The application of pedicled tunica vaginalis flap cover new urethra in redo and second-stage hypospadias repair

Abstract

Objective To investigate the application of pedicled tunica vaginalis flap cover new urethra in redo and second-stage hypospadias repair. Methods Retrospective analysis was performed in 45 redo hypospadias repair cases, aged from 1 year 3 months to 9 years 4 months (median 5 years 3month). All patients were divided into urethral dehiscence after hypospadias repair (group A) and the second stage surgery of two-stage hypospadias repair (group B) based on medical history. According to the site of dehiscence, the group A were further divided into midshaft urethral dehiscence (A1) and glans and distal urethral dehiscence with urethral opening located on midshaft (A2). After new urethra was completed, the appropriate size of the pedicledtunica vaginalis flap was transferred to cover the new urethra. Results There was no scrotal hematoma occurred in all 45 cases, and somecomplications occurred, including scrotal swelling in 1 case, high-riding testicle in 2 cases, penile clockwise torsion in 1 case, urethrocutaneous fistula in 6 cases. All the 45 cases were followed up for 1 to 4 years, with mean of 1.8 years. One more urethrocutaneous fistula occurred in group A2 and 1 more urethrocutaneous fistula with urethral stricture occurred in group B. There was no penile curvature and urethral diverticulum occurred in all cases. Conclusions Pedicled tunica vaginalis flap could be used as waterproofing layer to cover new urethra in redo hypospadias repair and presented a low incidence rate of postoperative complications. Key words: Hypospadias; Tunica vaginalis flap; Urethrocutaneous fistula