RESUMEN
Interposing vascularized flaps between the urethra and the skin sutures is recommended in hypospadias surgery. This decreases the rate of complications; mainly urethrocutaneous fistula. Although this is more needed in redo complicated cases, yet this is not always possible. The aim of this study was to evaluate our experience with the tunica vaginalis flap [TVF] and compare it with the use of the adjacent local para-urethral tissue as a second layer cover in complicated redo cases of proximal hypospadias. This is a retrospective study of the redo correction of proximal hypospadias cases with failed previous repairs, comparing the use TVF [group I] and the adjacent local para-urethral tissue [group II], as a second layer cover. The study included only the cases corrected by the modified Theirsch-Duplay technique. The age of the patients, types of hypospadias, the complications after the 1ry repair, the follow-up results were reported. Between 1999 and 2006, 26 children with failed previous repairs of proximal hypospadias were corrected using the modified Theirsch-Duplay technique. Eleven cases had scrotal and 15 had proximal penile hypospadias as their original pathology. Nine cases presented with complete disruption and 17 with partial disruption of the primary repairs. During the follow-up period [6-24; mean 9 months], in group I; [n=12 cases] 3 cases [25%] developed urethrocutaneous fistula and 1 case developed partial disruption, whereas in group II; [n=14 cases] 4 cases [29%] developed fistula, 2 partial disruption [14%] and 1 complete disruption [7%]. In group I, the appearance of the scrotum was almost normal in all cases. TVF is a good option that should always be kept in mind in redo complicated cases of hypospadias. When the local tissues seem to be scarred, it offers a second-layer cover that is properly vascularized, virgin and with mostly any length that might be needed