Multiple tissue transfer to minimise fistulization of hypospadias repair

ABSTRACT

In this study, various tissue flaps from local donor sites were used to minimize fistulization of the reconstructed urethra in 45 cases with complex hypospadius repair. Primary one stage repair was performed in 28 cases and secondary reconstruction was done for 17 cases with previous failed repairs. For redo cases, wrapping of the reconstructed urethra by pedicled tunica vaginalis flap was performed for eight cases and by scrotal dartos flap in nine cases. In the remaining 28 cases, primary urethral reconstruction was performed in the usual way [onlay island preputial flaps with intact urethral plate in 18 cases and tubularized pedicled preputial flaps with division of the plate in 10 cases]. After urethral reconstruction, the splayed spongiosum was mobilized distally and wrapped around the repaired urethra in those cases with intact urethral plate. The redundant pedicles of the preputial flaps were used for additional wrapping of the neourethra in all 28 cases. With tunica vaginalis wrapping, two cases developed fistula and meatal stenosis in one patient with glans channel. In the scrotal dartos wrapping group, one case of permanent fistula, one urethral stricture and one meatal stenosis were recorded. In the preputial and penile dartos wrapping of primary repair, the rate of fistula markedly dropped. The overall incidence of fistula in both redo and primary cases was four out of forty-five cases approximating the ideal goal of very low rate of fistula