Tunica vaginalis flap for urethrocutaneous fistula repair after proximal and mid-shaft hypospadias surgery: A 12-year experience

The commonest complication following hypospadias repair is occurrence of urethro-cutaneous stula(UCF) with a reported incidence of 4-25% 1. The expected stula rate is between 10% to 15% for onestage hypospadias surgery. UCF after hypospadias repair remains a signicant challenge for paediatric surgeons despite the advances in surgical techniques. Our aim is to assess the outcome of tunica vaginalis ap repair in cases of urethro-cutaneous stula. Our study included 23 patients who underwent UCF repair using TVF. Successful repair of these UCF depends on several basic principles, which are the avoidance of procedures on inamed tissue, correction of distal obstruction, a tension-free urethral closure with absorbable suture material, and covering of the urethral repair with well-vascularized tissue. From our study we feel that many complications mainly recurrent stula can be avoided using the above principles.

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Urethrocutaneous fistula repair after hypospadias surgery

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2004.03.019 ◽

2004 ◽

Vol 39 (5) ◽

pp. 789

Author(s):

M.N de la Hunt

Keyword(s):

Fistula Repair ◽

Urethrocutaneous Fistula ◽

Hypospadias Surgery

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A meta-analysis of tunica vaginalis fascia versus dartos fascia to prevent postoperative urethrocutaneous fistula in hypospadias and fistula repair

10.21203/rs.2.21473/v2 ◽

2020 ◽

Author(s):

Hao Yang ◽

Dong-lai Hu ◽

Xiao-xiao Xuan ◽

Hang Zhang ◽

Qiang Shu ◽

...

Keyword(s):

Comparative Studies ◽

Skin Necrosis ◽

Meta Analysis ◽

Wound Dehiscence ◽

Cochrane Library ◽

Fistula Repair ◽

Urethrocutaneous Fistula ◽

Tunica Vaginalis ◽

Intermediate Layers ◽

Registration Number

Abstract Background: Urethrocutaneous fistula (UCF) is the commonest postoperative complication in hypospadias and fistula repair. Several flap procedures have been recommended to decrease this complication rate, but no single flap procedure is ideal. The aim of this study was to compare the outcome of tunica vaginalis fascia (TVF) and dartos fascia (DF) as intermediate layers in prevention of the formation of UCF. Methods: We searched PubMed, EMBASE, the Cochrane Library and Web of Science for comparative studies up to July 1st, 2019. Studies were selected by the predesigned inclusion criterias. The primary outcomes was UCF incidence. Results: The pooled RR with 95% CI were calculated. We extracted the relevant informations from the included studie. 9 comparative studies were included The RR of UCF rate for TVF was 0.21 (95% CI: 0.09-0.51, P=0.0005) compared with DF in hypospadias and fistula repair. For other postoperative complications, the RR was 0.87 (0.28-2.70, P=0.80), 1.33 (0.41-4.35, P=0.64) and 0.17 (0.03-0.88, P=0.04) for meatal stenosis/ urethral stricture, glans dehiscence/ wound dehiscence and skin necrosis, respectively. Conclusions: This meta-analysis reveals that TVF is a better option in TIP repair as compared to DF in terms of decreasing the incidence of the UCF and skin necrosis. But there is limited for other hypospadias operative techniques and fistula repair. registration number: PROSPERO CRD42019148554

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Urethrocutaneous fistula repair after hypospadias surgery

BJU International ◽

10.1046/j.1464-410x.2003.04437.x ◽

2003 ◽

Vol 92 (6) ◽

pp. 621-623 ◽

Cited By ~ 24

Author(s):

M. Cimador ◽

M. Castagnetti ◽

E. De Grazia

Keyword(s):

Fistula Repair ◽

Urethrocutaneous Fistula ◽

Hypospadias Surgery

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Outcome of urethrocutaneous fistula repair after hypospadias surgery

Bangladesh Medical Journal Khulna ◽

10.3329/bmjk.v52i1-2.46140 ◽

2020 ◽

Vol 52 (1-2) ◽

pp. 3-6

Author(s):

Sahadeb Kumar Das ◽

Kaniz Hasina ◽

Md Ashraf Ul Huq ◽

SM Shafiqul Alam ◽

Syed Abdul Adil ◽

...

