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DOI: 10.4103/0970-0358.163059
Tunica vaginalis flap following ‘Tubularised Incised Plate’ urethroplasty to prevent urethrocutaneous fistulaa
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Publikationsverlauf
Publikationsdatum:
26. August 2019 (online)
ABSTRACT
Introduction: Surgery for hypospadias has been continuously evolving, implying thereby that no single technique is perfect and suitable for all types of hypospadias. Snodgrass technique is presently the most common surgical procedure performed for hypospadias. Materials and Methods: We analysed the results of tunica vaginalis flap (TVF) as an additional cover to the tubularised incised plate (TIP) repair. Results: A total of 35 patients of hypospadias were repaired using TIP urethroplasty and TVF as a second layer. Mean age at the time of presentation was 6.63 ± 3.4 years. Post-operative complications namely wound infection, flap necrosis, scrotal haematoma, scrotal abscess, urethral fistula, meatal stenosis were recorded and analysed during follow-up period. Need for re-do surgery was considered as failure of the operative procedure. Out of 35 patients, 8 (22.85%) patients had proximal penile hypospadias and 27 (77.14%) patients had distal penile hypospadias. Mean post-operative follow-up was 24.53 months. During the follow-up complications noticed included wound infection (n = 2), urethrocutaneous fistula (n = 1) and meatal stenosis (n = 1). Wound infection was managed with appropriate antibiotics as per hospital policy/culture and sensitivity reports. Meatal stenosis responded to bougie dilatation/calibration during follow-up. Conclusion: To conclude, TVF as an additional cover is associated with an acceptable complication rate and good cosmetic results if performed with meticulous tissue handling.
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Conflicts of interest
There are no conflicts of interest.
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REFERENCES
- 1 Snodgrass W. Tubularised, incised plate urethroplasty for distal hypospadias. J Urol 1994; 151: 464-5
- 2 Yang SS, Chen SC, Hsieh CH, Chen YT. Reoperative Snodgrass procedure. J Urol 2001; 166: 2342-5
- 3 Snow BW. Use of tunica vaginalis to prevent fistulas in hypospadias surgery. J Urol 1986; 136: 861-3
- 4 Dhua AK, Aggarwal SK, Sinha S, Ratan SK. Soft tissue covers in hypospadias surgery: Is tunica vaginalis better than dartos flap?. J Indian Assoc Pediatr Surg 2012; 17: 16-9
- 5 Steckler RE, Zaontz MR. Stent-free Thiersch-Duplay hypospadias repair with the Snodgrass modification. J Urol 1997; 158 (03) Pt 2 1178-80
- 6 Duckett Jr JW, Kaplan GW, Woodard JR, Devine Jr CJ. Panel: Complications of hypospadias repair. Urol Clin North Am 1980; 7: 443-54
- 7 Ahmed S, Gough DC. Buccal mucosal graft for secondary hypospadias repair and urethral replacement. Br J Urol 1997; 80: 328-30
- 8 Smith D. A de-epithelialised overlap flap technique in the repair of hypospadias. Br J Plast Surg 1973; 26: 106-14
- 9 Furness 3 rd PD, Hutcheson J. Successful hypospadias repair with ventral based vascular dartos pedicle for urethral coverage. J Urol 2003; 169: 1825-7
- 10 Tavakkoli Tabassi K, Mohammadi S. Tunica vaginalis flap as a second layer for tubularised incised plate urethroplasty. Urol J 2010; 7: 254-7
- 11 Routh JC, Wolpert JJ, Reinberg Y. Tunneled tunica vaginalis flap is an effective technique for recurrent urethrocutaneous fistulas following tubularised incised plate urethroplasty. J Urol 2006; 176 (04) Pt 1 1578-80
