Title: A study of use of Tunica Vaginalis flap in anterior urethral reconstruction
Authors: Frank Davis Daniel, Selvakumar Soman, Kannan Subramanian Ramasamy
DOI: https://dx.doi.org/10.18535/jmscr/v5i7.31
Abstract
Introduction
Hypospadias is the most common congenital anomaly of penis [1]. Surgical correction of proximal hypospadias is a technically challenging. Such surgeries are associated with maximum number of failures and results in cripples. Reoperation of failed childhood hypospadias repair is seriously bothersome and is surgeon’s nightmares because of lack of abundant penile and prepuce skin for urethroplasty and penile shaft coverage. Among the various complications of childhood hypospadias repair, partial disruption with urethrocutaneous fistula &complete disruption with pan urethral strictures and ueretro cutaneous fistula are most frustrating problem for urologists. But there is no best single technique to repair.
By using a water-tight second layer during reoperation, incidence of urethrocutaneous fistula recurrence can be reduced. Tunica vaginalis flap is used to provide robust cover to neourethra. It also provides a barrier between suture lines. It has a different blood supply from internal spermatic fascia & not depends on penile skin vascularity.
Long segment penile urethral strictures with urethro cutaneous fistula following childhood hypospadias repair are again a difficult surgical task. Most of times there is tissue shortage to cover such a long narrrowed urethral segments. These type of strictures are associated with complications most of the time. Tunica vaginalis flap has a definitive role in stage II repair of such pan urethral strictures to prevent urethrocutaneous fistula and for penile cosmesis.
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