The tunica-vaginalis flap to prevent postoperative fistula following severe hypospadias repair: Has the search for Holy Grail ended?

Autor: Radhakrishnan CN; Department of Paediatric Surgery, Manipal Hospital, Bengaluru, India., Radhakrishna V; Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, India. Electronic address: vbrps2016@gmail.com.
Jazyk: English; Spanish; Castilian
Zdroj: Actas urologicas espanolas [Actas Urol Esp (Engl Ed)] 2021 Oct; Vol. 45 (8), pp. 552-556. Date of Electronic Publication: 2021 Sep 14.
DOI: 10.1016/j.acuroe.2021.07.005
Abstrakt: 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.
(Copyright © 2021. Published by Elsevier España, S.L.U.)
Databáze: MEDLINE
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