- 12 Chatterjee US, Mandal MK, Basu S, Das R, Majhi T. Comparative study of dartos fascia and tunica vaginalis pedicle wrap for the tubularised incised plate in primary hypospadias repair. BJU Int 2004; 94: 1102-4
- 13 Snow BW, Cartwright PC, Unger K. Tunica vaginalis blanket wrap to prevent urethrocutaneous fistula: An 8-year experience. J Urol 1995; 153: 472-3
- 14 Braga LH, Lorenzo AJ, Salle JL. Tubularised incised plate urethroplasty for distal hypospadias: A literature review. Indian J Urol 2008; 24: 219-25
- 15 Snodgrass WT. Editorial comment. J Urol 2007; 178: 1456
- 16 Guralnick ML, al-Shammari A, Williot PE, Leonard MP. Outcome of hypospadias repair using the tubularised, incised plate urethroplasty. Can J Urol 2000; 7: 986-91
- 17 Landau EH, Gofrit ON, Meretyk S, Katz G, Golijanin D, Shenfeld OZ. et al. Outcome analysis of tunica vaginalis flap for the correction of recurrent urethrocutaneous fistula in children. J Urol 2003; 170 (04) Pt 2 1596-9
Address for correspondence:
-
REFERENCES
- 1 Snodgrass W. Tubularised, incised plate urethroplasty for distal hypospadias. J Urol 1994; 151: 464-5
- 2 Yang SS, Chen SC, Hsieh CH, Chen YT. Reoperative Snodgrass procedure. J Urol 2001; 166: 2342-5
- 3 Snow BW. Use of tunica vaginalis to prevent fistulas in hypospadias surgery. J Urol 1986; 136: 861-3
- 4 Dhua AK, Aggarwal SK, Sinha S, Ratan SK. Soft tissue covers in hypospadias surgery: Is tunica vaginalis better than dartos flap?. J Indian Assoc Pediatr Surg 2012; 17: 16-9
- 5 Steckler RE, Zaontz MR. Stent-free Thiersch-Duplay hypospadias repair with the Snodgrass modification. J Urol 1997; 158 (03) Pt 2 1178-80
- 6 Duckett Jr JW, Kaplan GW, Woodard JR, Devine Jr CJ. Panel: Complications of hypospadias repair. Urol Clin North Am 1980; 7: 443-54
- 7 Ahmed S, Gough DC. Buccal mucosal graft for secondary hypospadias repair and urethral replacement. Br J Urol 1997; 80: 328-30
- 8 Smith D. A de-epithelialised overlap flap technique in the repair of hypospadias. Br J Plast Surg 1973; 26: 106-14
- 9 Furness 3 rd PD, Hutcheson J. Successful hypospadias repair with ventral based vascular dartos pedicle for urethral coverage. J Urol 2003; 169: 1825-7
- 10 Tavakkoli Tabassi K, Mohammadi S. Tunica vaginalis flap as a second layer for tubularised incised plate urethroplasty. Urol J 2010; 7: 254-7
- 11 Routh JC, Wolpert JJ, Reinberg Y. Tunneled tunica vaginalis flap is an effective technique for recurrent urethrocutaneous fistulas following tubularised incised plate urethroplasty. J Urol 2006; 176 (04) Pt 1 1578-80
- 12 Chatterjee US, Mandal MK, Basu S, Das R, Majhi T. Comparative study of dartos fascia and tunica vaginalis pedicle wrap for the tubularised incised plate in primary hypospadias repair. BJU Int 2004; 94: 1102-4
- 13 Snow BW, Cartwright PC, Unger K. Tunica vaginalis blanket wrap to prevent urethrocutaneous fistula: An 8-year experience. J Urol 1995; 153: 472-3
- 14 Braga LH, Lorenzo AJ, Salle JL. Tubularised incised plate urethroplasty for distal hypospadias: A literature review. Indian J Urol 2008; 24: 219-25
- 15 Snodgrass WT. Editorial comment. J Urol 2007; 178: 1456
- 16 Guralnick ML, al-Shammari A, Williot PE, Leonard MP. Outcome of hypospadias repair using the tubularised, incised plate urethroplasty. Can J Urol 2000; 7: 986-91
- 17 Landau EH, Gofrit ON, Meretyk S, Katz G, Golijanin D, Shenfeld OZ. et al. Outcome analysis of tunica vaginalis flap for the correction of recurrent urethrocutaneous fistula in children. J Urol 2003; 170 (04) Pt 2 1596-9