Tunica Vaginalis Flap as a Second Layer for Tubularized Incised Plate Urethroplasty

Abstract

PURPOSE: To investigate the success rate of Snodgrass method in combination with tunica vaginalis flap as the second layer for hypospadias repair. MATERIALS AND METHODS: In a prospective study, 33 patients with penile hypospadias who were treated using a Tubularized Incised Plate Urethroplasty (Snodgrass method) and vascularized tunica vaginalis flap as a second layer, were evaluated. Wound infections, meatal stenosis, and urethrocutaneous fistula were considered as treatment complications. Success rates of surgery were recorded. Failure was defined as need for re-operation. RESULTS: The mean age of the patients was 9.93 ± 4.4 years (range, 1.5 to 18 years). The mean follow-up was 8.79 ± 5.43 months (range, 6 months to 5 years). Four patients were lost to follow-up and excluded from the study. The location of hypospadias was distal penile in 17 patients (59%) and midpenile in 12 (41%). Of studied patients, 3, 2, and, 1 developed fistula, wound infection, and meatal stenosis, respectively. Two subjects with meatal stenosis and one with wound infection were managed conservatively. CONCLUSION: Snodgrass technique in combination with tunica vaginalis flap as a second layer is a reasonable procedure for hypospadias repair because of good cosmetic appearance and acceptable complication rates. Currently, fistula formation remains the most common complication of this technique, which often needs surgical repair.

Keywords

• urethra
• urethral stricture
• hypospadias
• surgical flaps
• graft survival
• reconstructive surgical procedure