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Vol. 45. Issue 8.
Pages 552-556 (October 2021)
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Vol. 45. Issue 8.
Pages 552-556 (October 2021)
Original article
The tunica-vaginalis flap to prevent postoperative fistula following severe hypospadias repair: Has the search for Holy Grail ended?
Colgajo de túnica vaginal en la prevención de fístulas postoperatorias tras reparación de hipospadias severos: ¿ha terminado la búsqueda del Santo Grial?
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C.N. Radhakrishnana, V. Radhakrishnab,
Corresponding author
vbrps2016@gmail.com

Corresponding author.
a Department of Paediatric Surgery, Manipal Hospital, Bengaluru, India
b Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, India
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Table 1. Complications of urethroplasty.
Abstract
Introduction

Fistula following hypospadias repair remains a bane of the hypospadiologist resulting in the evolution of various techniques. Despite all these, the incidence of postoperative fistula varies from 10 to 30% and it increases with the severity of the hypospadias. Hence, a study was conducted to evaluate the efficacy of tunica vaginalis flap in preventing fistula formation following severe hypospadias repair.

Materials and methods

An observational study was carried out in a tertiary center between 2008 and 2017. The study included children with severe hypospadias (Proximal penile, Penoscrotal, scrotal, and Perineal). In all the patients, a Tunica-Vaginalis flap was used to buttress the urethroplasty. All the patients were followed up for at least a year after the completion of treatment.

Results

A total of 210 patients were included in the study. Bracka’s two-stage repair was performed in 180 patients who had either Penoscrotal hypospadias or a meatus even more proximal. The rest 30 patients with proximal penile hypospadias underwent a single-stage Snodgrass repair. Four (2%) patients developed a fistula, all following two-stage repairs, and half of them required surgical repair. Two (1%) patients had a partial breakdown of repair and underwent a residual repair after six months.

Conclusion

The Tunica-Vaginalis flap is an excellent buttress in severe hypospadias repair. It is readily available, easy to harvest, with its good vascularity helps to significantly reduce the incidence of postoperative fistula.

Keywords:
Hypospadias
Tunica-vaginalis flap
Urethro-cutaneous fistula
Resumen
Introducción

La fístula posterior a la reparación del hipospadias sigue siendo un desafío para el hipospadiólogo, por lo que se han desarrollado diversas técnicas. Sin embargo, la incidencia de la fístula postoperatoria sigue estando entre el 10 y el 30%, y aumentando de acuerdo con la severidad del hipospadias. Hemos realizado un estudio para evaluar la eficacia del colgajo de túnica vaginal en la prevención de la formación de fístulas tras la reparación de casos severos de hipospadias.

Materiales y métodos

Se realizó un estudio observacional en un centro terciario entre 2008 y 2017. El estudio incluyó a niños con hipospadias severos (proximal, penoescrotal, escrotal y perineal). En todos los pacientes se usó un colgajo de túnica vaginal para reforzar la uretroplastía. Todos los pacientes recibieron seguimiento durante al menos un año tras finalizar el tratamiento.

Resultados

Se incluyó un total de 210 pacientes en el estudio. Se realizó reparación en dos etapas de Bracka en 180 pacientes con hipospadias penoescrotal o un meato aún más proximal. Los 30 pacientes restantes con hipospadias proximales se sometieron a la reparación de Snodgrass de una sola etapa. Cuatro (2%) pacientes desarrollaron fístulas, todos después de la reparación en dos etapas, y la mitad de ellos requirieron corrección quirúrgica. Dos (1%) pacientes tuvieron una avería parcial de la reparación y se sometieron a una reparación residual a los seis meses.

Conclusión

El colgajo de túnica vaginal es un excelente refuerzo en la reparación de hipospadias severos. Es fácilmente accesible, fácil de extraer, y su buena vascularización ayuda a reducir significativamente la incidencia de fistulización postoperatoria.

Palabras clave:
Hipospadias
Colgajo de túnica vaginal
Fístula uretrocutánea

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