Tunica Vaginalis Flap Repair for Urethrocutaneous Fistulae

Abstract

Introduction: Hypospadias is a common condition which needs to be repaired within the first few years of life. However, the surgery is usually associated with several complications of which Urethrocutaneous Fistula (UCF) is the most common. Several surgical techniques have been described to correct these UCF. Use of a vascularized flap to repair this fistula is the current standard. Aim: To assess the feasibility of using tunica vaginalis flap in repair of UCFs. Materials and Methods: The present study was an observational study where 32 patients with UCF resulting from a previous failed hypospadias repair were subjected to tunica vaginalis flap repair. These patients were followed-up to a mean duration of 18 months to look for recurrence of fistula and other fresh complications. Results: The study included 32 patients of whom 19 had a fistula after primary surgery, 9 had undergone 2 failed surgeries and 4 had undergone 3 previous attempts at hypospadias repair. Majority (29 patients) had a single UCF. No scrotal haematoma or testicular complications were noted. Penile cosmesis was satisfactory as determined by HOSE scoring system. Erection seemed to be unaffected but could be a spurious result as majority of the patients were of pre-pubertal age. After median follow-up of 18 months, two cases had recurrence of fistula; both occurred within 1 month of the surgery. Conclusion: Tunica vaginalis interposition flap repair of urethrocutneous fistula has good outcome.

Keywords

• dartos flap
• fistula
• hypospadias