Application of Buck's fascia to restore the complete wrapping of the neourethra with corpus spongiosum in tubularized incised plate urethroplasty in hypospadias

Abstract

The aim of this study was to evaluate the outcome and complication rate of Buck's fascia used as the third coverage layer of the neourethra to restore the complete wrapping of the neourethra with corpus spongiosum in TIP surgery. 140 patients with hypospadias in our hospital from March 2016 to March 2018 were prospectively studied. Age range 9-48 months. All patients underwent TIP surgery to repair hypospadias. In the surgery corpus spongiosum tissues were sutured as the second coverage layer of the neourethra. Patients were randomly divided into two groups: group A (with dorsal dartos flap as the third coverage layer) and group B (with Buck's fascia as the third coverage layer). Complication rates were compared between two groups. There was no significant difference in the composition ratio of hypospadias between groups A and B (P > 0.05). All patients were followed up for 1 year. The incidence of complications in group A: urethrocutaneous fistula (11%), meatal stenosis (1.4%), partial glans dehiscence (5%) and wound infection (1.4%). The incidence of complications in group B: urethrocutaneous fistula (2%), meatal stenosis (2%), partial glans dehiscence (0%) and wound infection (0%). The occurrence rates of urethrocutaneous fistula and partial glans dehiscence of two groups were statistically significant (P < 0.05). Buck's fascia is easily available, needs minimal dissection. It is well vascularized, thick and has good tensile strength. Buck's fascia used as the third coverage layer of the neourethra in TIP can restore the complete wrapping of the neourethra with corpus spongiosum and regain normal anatomical structure of corpus spongiosum and corpora cavernosa. It is simple and very effective to prevent urethrocutaneous fistula and partial glans dehiscence.