APPLICATION OF TUNICA VAGINALIS INTERPOSITIONAL FLAP IN REPAIR OF URETHROCUTANEOUS FISTULAE AFTER HYPOSADIAS REPAIR

Abstract

Urethrocutaneous fistula is the commonest complication of
hypospadias surgery. The reported incidence varies from 2% to 17% in some series. As popularization
of tubularized incised plate eliminate using of healthy dartos flap as interpositional layer in repair of
fistula, tunica vaginalis can provide an excellent source for well vascularized, non fibrotic flap, being
unaffected layer and away from primary site of hypospadias repair. Patients and methods: Eighteen
patients with mean age 5.6yaers (range 3 to 8) with urethrocutaneous fistulae after repair of
hypospadias were treated with our elected technique, for every patient a record of the numbers ,site,
previous attempt for repair of the fistulae, original preoperative site of meatus, other penile
complications ,the technique and date of hypospadias repair were reported. All operations were done
under general anaesthesia and magnification (3.5x) .After identification of the site of fistulae they
were excised sharply down to the urethral mucosa and closed transversely. The tunicas were
approached through 2 cm transverse incision at penosecrotal junction for the distal fistulae, or through
the same incision around the fistula if it was a proximal penile one and flaps from parietal layer of
tunicas were harvested according to the location of fistulae then they were tunneled under the penile
skin to the site of fistula where they were tacked to corporal tissue and the penile skin was closed.
Results: Our patients were followed for a mean of 39 months (20-51) with no report of fistula
recurrence in any patient , also complications such as testicular fixation, hematomas, urethral stricture,
ventral chordee or cosmetic complication were not reported. Conclusion: using tunica vaginalis flap is
a simple and reliable method for correction of post hypospadias fistulae