealed malignant melanoma. We discuss the diagnosis, surgical intervention, and postoperative follow-up, which may assist clinicians. Although metastatic malignant melanoma is usually fatal, primary extracutaneous melanoma of the spine may respond well to surgery and adjuvant radiotherapy.