Keyword(s):

Small Sample ◽

P Value ◽

Urethrocutaneous Fistula ◽

Tunica Vaginalis ◽

Flap Coverage ◽

The Status ◽

Dartos Flap ◽

Hypospadias Surgery ◽

Surrounding Skin ◽

Better Than

Background: Urethrocutaneous fistula is the most prevalent complication after urethroplasty. Many methods have been developed for correction, and the best technique is determined based on the size, location, and number of fistulas, as well as the status of the surrounding skin. Objective: To compare the outcome of local dartos flap and tunnelled tunica vaginalis coverage in cases of repair of urethrocutaneous fistula. Materials and Methods: In the period of 2015-2018, 51 patients with 51 fistulas with an average age of 81.3 months (range 21-156 months) were classified into coronal-19, distal penile-11, mid penile-14, proximal penile-5 and penoscrotal-2. Thirty six patients were repaired with local dartos flap coverage and 15 patients were repaired with tunnelled tunica vaginalis coverage. Results: The repair was successful in all patients of tunica vaginalis coverage but 7 patients of dartos flap coverage developed recurrent fistulas (p value 0.066). There was no patient of scrotal complications. There were no statistically significant differences regarding age (p=0.83), location of fistula (p=0.40), size of fistula (p=0.29). Conclusions: Though the result of this study with such a small sample was not statistically significant, tunica vaginalis coverage seems to be better than dartos flap coverage in preventing recurrence. Bang Med J (Khulna) 2019; 52 : 3-6

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A meta-analysis of tunica vaginalis fascia versus dartos fascia to prevent postoperative urethrocutaneous fistula in hypospadias and fistula repair

10.21203/rs.2.21473/v1 ◽

2020 ◽

Author(s):

Hao Yang ◽

Dong-lai Hu ◽

Xiao-xiao Xuan ◽

Hang Zhang ◽

Qiang Shu ◽

...

Keyword(s):

Comparative Studies ◽

Skin Necrosis ◽

Meta Analysis ◽

Wound Dehiscence ◽

Cochrane Library ◽

Fistula Repair ◽

Urethrocutaneous Fistula ◽

Tunica Vaginalis ◽

Intermediate Layers ◽

The Cochrane Library

Abstract Background: Urethrocutaneous fistula (UCF) is the commonest postoperative complication in hypospadias and fistula repair. Several flap procedures have been recommended to decrease this complication rate, but no single flap procedure is ideal. The aim of this study was to compare the outcome of tunica vaginalis fascia (TVF) and dartos fascia (DF) as intermediate layers in prevention of the formation of UCF. Methods: We searched PubMed, EMBASE, the Cochrane Library and Web of Science for comparative studies up to July 1st, 2019. Studies were selected by the predesigned inclusion criterias. The primary outcomes was UCF incidence. Results: The pooled RR with 95% CI were calculated. We extracted the relevant informations from the included studie. 9 comparative studies were included The RR of UCF rate for TVF was 0.21 (95% CI: 0.09-0.51, P=0.0005) compared with DF in hypospadias and fistula repair. For other postoperative complications, the RR was 0.87 (0.28-2.70, P=0.80), 1.33 (0.41-4.35, P=0.64) and 0.17 (0.03-0.88, P=0.04) for meatal stenosis/ urethral stricture, glans dehiscence/ wound dehiscence and skin necrosis, respectively. Conclusions: This meta-analysis reveals that TVF is a better option in hypospadias and fistula repair as compared to DF in terms of decreasing the incidence of the UCF and skin necrosis.

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Urethrocutaneous Fistula Repair following Hypospadias Surgery using the PATIO Technique for Small Fistulae: A Single Centre Experience

Journal of Pediatric Urology ◽

10.1016/j.jpurol.2021.11.014 ◽

2021 ◽

Author(s):

Jas Singh

Keyword(s):

Fistula Repair ◽

Urethrocutaneous Fistula ◽

Single Centre ◽

Single Centre Experience ◽

Hypospadias Surgery

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