Role of tunica vaginalis interposition layer in hypospadias surgery

ABSTRACT

Hypospadias surgery has evolved with more than 150 procedures for surgical correction of single anomaly .urethro-cutaneous fistula continues to be single most common complication of regardless of location of meatus, procedure performed and experience of surgeon. Every effort goes in prevention of this complication including overlapping suture line. Two stage repair, burying repaired urethra in scrotum, dartose flap. Parietal layer of tunica vaginalis from testis as a water proofing layer over reconstructed neo urethra decreasing fistula rate. Unlike dissection of dartose layer which can damage blood supply of overlying skin with impaired wound healing, tunica vaginalis brings vascular supply from outside source hence helping in healing of suture line of neo-urethra. Study of effectiveness of tunica vaginalis flap covering different hypospadias procedures in 126 cases over 6 years is presented with inference of significant decrease of urethra-cutaneous fistula rate.

KEY WORDS

Hypospadias - fistula - tunica vaginalis flap

• 1 Hodgson NB. History of hypospadias repair, Reconstructive and plastic surgery of the external genitalia adult and pediatric. WB Saunders Company; 1999: p. 16
• 2 Belman AB. In Kelalis PP, King LR, Belmanab B. (editors) Urethra Clinical Paediatric Urology. 2nd. ed WB Saunders; 1985: p. 781
• 3 Culp OS. Experience with 200 hypospadias: Evolution of a therapeutic plan. Surg Clin North Am 1959; 39: 1007-23
• 4 Retic AB, Mandell J, Bauer SB, Atala A. Meatal based hypospadias repair with use of dartos sub-cutaneaous flap to prevent urethra-cutaneous fistula. J Urol 1994; 152: 1229-31
• 5 Gittes RF, Mclaughlin 3rd AP. Injection technique to induce penile erection. Urology 1974; 4: 473-4
• 6 Smith ED. Durham smith repair of hypospadias. Urol Clinic North Am 1981; 8: 451-5
• 7 Retic AB, Keating M, Mandell J. Complications of hypospadias repair. Urol Clin North Am 1988; 15: 223-6
• 8 Durham SE. Hypospadias. In Ashcraft K. (editor) Pediatric urology. WB Saunders; Philadelphia: 1990: p. 353-95
• 9 Shapiro SR. History of hypospadias repair, reconstructive and plastic surgery of the external genitalia adult and pediatric. WB Saunders Company; 1999: p. 132
• 10 Smith ED. Durham smith repair of hypospadias. Urol Clin North Am 1981; 8: 451-5
• 11 Shanker KR, Losty PD, Hopper M, Wong L, Rickwood AM. Outcome of hypospadias fistula repair. BJU Int 2002; 89: 103-5
• 12 Richter F, Pintopa P, Stock JA, Hanna MK. Management of recurrent urethral fistulas after hypospadias repair. Urology 2003; 61: 448-51
• 13 Snow BW, Cartwright PC, Unger K. Tunica vaginalis blanket wrap to prevent urethra-cutaneous fistulas an eight year experience. J Urol 1995; 153: 472-3
• 14 Baskin S. Laurencepenile curvature reconstructive and plastic surgery of the external genitalia adult and pediatric. WB Saunders Company; 1999: p. 23
• 15 Das S, Maggio AJ. Tunica vainalis autografting for Peyronie’s disease. An experimental study. Invest Urol 1979; 17: 186-7
• 16 Snow BW, Cartwright PC. Tunica Vaginalis Blanket wrap, reconstructive and plastic surgery of the external genitalia adult and paediatric. WB Saunders Company; 1999: p. 112
• 17 Duckett JW. Campbell’s urology. 7th ed. WB Saunder Company; 1998: p. 2114