Tunica vaginalis flap cover in repair of recurrent proximal urethrocutaneous fistula: A final solution

Abstract

Background: The objective of this study was to assess the significance of tunica vaginalis flap cover in cases of recurrent proximal penile fistula. Materials and Methods: This retrospective study included complicated cases of proximal penile hypospadias with recurrent fistula. Recurrent fistula was defined as fistula after at least two previous attempts of closure. Group 1 included cases with tunica vaginalis flap and Group 2 included cases with local flap. Outcome was assessed at day 10 after stent removal and at first follow-up. Fistula closure was considered successful in case with no leak. Results: Out of 39 cases of recurrent fistulas, 20 cases in Group 1 and 18 cases in Group 2 formed the study group. The mean age at fistula repair was 7.2 ± 0.9 years (range: 2.1-12 years) and 7.1 ± 0.7 years (range: 2.3-12 years) in Group 1 and 2 respectively. Leak at the time of stent removal was present in 1/20 (5%) and 3/18 (16.67%) cases in Group 1 and 2 respectively (P = 0.04). Leak at the time of first follow-up was present in 2/20 (10%) and 4/18 (22.22%) cases in Group 1 and 2 respectively (P = 0.03). Complete disruption of fistula closure was present in 1/20 (5%) and 2/18 (11.11%) cases in Group 1 and Group 2 respectively (P = 0.1). The overall success rate in Group 1 and 2 was 16/20 (80%) and 9/18 (50%) respectively (P = 0.01). Conclusions: Tunica vaginalis flap reinforcement is a viable and reliable option. With proper use cases of recurrent fistula can be managed successfully.

Keywords

• Leak
• local flaps
• recurrent fistula
• tunica vaginalis flap