Mohammed H Aldabbagh
Duhok University, Iraq
Title: The role of tunica vaginalis flap as a supportive additional layer in the repair of proximal hypospadias
Biography
Biography: Mohammed H Aldabbagh
Abstract
Aim: To evaluate the role of tunica vaginalis flap in preventing fistula formation of severe hypospadias (like scrotal hypospadias)
repair and problems related to its use.
Patients & Methods: Between 2016 and 2017 five children with scrotal hypospadias were operated on. Only severe cases were
treated with this method other simpler and more common cases were treated by different surgeries like Snodgrass technique.
The age range was 2 to 16 years. All of them had two staged repair, the first stage was correcting the chordae by incising the
urethral plate then covering the bare shaft with dorsal flaps. The tunica flap was used in the second stage which was done 6 to 12
months later. The neo urethra was created by tabularizing the local skin flaps, and then a 2nd layer added from the surrounding
tissues. The edge of the wound elevated toward the scrotum subcutaneous tunnel created. Tunica vaginalis vascularized flap
then created from one side left or right tunica. The flap then passed under the sin toward the ventral penile site and used to
cover the neourethra. The cremasteric muscles were not excluded from the flap. The skin closed over the flaps. Folly's catheter
was used for ten to fourteen days after surgery. And the patients were followed for a variable time three months to two years
period for the development of complications like fistula formation or stricture. Cosmetic considerations were also noted.
Results: All the five patients had scrotal type hypospadias. After surgery all patients had neither fistula formation nor stricture,
with good cosmetic outcome. No post-operative penile torsion was noted. One patient developed local infection treated
conservatively, one patient had partial glanular dehiscence at the distal end which had no clinical significance.
Conclusions: Using tunica vaginalis vascularized flap to cover the new urethra in severe proximal hypospadias during the
second stage seems to be a successful way in preventing fistula formation without increasing the patient's morbidity.