Soft tissue covers in hypospadias surgery: Is tunica vaginalis better than dartos flap?
Anjan Kumar Dhua1, Satish Kumar Aggarwal, Shandip Sinha
1Department of Pediatric Surgery, Maulana Azad Medical College, Delhi, India.
Aim:
To compare tunica vaginalis with dartos flap as soft tissue cover in primary hypospadias repair.
Materials And Methods:
25 cases (age range: 12-132 months; all fresh cases) of primary hypospadias were prospectively repaired by tubularized incised plate (TIP)/TIP + graft urethroplasty using tunica vaginalis flap (TVF) as soft tissue cover to urethroplasty (group A). Their results were compared with another set (group B) of age- and anatomy-matched controls (25 patients operated during the previous 3 years) who had undergone TIP repair using dartos flap as soft tissue cover. Statistical analysis of results was done with Fischer's exact test.
Group A:
No fistula, skin necrosis, meatal stenosis, urethral stricture. One case had partial wound dehiscence that resolved on conservative treatment with no sequelae. One case required catheter removal on 3(rd) day because of severe bladder spasm. There was no testicular atrophy/ascent. Group B: 3 fistulae - all required surgery. There were three cases of superficial skin necrosis that healed spontaneously without sequel. There was no meatal stenosis/urethral stricture. The difference in fistula rate between both the groups, however, was not statistically significant (P = 0.4).
Conclusion:
TVF may have an edge over dartos fascia for soft tissue coverage of the neourethra.
