The outcome of Tunica Vaginalis flap in Hypospadias repair

Abstract

Background: Putting vascularized flaps over the neourethra is indicated in hypospadias surgery. This will lessen the complications rate, mostly the  urethrcutaneous  fistula,  this  is  more  indicated  in  secondary  and complicated cases. 
The study’s Aim:  To assess our initial experience with tunica vaginalis flap (TVF) in proximal primary and secondary hypospadias. 
Materials and methods: This study prospectively included secondary and primary proximal hypospadias which are corrected using tubularized incised  plate  (TIP).  The  age  of  the  patient,  type  of  hypospadias, complications of primary repair, complications of our repair and the follow up results were reported. 
Results: Between December 2011 to December 2018, 33 children with primary proximal or failed cases were repaired using TIP with the use of (TVF) interposition. Seventeen cases were primary with peno-scrotal opening repaired by single stage (Group A).
Sixteen cases were secondary hypospadias (Group B), 5 of them had distal opening as their original pathology while the remaining 11 cases had  peno-scrotal  opening  with  complete  dehiscence  of  the  previous repair. 
The follow-up time extended from 2 to 60 months, Group A (n=17); 4 cases (23%) developed Urethral fistula and 2 cases (12%) developed Meatal Stenosis. While in Group B (n=16); 3 cases (19%) developed fistula and 3 cases (19%) developed Meatal Stenosis. Only one case (6%)  developed  glandular  dehiscence.  The  scrotum  was  obviously normal in both groups. 
Conclusion:  TVF looks to be good interposition layer and good option in crippled and proximal hypospadias. It is a vascularized layer that could cover any urethroplasty length.